Diabetes And Antidiabetes

Front 1

Insulin was first discovered in---- by---

Back 1

1921

Banting and Best

Front 2

Insulin was obtained in pure crystalline form in --- while --- worked out the chemical structure in--

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1926

Sanger

1956

Front 3

Insulin

Back 3

It is a simple polypeptide hormone synthesized by the beta cells of islets of langerhans which consists of cord-like groups of cells found along the pancreatic Capillary channels

Front 4

As a protein, insulin consists of

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51 amino acids arranged as 2 polypeptide chains viz A-chain(21 AA) and B-chain (30 AA) connected together by disulphide bonds

Front 5

In the course of insulin synthesis, ---- is synthesized first

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Preproinsulin is first synthesized from which proinsulin is produced

Front 6

Molecular weight of insulin

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6000

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Preproinsulin is converted to proinsulin by

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Microsomal enzymes

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The specific stimulus for the secretion of insulin involves

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The elevation of the circulating glucose level and to a much less extent other substrates

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The B-cell membrane has specific gluco-receptors that recognises

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D-glucose

Front 10

Secretion of insulin from the B-cell is regulated by

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-Chemical

-Hormonal(growth hormone, thyroxine, corticosteroid etc)

-Neural mechanism (sympathetic + vagal NVS)

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The insulin receptors

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Are located on the outside surface of the cell plasma membrane

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FFA are precursors of

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Ketone bodies

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Side effects of insulin therapy include

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Front 14

Possible causes of DM

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1. Insulin deficiency

2. Genetic factor

3. The risk of DM development increases with age

4. Changes in plasma levels of adrenal hormones/adrenal cortex or medulla, thyroid hormones and other hormones of the anterior pituitary. Adrenaline causes hepatic glycogenolysis (with insulin inhibition) and a transient hyperglycemia.

5. Steroid diabetes caused by over zeallous use of anti inflammatory agents- steroid(prednisolone, corticosteroids) resulting in hyperglycemia. Aspirin also has same effect

6. Thyrotoxicosis increases blood glucose level

7. Insulin resistance reduces the sensitivity of fat or muscle cells to effects of insulin

Front 15

Define DM

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It is a metabolic disorder in which Carb metabolism is reduced while that of protein and lipids are increased

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Retinopathy in DM is due to

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Appearance of a Sorbitol induced cataract in the lens of the eyes eventually lead to blindness

Front 17

Ketone bodies cause

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1. Hunger and polyphagia

2. Electrolyte imbalance via increased urination from polyuria

3. Dehydration

4. Increased taste...polydypsia

Severe uncontrolled diabetic ketoacidosis will eventually result in coma and Death

Front 18

What is recommended for the treatment of labile and juvenile DM treatment of DM coma and ketoacidosis, pregnant diabetics and in diabetics b4 surgery

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Insulin

Front 19

Drug of choice when trauma occurs in a patient with unstable diabetes is

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Regular insulin - Crystalline zinc insulin injection

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What is the primary role of Regular insulin- crystalline zinc insulin

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To supplement the intermediate and long acting insulin preparations. It is given as IV as well as IM

Front 21

Insulin preparations

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1. Insulin injection- regular insulin-crystalline zinc insulin. Fast acting short duration. Given iv or sc to supplement the intermediate and long acting insulin preparation.

2. Insulin zinc suspension;

Insulin zinc prompt

lente

Rapid acting insulin. Can be given sc. Used to supplement the intermediate and long acting insulin preparation.

3. Insulin (suspension) isophane. It is an intermediate acting insulin preparation whose rate of absorption from the subcutaneous sites has been delayed by conjugating the hormone with the protein- protamine .used in treatment of all diabetic states except for the initial management of diabetic ketoacidosis or diabetic emergency.

Semi lente Rapid acting insulin. Can be given sc. Used to supplement the intermediate and long acting insulin preparation. 3. Insulin (suspension) isophane. It is an intermediate acting insulin preparation whose rate of absorption from the subcutaneous sites has been delayed by conjugating the hormone with the protein- protamine .used in treatment of all diabetic states except for the initial management of diabetic ketoacidosis or diabetic emergency. 4. Insulin zinc (suspension) - lente insulin. It is an intermediate acting mixture of prompt insulin used similarly to isophane insulin suspension. 5. Insulin (suspension) protamine zinc. It is a long acting preparation whose effects have been extended by incoporating more protamine and zinc in the mixture than is found in isophane insulin suspension

lente Rapid acting insulin. Can be given sc. Used to supplement the intermediate and long acting insulin preparation. 3. Insulin (suspension) isophane. It is an intermediate acting insulin preparation whose rate of absorption from the subcutaneous sites has been delayed by conjugating the hormone with the protein- protamine .used in treatment of all diabetic states except for the initial management of diabetic ketoacidosis or diabetic emergency. 4. Insulin zinc (suspension) - lente insulin. It is an intermediate acting mixture of prompt insulin used similarly to isophane insulin suspension. 5. Insulin (suspension) protamine zinc. It is a long acting preparation whose effects have been extended by incoporating more protamine and zinc in the mixture than is found in isophane insulin suspension

- lente insulin. It is an intermediate acting mixture of prompt insulin used similarly to isophane insulin suspension.

4. Insulin zinc (suspension) - lente insulin. It is an intermediate acting mixture of prompt insulin used similarly to isophane insulin suspension. 5. Insulin (suspension) protamine zinc. It is a long acting preparation whose effects have been extended by incoporating more protamine and zinc in the mixture than is found in isophane insulin suspension

5. Insulin (suspension) protamine zinc. It is a long acting preparation whose effects have been extended by incoporating more protamine and zinc in the mixture than is found in isophane insulin suspension

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Insulin therapy is usually started with

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Regular insulin given SC before each major meal

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The chief draw back of insulin is

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That it must be given via injection

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The first clinically accepted sulfonylurea is

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Tolbutamide

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The initial drug that used in the management of DM was

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Sulfonamide because they produce hypoglycemia as adverse effect

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Classification of OHA

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1. Sulfonylurea

A. First generation

i. Tolbutamide

ii. Chlorpropramide

B. Second generation

i. Glibenclamide (glyburide)

ii. Glipizide

iii. Gliclazide

iv. Glimezide

2. Biguanide

Metformin

3. Alpha glucosidase inhibitor

Rosiglitazone

Pioglitazone

4. Meglitinide analog

Nateglinide

Repaglinide

5. Thiazolinediones

Acarbose

Miglitol

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2 classes of OHA that improve insulin action by proving target cell response to insulin without increasing pancreatic insulin secretion are

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Biguanide

Thiazolidinediones

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2 classes of OHA that improve insulin action by proving target cell response to insulin without increasing pancreatic insulin secretion are

Back 28

Biguanide

Thiazolidinediones