Insulin And Oral Hypoglycaemic Agents

Front 1

Therapies for diabetes

Back 1

Type 1
-Insulin
-Lifestyle (diet/exercise)
Type 2
-Lifestyle (diet/exercise)
-Oral hypoglycemic agents
-Insulin

Front 2

the three characteristics of
Insulin (therapy) are:

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(onset/peak/duration)

subcutaneously

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Side effects of Insulin Therapy

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1) Hypoglycaemia
2) Weight gain - modest
3) Problems at injection site (lipo-hypertrophy and atrophy - decr absorption)
4) Allergic reactions & insulin resistance

Front 4

Oral Hypoglycaemic agents

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1) Biguanides - Metformin
2) Sulphonylureas
3) Thiazolidinediones
4) Meglitinides
5) Post prandial

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Biguanides (Metformin)

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Mechanism - reduce hepatic glucose output and increase muscle glucose uptake

Adverse - Nausea / vomiting
drug tolerance
acidosis (build up of lactic acid especially in elderly or those with renal, cardio or liver disease)

Front 6

Sulphonylureas

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Mechanism - stimulates release of insulin from pancreas
-inhibit the process of gluconeogenesis (formation of glucose from amino acids and fatty acids
-increase number of insulin receptors on target cells

Glipizide (Minidiab)

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Thiazolidinediones - Glitazones

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Mechanism - increase insulin sensitivity within skeletal muscle and help to decrease the amount of glucose produced by the liver

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Sulphonureas
Adverse effects

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Hypoglycaemia
slight weight gain
GIT disturbances
Bone marrow depression

Front 9

adverse effects of Thiazolidinediones
(Glitazones)

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oedema
mild anaemia
weight gain
hypercholesterolaemia (Rosiglitazone)

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Indication for use of Insulin

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-Insulin dependant Diabetes (Type 1)
-Gestational Diabetes
-Elevated blood glucose levels due to insulin resistance in people with type 2 diabetes.

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Insulin
mechanism of action

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Insulin lowers blood glucose levels by facilitating glucose uptake into bodycells.

Insulin also affects the metabolism of protein and fats, stimulating amino acid uptake into cells and subsequently protein synthesis and promotes fat storage.

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adverse drug reactions

Hypoglycaemia

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-overdose of insulin or mismatch in blood glucose level with ordered dose of insulin.

-may occur due to missing a meal or increased metaboic demand caused by exercise or stress.

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adverse drug reactions

Lipodystrophy

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- a localized effect at the injection site which appears to be associated with contaminants in the preparation
- may occur as depression in the skin or localized enlargement.
- can be avouded by massaging site after injection and rotation of injection sites.

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adverse drug reactions

Insulin resistance

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formation of insulin antibodies in the blood, requiring an increased dose toattain the desired effect.

Front 15

adverse drug reactions

Allergic reaction

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the incidences of lipodystrophy, allergy and resistance have fallen as a result of using human insulin and increasing the purity of the animal forms.