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    Diabetes Mellitus (DM) : Content

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    Mompati Letsweletse
    Anti Diabetics pathophysiology and the causes of both type 1 and type 2 diabeties and the treatment

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    Diabetes Mellitus (DM) : Content

    Uploaded by

    Mompati Letsweletse
    40 views30 pages
    Anti Diabetics pathophysiology and the causes of both type 1 and type 2 diabeties and the treatment

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    Anti Diabetics

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    Anti Diabetics pathophysiology and the causes of both type 1 and type 2 diabeties and the treatment

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    40 views30 pages

    Diabetes Mellitus (DM) : Content

    Uploaded by

    Mompati Letsweletse
    Anti Diabetics pathophysiology and the causes of both type 1 and type 2 diabeties and the treatment

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 30

    DIABETES MELLITUS

    (DM)
    Content
    Definition,Pathophysiology & causes of DM
    Types of DM
    Symptoms
    Management & Treatment
    Complications of Diabetes

    What is Diabetes Mellitus?


    Persistent high blood sugar levels.
    Diabetes is derived Greek word diabanein
    that means "passing through," (excess urine)
    Mellitus from Latin means honey the blood
    & urine of a diabetic has a sweet taste.
    It does not have a cure but can be managed.

    Pathophysiology
    Insulin is released into the blood by beta cells (cells) in the pancreas in response to rising levels
    of blood glucose (e.g after a meal).
    Insulin regulates uptake of glucose from the blood
    into cells.
    If insulin is absent or insufficient, glucose
    accumulates in blood causing a metabolic
    disorder called diabetes mellitus.

    PANCREAS
    |
    ISLETS OF LANGERHANS

    \
    Beta cells
    alpha cells

    \
    Insulin
    Glucagon

    \
    Cells & liver glucose uptake
    Glycogenolysis

    Glycogenesis

    Causes of diabetes
    The absolute lack of insulin esp.in IDDM.
    Insufficient production of insulin.
    Production of defective insulin.
    Inability of cells to use insulin properly and
    efficiently especially cells of muscle and
    fat tissues causing "insulin resistance."
    This is the primary problem in NIDDM
    A steady decline of beta cells

    DM Risk factors
    Obesity
    DM family history of DM
    Age greater than 45 years
    Pregnancy diabetes or delivering a baby
    weighing more than 3.5 kg
    High blood pressure
    High blood levels of triglycerides (a type of
    fat molecule)
    High blood cholesterol level

    TYPES OF DM
    Type 1 - insulin dependent diabetes mellitus
    (IDDM)
    Type 2 - non insulin dependent diabetes mellitus
    (NIDDM),
    Gestational Diabetes occurs during pregnancy

    1. TYPE 1 (IDDM)
    Also called childhood or juvenile diabetes
    Is characterized by loss of beta cells due to
    autoimmune destruction.
    No preventative measure can be taken (Diet
    and exercise cannot reverse or prevent it).
    Insulin is the principal treatment and must be
    continued indefinitely.

    2. TYPE 2 (NIDDM)
    Also known as adult or maturity-onset diabetes
    It is due to defective insulin secretion &/or
    insulin resistance or reduced insulin sensitivity.
    Characterized by elevated levels of insulin in
    the blood
    Medications used improve insulin sensitivity or
    reduce glucose production.
    Obesity is known to predispose people for
    insulin resistance

    3. GESTATIONAL DIABETES
    Occurs in pregnancy esp. after the 24th week.
    Similar to type 2 diabetes, it involves insulin
    resistance
    The hormones of pregnancy cause insulin
    resistance in genetically predisposed women.
    It occurs in 2-5% of all pregnancies
    Normally disappears after delivery
    20-50% of these women develop type 2 diabetes
    later in life, especially if they are overweight.
    It requires careful medical supervision

    Symptoms & clinical manifestation


    The common symptoms of both IDDM and
    NIDDM are:
    - polyuria
    - polydipsia - weight loss
    - nephropathy - blurred vision

    Common features of Type 1 are:


    diabetic ketoacidosis, postural
    hypotension and in severe cases coma.
    Patients with type 2 diabetes may not
    show any symptoms but chronic skin
    infections are quite common

    High blood sugar levels loss of glucose in


    the urine increased urine output
    dehydration.
    Dehydration increased thirst increased
    water consumption.
    Glucose not utilised body makes glucose
    from stores weight loss despite an increase in
    appetite.
    Some untreated diabetes patients also complain
    of fatigue, nausea and vomiting. Patients with
    diabetes are prone to dev

    MANAGEMENT
    NIDDM
    Life style changes-limit salt intake, loose
    weight & exercise
    Type 2 diabetes is usually 1st treated by :
    Increase physical activity (exercise)
    The diet (decrease carbohydrate intake)
    Weight loss
    Drugs
    Insulin (can be used for both type I & II)
    Oral antidiabetes (cannot be used in type I)

    INSULIN
    Insulin is required by all type 1 diabetic patients.
    Types:
    - bovine (beef)
    - porcine (pork)
    - human insulin.
    Bovine insulin is more antigenic as it differs from
    human insulin by 3 amino acids while porcine
    differs by only one amino acid
    Functions of Insulin
    - helps glucose enter the cells,
    - regulates the level blood sugar

    Insulin preparations
    Preparations are of three types:Short acting with rapid onset of action e.g soluble
    (neutral) insulin (actrapid)
    Intermediate acting e.g isophane insulin
    Long acting with slow onset of action e.g insulin
    zinc suspension Long acting with slow onset of
    action e.g insulin zinc suspension

    NB: Short & long acting can be combined to


    ensure rapid onset with long action e.g.
    mixture of soluble insulin and isophane insulin
    (human mixtard)

    Pharmacokinetics
    Insulin undergoes extensive FPE.
    Metabolism: mainly liver and kidney.
    Soluble insulin has a duration of action
    of 4-8 hours and can be given thrice
    daily
    Intermediate acting ones require BD
    dosing
    Insulin is mostly given half an hour
    before a meal (why)

    Adverse effects of Insulin


    Hypoglycemia (most common),
    symptoms include palpitations,
    tremor, tachycardia hunger and
    sweating
    Thickening of subcutaneous tissue
    can occur at injection sites (advise
    patient to change injection site often)
    Systemic allergic reaction do occur
    but rarely

    ORAL ANTIDIABETES DRUGS


    The oral antidiabetes drugs are of two kinds:
    Sulphonylureas
    Biguanides
    NB: are not used in type 1

    SULPHONYLUREAS
    MoA:
    - increase cell sensitivity to glucose
    - increases tissue sensitivity to glucose
    Secondary failure can occur after
    months or years of treatment due to
    decline in cell function.
    Pharmacokinetics: they undergo hepatic
    metabolism with some having active
    metabolites

    Sulphonylureas contd
    Glibenclamide has a short elimination
    half-life but has a long biological effect
    due to slow distribution
    Adverse effects: hypoglycaemia and
    weight gain
    Dose: glibenclamide is usually in a dose
    of 5 mg daily (max 15mg)
    Interactions: effects may be enhanced
    by alcohol.

    BIGUANIDES
    MoA: inhibit hepatic gluconeogenesis.
    Pharmacokinetics: Metformin is not
    hepatically metabolized and is totally
    renally eliminated.
    S/Es: GI disturbance eg anorexia,
    nausea abdominal discomfort and
    diarrhoea

    Biguanides contd
    Dose: Metformin 500 mg TID, with meals
    (max 3g )
    Interactions: metformin use with alcohol
    increases lactic acidosis risk
    NB: Metformin is the drug of choice in
    overweight patients

    OTHER ANTIDIABETES
    Acarbose
    MoA: Inhibits intestinal alpha glucosidases
    Delays the digestion and absorption of starch
    and sucrose
    Can be used on its own or as an adjunct to
    metformin or Sulphonylureaus
    Should be taken before the meal with water or
    chewed with food.
    S/Es: flatulence, diarrhea, abdominal distention
    & pain, abnormal liver function tests.

    Other antidiabetes contd


    Nateglinide and Repaglinide stimulate
    insulin release
    They have rapid onset of action and
    Short duration of activity
    To be administered shortly after main
    meal
    Thiazolidinediones eg pioglitazone,

    rosiglitazone. They reduce peripheral


    insulin resistance. May be used alone or
    with metformin and sulphonylureas.

    Complications of Diabetes
    Eye disease ( Cataract, retinopathy ) do
    routine checks toprevent blindness.
    Nephropathy (due to protenuria,
    decreaase in glomerular filtration rate,
    increased microalbumin)
    Neuropathy ( nerve dermage )
    Diabetic foot (counsel patients to prevent)
    Hypertension
    Hypoglycaemic or insulin-induced coma
    Hyperglycaemic coma or diabetic coma

    CONCLUSION & SUMMARY


    Risk Factors For Diabetes Mellitus:
    -Family histry, HPT, age>45,pg,
    obesity,high cholesterol
    Treatment of Diabetes Mellitus
    Type 1:- Diet, exercise and Insulin.
    Type 2
    * Diet and exercise alone
    * Diet, exercise and hypoglycaemic agents
    * Diet, exercise plus insulin (oral
    hypoglycemic agents may also be used).

    Treating Diabetes with HPT


    Target Bp is 130/80
    Advantage of propranolol : blocks
    glycogenolysis.
    ACE inhibitors e. g. Captopril and
    Enalapril have a protective effect on the
    kidneys and should be used for
    hypertension or when proteinuria is
    present.

    FBS fasting blood sugar (after 8-10hr fast, in


    the mourning) 3.9 to 5.5 mmol/L normal,
    (5.6 to 6.9 mmol/L) pre diabetes, (>7.0
    mmol/L) diabetes.
    A normal blood glucose level is less than 6.1
    mmol/L, when measured after a fast.
    The glucose levels we aim for less than 7
    mmol/L

    Role of pharmacy personnel in DM


    management
    Counsel & emphasis on the need &
    advantages of life style modification.
    Monitor patients blood sugar levels and
    encourage patients to do self monitoring.

    Questions
    What is the normal blood glucose level.
    What glucose level do you aim at when
    treating DM.
    Which is the best therapy for gestational
    diabetes?

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