glucoregulatory drugs ways to control blood glucose in diabetic patients
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Glucoregulatory Drugs Glucoregulatory Drugs
Ways To Control Blood Ways To Control Blood Glucose In Diabetic PatientsGlucose In Diabetic Patients
Classification Of Diabetic PatientsClassification Of Diabetic Patients
Type I Diabetic PatientType I Diabetic Patient Insulin-Dependent Diabetes Insulin-Dependent Diabetes MellitusMellitusJuvenile Onset DiabetesJuvenile Onset Diabetes
Type I Diabetes MellitusType I Diabetes Mellitus
ProblemProblem : : Loss Of Insulin ProductionLoss Of Insulin ProductionDevelopment Of HypoinsulinemiaDevelopment Of HypoinsulinemiaDevelopment Of DiabetesDevelopment Of Diabetes
Type II Diabetic PatientType II Diabetic PatientAdult-Onset Diabetes MellitusAdult-Onset Diabetes MellitusNon-Insulin Dependent Non-Insulin Dependent
Diabetes MellitusDiabetes Mellitus
ProblemProblem : :No Functional Loss Of The No Functional Loss Of The
Beta Cell PopulationBeta Cell PopulationBlood Insulin Levels May Be Blood Insulin Levels May Be
Below Normal, Normal, or Below Normal, Normal, or Higher Than NormalHigher Than Normal
Exhibit Peripheral Tissue Exhibit Peripheral Tissue Resistance To InsulinResistance To Insulin
ObesityObesity
Drug Choices For Drug Choices For The Diabetic PatientThe Diabetic Patient
Oral Hypoglycemic AgentsOral Hypoglycemic AgentsThe SulfonylureasThe SulfonylureasThe BiguanidesThe BiguanidesAlpha-Glucosidase InhibitorsAlpha-Glucosidase InhibitorsOthersOthers
The SulfonylureasThe Sulfonylureas
Increase The Availability Of Increase The Availability Of Insulin In Type II DiabeticsInsulin In Type II Diabetics
SulfonylureasSulfonylureas
First Generation DrugsFirst Generation DrugsTolbutamide (Orinase)Tolbutamide (Orinase)Chlorpropamide (Diabinese)Chlorpropamide (Diabinese)Tolazamide (Tolinase)Tolazamide (Tolinase)Acetohexamide (Dymelor)Acetohexamide (Dymelor)
Second Generation DrugsSecond Generation DrugsGlipizide (Glucotrol)Glipizide (Glucotrol)Glyburide (Micronase, Diabeta)Glyburide (Micronase, Diabeta)Glimepiride (Amaryl)Glimepiride (Amaryl)
SulfonylureasSulfonylureas
Mechanism Of ActionMechanism Of Action
Stimulate Release Of Insulin From Stimulate Release Of Insulin From Pancreatic Islet Cells In Type II Pancreatic Islet Cells In Type II NIDDM PatientsNIDDM Patients
Blunt The Release Of GlucagonBlunt The Release Of Glucagon
Increase The Sensitivity of Increase The Sensitivity of Peripheral Tissues To InsulinPeripheral Tissues To Insulin
Up-Regulation Of Insulin Up-Regulation Of Insulin ReceptorsReceptors
Improve The Binding Of Insulin Improve The Binding Of Insulin To Its RecptorTo Its Recptor
Medical Uses Of The Medical Uses Of The SulfonylureasSulfonylureas
Used Only In Type II DiabeticsUsed Only In Type II DiabeticsFunctional Only In A Patient Functional Only In A Patient
With A Pancreas That Is Still With A Pancreas That Is Still Making InsulinMaking Insulin
SulfonylureasSulfonylureas
Used To Blunt Glucagon ReleaseUsed To Blunt Glucagon ReleaseKeeps Insulin To Glucagon Keeps Insulin To Glucagon
Ratio HigherRatio HigherHigher Insulin:Glucagon Ratio Higher Insulin:Glucagon Ratio
Favors Glucose Uptake Into Favors Glucose Uptake Into CellsCells
The Overall Effect :The Overall Effect :
Blood Glucose RegulationBlood Glucose Regulation
EuglycemiaEuglycemia
Adverse Side Effects Adverse Side Effects For The SulfonylureasFor The Sulfonylureas
HypoglycemiaHypoglycemia Skin RashesSkin Rashes NauseaNausea VomitingVomiting
Biguanides Biguanides Mechanism Of ActionMechanism Of Action
Create An Environment Create An Environment Conducive to Keeping Blood Conducive to Keeping Blood Sugar LowSugar Low
Suppress Gluconeogenesis In Suppress Gluconeogenesis In The LiverThe Liver
Inhibit The Absorption Of Inhibit The Absorption Of Glucose In The IntestineGlucose In The Intestine
Stimulate GlycolysisStimulate GlycolysisProbably Up-Regulates Insulin Probably Up-Regulates Insulin
Receptors For Improved Receptors For Improved Clearance of GlucoseClearance of Glucose
Medical Uses Of The BiguanidesMedical Uses Of The Biguanides
Used Only In Conjunction With Used Only In Conjunction With SulfonylureasSulfonylureasInhibit The Liver From Inhibit The Liver From
Making New Glucose & Making New Glucose & Stimulates The Burning Of Stimulates The Burning Of Endogenous GlucoseEndogenous Glucose
Help To Deplete Blood Levels Help To Deplete Blood Levels Of Glucose By Reducing Of Glucose By Reducing Uptake Of Dietary GlucoseUptake Of Dietary Glucose
The Overall Effect :The Overall Effect :
Blood Glucose RegulationBlood Glucose Regulation
EuglycemiaEuglycemia
Adverse ReactionsAdverse Reactions For The Biguanides For The Biguanides
NauseaNausea VomitingVomiting AnorexiaAnorexia DiarrheaDiarrhea Metallic TasteMetallic Taste
Alpha-Glucosidase InhibitorsAlpha-Glucosidase Inhibitors
Miglitol ( Glyset)Miglitol ( Glyset) Acarbose (Precose)Acarbose (Precose)
Mechanism Of Mechanism Of Action For AGI’sAction For AGI’s
Delay The Digestion Of Ingested Delay The Digestion Of Ingested CarbohydratesCarbohydrates
Results In A Lower Postprandial Results In A Lower Postprandial Blood GlucoseBlood Glucose
The Alpha-Glucosidase The Alpha-Glucosidase Inhibitors Inhibitors do notdo not increase insulin increase insulin receptor sensitivity and do not receptor sensitivity and do not increase blood insulin levels in increase blood insulin levels in Type II diabetics.Type II diabetics.
Medical Uses Of AGI’sMedical Uses Of AGI’s
The Alpha-Glucosidase Inhibitors The Alpha-Glucosidase Inhibitors are used alone or in combination are used alone or in combination with Sulfonylureas to improve with Sulfonylureas to improve blood glucose control. The net blood glucose control. The net effect is euglycemia.effect is euglycemia.
Adverse Side Effects Of AGI’sAdverse Side Effects Of AGI’s
Skin rashesSkin rashes FlatulenceFlatulence DiarrheaDiarrhea Abdominal painAbdominal pain
OthersOthers
Repaglinide (Prandin)Repaglinide (Prandin)
Troglitazone (Rezulin)Troglitazone (Rezulin)
RepaglinideRepaglinideMechanism of ActionMechanism of Action
Stimulates release of insulinStimulates release of insulin Regulates calcium channel Regulates calcium channel
function in the beta cellfunction in the beta cell
Adverse ReactionsAdverse Reactions
HypoglycemiaHypoglycemia DiarrheaDiarrhea NauseaNausea VomitingVomiting ArthralgiaArthralgia Chest painChest pain
Medical UsesMedical Uses
Used to regulate blood glucose Used to regulate blood glucose levelslevels
Can be used in combination with Can be used in combination with Metformin (Glucophage)Metformin (Glucophage)
TroglitazoneTroglitazone
Troglitazone is a thiazolidinedione Troglitazone is a thiazolidinedione antidiabetic agent.antidiabetic agent.
Mechanism Of ActionMechanism Of Action
Improves target cell Improves target cell responsiveness to insulin without responsiveness to insulin without increasing insulin secretion - increasing insulin secretion - reduces peripheral resistance.reduces peripheral resistance.
Decreases liver glucose outputDecreases liver glucose output Helps to increase skeletal muscle, Helps to increase skeletal muscle,
liver and adipose tissue uptake of liver and adipose tissue uptake of glucoseglucose
Adverse Side EffectsAdverse Side Effects
Headache & PainHeadache & Pain DizzinessDizziness HepatotoxicityHepatotoxicity Nausea & VomitingNausea & Vomiting RhinitisRhinitis DiarrheaDiarrhea
Medical UsesMedical Uses
Used to regulate blood glucose Used to regulate blood glucose levels - euglycemialevels - euglycemia
The InsulinsThe Insulins
To Encourage Glucose To Encourage Glucose Transport Into The CellTransport Into The Cell
To Reduce The Possibility Of To Reduce The Possibility Of HyperglycemiaHyperglycemia
Porcine, Bovine, HumulinPorcine, Bovine, Humulin
Short Acting Short Acting : 2-4 Hrs : 2-4 HrsRegular, Semilente, Regular Regular, Semilente, Regular
IletinIletin
Intermediate ActingIntermediate Acting : 12-20 Hrs : 12-20 HrsNPH, Lente, Lente Iletin INPH, Lente, Lente Iletin I
Long ActingLong Acting : 24-36 Hrs : 24-36 HrsUltralente Iletin I, UltralenteUltralente Iletin I, Ultralente
Mechanism Of ActionMechanism Of Action Binding Of Insulin To Cell Receptors Binding Of Insulin To Cell Receptors
Causes :Causes :Glucose Transporters To Be Made Glucose Transporters To Be Made
In Greater Numbers - Up RegulationIn Greater Numbers - Up RegulationGlucose Transporters Migrate To Glucose Transporters Migrate To
The Cell Membrane And Bring The Cell Membrane And Bring Glucose Into The CellGlucose Into The Cell
Medical UsesMedical Uses
Essential For Type I DiabeticsEssential For Type I DiabeticsMust Have To Control Blood SugarMust Have To Control Blood Sugar
May Be Used In Type II DiabeticsMay Be Used In Type II DiabeticsIf Sulfonylureas and Biguanides Do If Sulfonylureas and Biguanides Do
Not Keep Blood Sugar In ControlNot Keep Blood Sugar In Control
Adverse Reactions Adverse Reactions HypoglycemiaHypoglycemia
SweatingSweatingDizzinessDizzinessPalpitationsPalpitationsTremorTremorHungerHungerTingling In ExtremitiesTingling In ExtremitiesLightheadednessLightheadedness
HeadachesHeadachesAnxietyAnxietyDrowsinessDrowsinessSlurred SpeechSlurred SpeechIrritabilityIrritabilityUnsteady MovementUnsteady MovementSeizuresSeizures
LipodystrophyLipodystrophy Allergic ReactionsAllergic Reactions
Shortness of BreathShortness of BreathSkin Rashes At Site of InjectionSkin Rashes At Site of InjectionWhole Body RashesWhole Body RashesSweatingSweatingTachycardiaTachycardiaWheezingWheezing
Clinical ConsiderationsClinical Considerations
Be Familiar With The Signs Of Be Familiar With The Signs Of HypoglycemiaHypoglycemia
Make Sure The Patient Has Not Make Sure The Patient Has Not Skipped MealsSkipped Meals
Know The Patient's MedicationsKnow The Patient's Medications
Make Sure The Patient Is HydratedMake Sure The Patient Is Hydrated Advise The Patient To Wear Medical Advise The Patient To Wear Medical
ID TagsID Tags Teach The Patient To Monitor Their Teach The Patient To Monitor Their
Blood Sugar - GlucometerBlood Sugar - Glucometer
Exercise ConsiderationsExercise Considerations
Type I DiabeticType I DiabeticMode : AerobicMode : AerobicFrequency : 7 days/weekFrequency : 7 days/weekDuration : 20-30 min/sessionDuration : 20-30 min/sessionIntensity : 45%-85% MHRIntensity : 45%-85% MHR 10 - 14 RPE (Borg) 10 - 14 RPE (Borg)
Type II DiabeticType II DiabeticMode : AerobicMode : AerobicFrequency : 5 days/weekFrequency : 5 days/weekDuration : 30-60 min/sessionDuration : 30-60 min/sessionIntensity : 45%-70% MHRIntensity : 45%-70% MHR 10 - 14 RPE (Borg) 10 - 14 RPE (Borg)
Blood GlucoseBlood Glucose< 6 mmol/L ( <108 mg/dl) = Eat < 6 mmol/L ( <108 mg/dl) = Eat
CHOCHO6-16 mmol/L (108-288 mg/dl) = Ex.6-16 mmol/L (108-288 mg/dl) = Ex.> 16 mmol/L (>288 mg/dl) = See MD> 16 mmol/L (>288 mg/dl) = See MD
Exercise ConsiderationsExercise Considerations
Avoid Exercising During The Avoid Exercising During The Peak Insulin ActivityPeak Insulin Activity
To Avoid Hypoglycemia (Type I)To Avoid Hypoglycemia (Type I)Eat a meal 1-2 hrs. before Eat a meal 1-2 hrs. before
exerciseexercise
Eat extra CHO during Eat extra CHO during exercise if longer than 30 exercise if longer than 30 minutesminutes
Measure blood glucose Measure blood glucose before, during and after before, during and after exerciseexercise
Inject Insulin Into Skinfold of Non-Inject Insulin Into Skinfold of Non-Exercising Muscle (Abdominal Wall)Exercising Muscle (Abdominal Wall)
Drop Insulin Levels 1-2 Units Before Drop Insulin Levels 1-2 Units Before ExerciseExercise
Exercise With A PartnerExercise With A Partner
Carry Money While ExercisingCarry Money While Exercising Wear Good Foot WearWear Good Foot Wear Practice Scrupulous Foot CarePractice Scrupulous Foot Care
Inspect CallusesInspect CallusesLook For Red Pressure AreasLook For Red Pressure AreasLook For Blisters & UlcerationsLook For Blisters & Ulcerations