DIABETES MELLITUS

GLUCOSE CONTROL

l    Increases Blood Glucose

•   Glucose intake

•   Glucagon

•   Corticosteroids

l    Decreases Blood Glucose

•   Insulin

•   Oral hypoglycemic agents

INSULIN DEPENDENT DM

l    Also known as:  juvenile onset and Type 1

l    Most severe form of DM

•   Complications include diabetic ketoacidosis

l    Decreased synthesis and release of insulin from pancreas

NON-INSULIN DEPENDENT DM

l    Also known as Adult Onset DM and Type 2 DM

l    Usually overweight

l    Functional beta cells in pancreas and/or decrease sensitivity of peripheral cells to insulin

l    No ketoacidosis associated

CONSEQUENCES

l    Cardiac Disease

l    Renal Disease

l    Blindness

l    Peripheral Vascular Disease

l    Gangrene

INSULINS

l     Sources

•    Pork, Bio-genetic (Human)

•    Reactions:  Lipodystrophy

l     Varieties

•    U-100 versus U-500

•    Ultra-Short Acting:  Lispro (Humalog®)

•    Short Acting:  Regular, Semi-lente

•    Intermediate: NPH, Lente

•    Long Acting:  Ultra-Lente

REGULAR INSULIN

l     Onset:  less than 1 hour

l     Uses:

•    Adjunct with longer acting-draw up in syringe first

•    Sliding Scale

•    Intravenous:  Treat Ketoacidosis

•    Intravenous:  Parenteral Nutrition

•    Only Regular insulin can be administered intravenously

INTERMEDIATE INSULINS

l    Onset:  2 hours

 

l    Duration:  24 hours

LONG ACTING INSULINS

l    Onset:  3 hours

 

l    Duration:  30 hours

 

INSULIN DOSE VARIABILITY

l    Patient variability

l    Diet Compliance

l    Complications

•   Infection

•   Physical Stress (e.g. surgery)

TYPE 2 DM Therapy

l    Diet and Weight Loss

 

l    Oral Hypoglycemic Agents

•   Sulfonylureas

•   Biguanides

•   Thiazolidinediones

•   Miscellaneous

SULFONYLUREAS

l    Increases Beta Cell production of insulin

l    First Generation

•   If one fails at maximum dose all will fail.  Switch if side effects.

l    Second Generation

•   If one fails at maximum dose, others may be effective

SULFONYLUREA CONCERNS

l    Side effects

•   examples:  tolbutamide - tinnitus, chlorpropamide - cholestatic jaundice

l    Hypoglycemia

l    Cardiovascular abnormalities

BIGUANIDES

l    Increases peripheral cell sensitivity to insulin

l    Avoid use in renal impairment or prior to administration of radiologic dyes

•   Otherwise may lead to lactic acidosis

THIAZOLIDINDIONES

l    Increases sensitivity of peripheral cells and hepatic cells to insulin

l    Deaths have been associted with troglitazone - liver failure

l    Associated with causing cardiac abnormalities

l    Not first line therapy

l    Examples:  pioglitazone (Actos®), rosiglitazone (Avandia®)

MISCELLANEOUS

l    Acarbose (Precose®)

•   Decreases oral absorption of disaccharides

•   Minimal effects on blood sugar

•   3rd or 4th line agent

•   CAUTION:  Cannot reverse hypoglycemia with oral dissacharides

TREATMENT OF HYPOGLYCEMIC REACTIONS

l    Glucose

l    Glucagon

l    Diazoxide (Proglycem®) - treatment for non-diabetics with chronic hypoglycemia

DRUG CAUTION

l    Beta Blockers - block symptoms of hypoglycemia