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Asif Imran Ruben
ID- 2007-1-70-039
Mashiur Rahman
ID- 2006-2-70-044
MD. Ruhul Amin
ID- 2007-1-70-039
MD. Nazmul Haque
ID- 2007-
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Type 2 Diabetes risk factors includesType 2 Diabetes risk factors includes
Age of 45 years or older
Obesity
Family history of diabetes
Diabetes during pregnancy
Impaired Glucose Tolerance ( IGT )
Physical inactivity
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Symptoms of Type 2 DiabetesSymptoms of Type 2 Diabetes
The symptoms of type 2 Diabetes vary from person toperson but may include:
Increased thirst
Increased hunger (especially after eating)
Dry mouthNausea and occasionally vomiting
Frequent urination
Fatigue (weak, tired feeling)
Blurred visionNumbness or tingling of the hands or feet
Frequent infections of the skin, urinary tract or vagina
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Drugs used to treat NIDDM PatientsDrugs used to treat NIDDM Patients
Medications that increase the insulin output by the
pancreas
Sulfonylureas primarily lower blood glucose levels byincreasing the release of insulin from the pancreas.
Sulfonylureas
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1st Generation-
Carbutamide
Acetohexamide Chlorpropamide
Tolbutamide
Tolazamide
2nd Generation- Glipizide
Gliclazide
Glibenclamide
Gliquidone
Glyclopyramide
3rd Generation-
Glimepiride
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What Do They Do?What Do They Do?
When the body does not have enough insulin, or does
not use the insulin it has effectively, blood sugar levelsincrease. Sulfonylureas stimulate beta cells in the
pancreas to produce more insulin and also help the body
use insulin, lowering blood sugar levels by up to 20%.
Who Should Not UseWho Should Not Use SulfonylureasSulfonylureas??
Patients with type 1 diabetes or with allergies to
sulfonamides (sulfa drugs) should not use sulfonylureas.
In addition, sulfonylureas may have to be discontinued in
patients who are exposed to high levels of physical
stress (infection, injury or surgery, for example), and mayhave to be stopped temporarily for patients who are not
eating regularly. Glyburide should not be taken
simultaneously with Tracleer (bosentan), which is used
in the treatment of pulmonary artery hypertension.
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Side EffectsSide Effects
Hypoglycemia
Weight gain
Drug interaction (mainly 1st Generation)
Allergic reaction
-Pruritus
-Rash
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Brands in BangladeshBrands in Bangladesh
Brand Name Generic Name Dose Company Name
Comprid Tablet Gliclazide 80 mg & 30 mg Square
Secrin 1 Tablet Glimepiride 1 mg , 2 mg, 3 mg& 4 mg
Square
DIALON Glimepiride Eskayef
Consucon Gliclazide 80 mg Incepta
Losucon 1 & 2 Glimepiride 1 mg & 2 mg Incepta
Glims Glimepiride ! Mg & 2 mg Opsonin
Glizid Gliclazide 80 mg Opsonin
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Meglitinides also work on the pancreas to promote
insulin secretion. Unlike sulfonylureas that bind to
receptors on the insulin producing cells, meglitinides
work through a separate potassium based channel on
the cell surface. Unlike the sulfonylureas which last
longer in the body, repaglinide (Prandin) and nateglinide
(Starlix) are very short acting, with peak effects within
one hour. For this reason, they are given up to three
times a day just before meals. Since these drugs alsoincrease circulating insulin levels, they may cause
hypoglycemia, but the literature suggests this is less
frequent than the hypoglycemia seen with sulfonylureas.
Meglitinides
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How It Works?How It Works?
Meglitinides prevent a rise in blood sugar levels by
increasing the amount of insulin produced by thepancreas, similar to the way sulfonylurea medications
work.
Side EffectsSide Effects
Low blood sugar Upper respiratory infections, nasal and sinus
inflammation, and bronchitis
Joint pain
Nausea Weight gain
While repaglinide may cause low blood sugar and weight
gain, these side effects are milder than in those people
who take glyburide
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DrugDrug--Drug InteractionsDrug Interactions
Azole antifungals and erythromycin may interfere with the
metabolism of repaglinide, resulting in hypoglycemia. Rifampin
may decrease the effectiveness of repaglinide, resulting in
hyperglycemia. Calcium channel blockers, corticosteroids,
estrogens, isoniazid, nicotinic acid, oral contraceptives,
phenothiazines, phenytoin, sympathomimetics, thiazide diuretics,
and thyroid supplements may cause hyperglycemia in
combination with other antidiabetic agents, so blood glucoselevels should be closely monitored when one of these drugs is
added or discontinued. Monoamine oxidase inhibitors, non-
selective beta blockers, NSAID's, probenecid, salicylates, and
sulfonamides may cause hypoglycemia in combination with other
antidiabetic agents, so blood glucose levels should be closelymonitored when one of these drugs is added or discontinued.
DrugDrug--Food InteractionsFood Interactions
Should be taken 1-30 minutes prior to meals
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Brands in BangladeshBrands in Bangladesh
Brand Name GenericName Dose CompanyName
Repanid Repaglinide 0.5 mg, 1 mg
& 2 mg
Opsonin
NomopilR
epaglinide 0.5 mg, 1 mg& 2 mg Incepta
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Medications that decrease the amount of glucose
produced by the liver-
Biguanides are another type of diabetes medicine.Biguanides that helps lower blood glucose by making sure
your liver does not make too much glucose. Biguanides also
lowers the amount of insulin in the body.
Biguanides
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Metformin
Phenformin
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Side EffectsSide Effects
The most common side effects of metformin are-
Temporary nausea.
Loss of appetite. Diarrhea.
Increased abdominal gas.
A metallic taste
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Brands in BangladeshBrands in Bangladesh
Brand Name Generic Name Dose Company
Name
Comet XR 1 Gm
TabletMetformin HCl 1000 mg
Square
Comet 1 Gm Tablet Metformin HCl 1 gmSquare
Comet 500 Tablet Metformin HCl 500 mg
Square
Comet 750 Tablet Metformin HCl 750 mgSquare
Comet 850 Tablet Metformin HCl 850 mgSquare
Comet X
R500 Tablet Metformin
HCl 500 mg
Square
GLUNORMetformin
hydrochlorideEskayef
GLUNOR XRMetformin
hydrochlorideEskayef
Mefoglip 500 & 850Metformin
Hydrochloride
500 mg & 850 mg Incepta
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Medications that increase the sensitivity of cells to
insulin
Thiazolidinediones are oral medications that help lowerblood sugar in type 2 diabetes. In addition to a healthy diet
and exercise, they are another way to control blood sugar
levels.
Thiazolidinediones
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Rosiglitazone
Pioglitazone
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WhatWhat ThiazolidinedionesThiazolidinediones Do?Do?
Thiazolidinediones help to lower insulin resistance in cells,improving the way that the body responds to insulin.
Thiazolidinediones are typically taken by mouth once or
twice daily. They may be used alone, with other pills or with
insulin.
Who Should Not UseWho Should Not Use ThiazolidinedionesThiazolidinediones??
People with type 1 diabetes (requiring regular insulin
injections), heart failure or liver disease should not use
thiazolidinediones. Children and pregnant or nursing womenshould also avoid using these medications. People with eye
or bone problems should talk with their health care providers
before taking thiazolidinediones.
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Side EffectsSide Effects
Some reported side effects of thiazolidinediones include:
Upper respiratory infections and sinusitis
Headaches.
Mild anemia
Retention of fluid in the body. This may lead to heartfailure
Weight gain
Muscle pain
Women who take rosiglitazone (Avandia) or pioglitazone(Actos) may increase their risk for upper arm or foot
fractures, according to a warning from the U.S. Food and
Drug Administration
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Brands in BangladeshBrands in Bangladesh
Brand Name Generic Name Dose Company Name
Sensulin Rosiglitazone 2 mg & 4 mg
Square
Tos Pioglitazone 15 mg & 30 mg
Square
Piol Pioglitazone 15 mg & 30 mg Opsonin
Piodar 15 & 30 Pioglitazone 15 mg & 30 mg Incepta
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Medications that decrease the absorption of
carbohydrates from the intestine
A class of oral medications for type 2 diabetes that decrease
the absorption of carbohydrates from the intestine, resulting
in a slower and lower rise in blood glucose throughout the
day, especially right after meals.
Alpha glucosidase inhibitor
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How It Works?How It Works?
Acarbose and miglitol help keep blood sugar levels within a
safe range by slowing the rate at which the intestines absorb
sugar (glucose) from food. These medications do not cause
the pancreas to produce more insulin. They will not cause
low blood sugar (hypoglycemia) unless they are used in
combination with other oral medications for diabetes or with
insulin.
ContraindicationsContraindications
Diabetic Ketoacidosis (DKA)
Intestinal disorder Inflammatory Bowel Disease
Colonic Ulceration
Partial Intestinal Obstruction
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Side EffectsSide Effects
Poorly tolerated
Gastrointestinal side effects (unabsorbed carbohydrate)
Abdominal Pain
Diarrhea
Flatulence
Hypoglycemia
If used with other Oral Hypoglycemic agent or Insulin
Use oral glucose (not sucrose) to treat Hypoglycemia
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Dosages
Acarbose (Precose) Start dose: 25 mg PO tid at start of meal
Maintenance: 50-100 mg PO tid
Miglitol (Glyset)
Start dose: 25 mg PO tid at start of meal Maintenance: 50-100 mg PO tid
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New medications that affect glycemic control
Pramlintide (Symlin) is the first in a new class of injectable, anti-
hyperglycemic medications for use in patients with type 2 or type 1
diabetes treated with insulin. Pramlintide, the active ingredient in Symlin,
is a synthetic analog of human amylin, a naturally occurring
neuroendocrine hormone synthesized by pancreatic beta cells that helps
control glucose control after meals. Amylin, similar to insulin, is absent or
deficient in patients with diabetes.When used with insulin, this
compound can improve glycemic control and has additional benefits that
cannot be realized with insulin alone.
According to published data, Symlin reduces post meal blood sugar
peaks, reduces glucose fluctuations throughout the day, enhancessatiety (the sensation of fullness) leading to potential weight loss, and
lowers mealtime insulin requirements. Studies have shown it improves
A1C beyond the effect of insulin alone.
Symlin is taken just prior to meals, three times a day. It is given in
injection form and is used for:
Symlin (pramlintide)
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Type 2 diabetes, as an additional treatment in patients who
use mealtime insulin therapy and have failed to achieve
desired glucose control despite optimal insulin therapy, with
or without a concurrent sulfonylurea agent and/or metformin.
Type 1 diabetes, as an additional treatment in patients who
use mealtime insulin therapy and who have failed to achieve
desired glucose control despite optimal insulin therapy.
Symlin is considered a therapy option in patients withinsulin-using type 2 or type 1 diabetes, that are unable to
achieve adequate glycemic control despite individualized
insulin management. Insulin-using patients with type 2
diabetes may also be taking a concurrent sulfonylurea agent
and/or metformin.
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Exenatide (Byetta) is a medication on the market that has it's origins in
an interesting place--the Gila monster's saliva. Scientists studying thissmall lizard noted it could go a long time without eating. They found a
substance in it's saliva that slowed stomach emptying, thus making the
lizard feel fuller longer. This substance was similar in nature to a gut
hormone found in humans known as GLP-1. GLP-1 is broken down in
the body by an enzyme called DPP-IV. So, if you could make a
substance like GLP-1 that was not so easy to breakdown, this would
have potential benefit; thus, the studies began. Ultimately, after
modifying this hormone, exenatide (with the trade name Byetta) was
developed.
Byetta is the first in a class of drugs for the treatment of type 2 diabetes
called incretin mimetics. Byetta has been shown to have many of thesame effects on sugar regulation as GLP-1, so it mimics the body's
natural physiology for self-regulating blood sugar. Namely, it slows the
release of glucose from the liver, slows stomach emptying thereby
regulating delivery of nutrients to the intestine for absorption, and works
centrally in the brain to regulate hunger.
Byetta (exenatide)
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Byetta is indicated as additional therapy to improve controlof blood sugars in patients with type 2 diabetes who are
taking metformin, a sulfonylurea, or a combination of
metformin and a sulfonylurea but who have not achieved
adequate sugar control. It enhances the way the insulin
producing beta cells in the pancreas work. Insulin secretionincreases only when blood sugars are high and decreases
as blood sugars approach normal. In addition to enhancing
the normal physiology of the beta cell, Byetta suppresses
glucose release from the liver, slows stomach emptying and
the absorption of nutrients including carbohydrate, and
reduces intake of food.
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Victoza (lyraglutide) is an injectable prescription medicine
that improves blood sugar (glucose) in adults with type 2
diabetes when used with a diet and exercise program.
Victoza is not insulin. It is not known if Victoza is safe and
effective when used with insulin. Victoza is not for people
with type 1 diabetes or people with diabetic ketoacidosis.
Victoza is not recommended for use in children. Victoza, like
Byetta, belongs to a class of medicines known as glucagon-
like peptide-1 (GLP-1) receptor agonists, which help thepancreas make more insulin after eating a meal.
Victoza (lyraglutide)
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GLP-1 in the body is broken down by an enzyme called DPP
IV. Logically, you can either make a synthetic GLP-1 that is
not broken down by this enzyme (for example, Byetta) OR
you could try to stop the enzyme that breaks down the GLP-
1 your body already makes. Hence, the new class of drugscalled DPP IV inhibitors. They do just that, that is, they
inhibit this enzyme from breaking down GLP-1. This allows
GLP-1 already in the blood to circulate longer. There are a
number of companies working on this class of drug.
DPP-IV inhibitors
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Combination medications
Glyburide/metformin (Glucovance), rosiglitazone/metformin
(Avandamet), glipizide/metformin (Metaglip), andpioglitazone/metformin (Actoplus met), and metformin/sitagliptin
(Janumet) are are five relatively new combination pills that are on
the market to treat diabetes.
Brand Name Generic Name Dose Company Name
GlyrosGlimepiride +
Rosiglitazone1 mg + 4 mg
Square
RezulinPioglitazone +
Metformin HCl15mg+500mg
Square
SensimetRosiglitazone +
Metformin HCl4mg+1000mg
Square
TosirinPioglitazone +
Glimepiride30mg+2mg
Square
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