Diabetes melitus
Autor: Lígia Martins | Publicado: 2011-10-05T17:51:00-07:00

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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; O diabetes é classificado em tipo1, totalmente de origem genética, tipo 2, que se origina da relação entre predisposição genética e fatores ambientais e sociais, e o diabetes gestacional. O tratamento do tipo 2 é quase exclusivamente feito com insulina, enquanto para os outros tipos é mais comum a utilização de hipoglicemiantes orais.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A insulina é aplicada por via parenteral, aumenta a captação de glicose e gordura, e a síntese de glicogênio, ao mesmo tempo diminui a gliconeogênese e a degradação do glicogênio. É usada clinicamente no tratamento de diabetes tipo 1, emergências hiperglicêmicas, comprometimento da tolerância à glicose durante eventos intercorrentes, diabetes gestacional não controlado apenas por dieta, tratamento de emergência da hipercalemia e em casos de pacientes tipo 2 não-responsivos a outros medicamentos. O principal efeito adverso é a hipoglicemia.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A metiformina é o medicamento de primeira escolha para pacientes tipo 2, uma biguanida que aumenta a captação de glicose e a utilização no músculo esquelético, reduz a produção hepática de glicose, o LDL e o VLDL. Pode causar distúrbios gastrintestinais relacionados com a dose e mais raramente produz acidose lática, seu uso prolongado interfere na absorção de vitamina B12.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sulfoniluréias, como a alopropamida e a glibenclamida, bloqueiam a ativação dos canais KATP na célula β causando despolarização, entrada de Ca2+ e secreção de insulina. Só podem ser usadas por diabéticos tipo 2 com células β funcionais. Os efeitos adversos incluem hipoglicemia, ganho de peso, desconfortos gastrintestinais, rashes cutâneos alérgicos e lesão na medula óssea. Interage com diuréticos tiazídicos, corticóides, AINE´s entre outros.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Rosiglitazona e pioglitazona são glitazonas, reduzem a saída de glicose hepática e aumentam a captação de glicose para o músculo. Usadas no diabetes tipo 2, pois aumentam a sensibilidade à insulina, o que pode tonar perigosa a associação com outros hipoglicemiantes. Geram ganho de peso, retenção hídrica, cefaléia, cansaço e distúrbios gastrintestinais.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A acorbase é um inibidor da α-glicosidase, que retarda a absorção de carboidratos. &nbsp;É recomendada principalmente para pacientes tipo 2 obesos, mas causa flatulência, fezes amolecidas ou diarréia.