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

InsulinInsulinPorcine InsulinPorcine InsulinBovine InsulinBovine InsulinHumulinHumulin

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

The BiguanidesThe Biguanides

Metformin (Glucophage)Metformin (Glucophage) Buformin Buformin

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