drug therapy in Diabetes Mellitus

treatment of diabetes mellitus

types of DM
•    type1>>>> insulin dependent diabetes mellitus(IDDM):
occer during childhood or puberty
beta cells are dertroyed

•    type2>>>non insulin dependent diabetes mellitus(NIDDM):
occur over age 35
beta cells are unable to produce sufficient insulin

Treatment
1.    Insulin
2.    Oral Hypoglyecemic Drugs>>for treatment of patient with type2 DM

1.    Insulin:
is apolypeptide hormone given by subcutaneous injection


Indication of insulin:
1.    IDDM
2.    Diabetic ketoacidosis
3.    NIDDM:with
•    permanent:failed oral hypoglycemic ttt in IDDM
•    temporarily:in some stress situation as infection,surgery,pregnancy

Adverse effects of insulin
1)Hypoglycemia:
most sreious&common in overdose
•    treatment of hypoglycemia
if conscious : sweets or juice
if unconscious : 20_50 ml glucose 50% intravenous or glucagon 1mg intramuscular
2)Lipodystrophy(less common)
3)Allergic Reaction(less common)
4)insulin resistance

2)Oral Hypoglycemic Drugs
for treatment of patient with type2 DM

Types of oral hypoglycemic drugs:
A.    insulin secretagogues as Sulfonylureas>>>increase insulin resistance
B.    insulin sensitizers as Biguanide(metformin) or glitazones>>>improve insulin action
C.    Modify intestinal absrption of carbohydrates as alpha glucosidase inhibitor


A)insulin secretagogues
Sulfonylureas
•    indication of Sulfonylureas
stimulate  insulin release from the beta cells of pancreas

•    Adverse effects of  Sulfonylureas
1.    Hypoglycemia
2.    weight gain
3.    Sulfonylureas transverse the Placenta(beplate insulin from fetal pancreas)

B)insulin sensitizers
1.    Biguanide(metformin)
2.    glitazones

1)Biguanide(metformin) :
•    Indication of Biguanide(metformin)
1.    increase glucose uptake  by target tissues,thereby decreaseing insulin risistance
2.    Euglycemia(no fear of hypoglycemia)
3.    loss of weight(loss of appetite)
N.B
these effects maynot be apparent untill 4-6 weeks of use

Adverse effects of Biguanide(metformin)
1.    Gastrointestinal(anorexia,nausia,vomiting,diarrhea)
2.    longterm use may iterfer with vitamin B12 absorption
3.    Potentially fetal lactic acidosis may occur

2)glitazones
•    Indication of glitazones
increase insulin sensitivity in adipose tissues,liver and skeletal muscles

•    Adverse effects of glitazones
1.    strongly recommended to measure liver enzyme levels of patients on these medications initially and periodically
2.    weight increase(increase subcutaneous fat or due to fluid retention)


C)alpha glucosidase inhibitor
Acarbose(glucobay):

•    Indication of Acarbose(glucobay)
Reversibly inhibiting membrane-bound-glucosidase in the intestinal brush border thereby decreasing glucose absorption

•    Adverse effects
flatulence,diarrhea and abdominal cramping