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1605 Abubakkar Raheel
1553 Nazia Hassan
1652 Abrar Afridi
1638 Kehkashan Alam
Diabetes Mellitus
4th
Clinico-Pharmacologica...
4th
Clinico-Pharmacological Conference
Frontier Medical College
Learning Objectives
Diabetes MellitusDiabetes Mellitus
 D...
4th
Clinico-Pharmacological Conference
Frontier Medical College
 Discuss the mechanism of action of Proto-Type Drugs
 Un...
4th
Clinico-Pharmacological Conference
Frontier Medical College
• In Simple terms, Diabetes Mellitus is a disease marked b...
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
History
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
4th
Clinico-Pharmacological Conference
Frontier Medical College
• There are currently over 2 million people diagnosed with...
4th
Clinico-Pharmacological Conference
Frontier Medical College
• Estimated 245 million people globally
• 20% of adult pop...
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Biostatical Analysis
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
4th
Clinico-Pharmacological Conference
Frontier Medical College
• A parent, brother, or sister with diabetes
• Obesity
• A...
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Normal Metabolism of Gl...
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Type 1 Diabetes
Type 1 Diabetes
• Insulin not produced due to non
fuctional beta-cell  Hence no
maintainance of basal secretion level of
...
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Type 1 Diabetes
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Blood Sugar &
Spine con...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Symptoms of type 1 Diab...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Morbidity/Complications...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Morbidity/Complications...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• Associated with aging...
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Diabetes MellitusDiabetes Mellitus
Pancreas retain some be...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Slower onset
• Polydi...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Hyperglycemia
• Diabe...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Polyuria
• Polydipsia...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Microvascular Complicat...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Microvascular Complicat...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Microvascular Complicat...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Microvascular Complicat...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Macrovascular Complicat...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Macrovascular Complicat...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Macrovascular Complicat...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Macrovascular Complicat...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Treatment: Dugs Classif...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Insuline and its
Prepar...
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Clinico-Pharmacological Conference
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Insuline is a polypeptide hormone, consisting of two
pepti...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Insuline is secreted fr...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Insuline and Glucagon
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Clinico-Pharmacological Conference
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• Insulin is stored in beta cells of pancreas in the form ...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Because insuline is a p...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Liver and kidney remo...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Insulin is measured i...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
The symptoms of hypogly...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• S.t therapy involves ...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Insuline Preparations
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Treatment: Drugs Classi...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Treatment: Drugs Classi...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• This group includes l...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• It includes Neutral p...
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Diabetes MellitusDiabetes Mellitus
• This group include gl...
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Diabetes MellitusDiabetes Mellitus
Plasma Insuline Levels/...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Synthetic Amylin Analog...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Pramlintide is indica...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Pharmacokinetics
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Inhibits Glucagon rel...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Along with insulin in...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Hypoglycemia
• Nausea...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Gastroparesis( delaye...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
1) Sulfonylureas 2) Gli...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• Given Orally before m...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Tolbutamide 4-5 hours
C...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Mechanism of action
• B...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
•Hyperinsulinemia
•Prol...
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Clinico-Pharmacological Conference
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• Severe Hepatic & Renal Failure
• Pregnancy
• Lactation
•...
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Clinico-Pharmacological Conference
Frontier Medical College
• Orally administered
• Well absorbed after being taken 1-...
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Clinico-Pharmacological Conference
Frontier Medical College
• Bind to sulphonylurea receptor of ATP sensitive potassiu...
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Clinico-Pharmacological Conference
Frontier Medical College
• Hypoglycemia in patients who are also taking lipid lower...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Insulin Sensitizers: Or...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Biguanides
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Mechanism of action
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Pharmacokinetics
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Used in insulin resis...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Adverse affects
• Lacti...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
Contraindications
• Ren...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• These are also insuli...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• Tissues to be targete...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• Both pioglitazone and...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
• Hepatotoxicity
• Weig...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• This group includes a...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Inhibits glucosidases...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• These agents are inte...
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Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
• Diarrhea
• Abdominal ...
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Clinico-Pharmacological Conference
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What is an Incretin affect?
Oral glucose results in a high...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
Incretin hormone
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Diabetes MellitusDiabetes Mellitus
Classification
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LIRAGLUTIDE EXENATIDE
ADMINISTRATION S/C S/C
HALF LIFE LON...
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Clinico-Pharmacological Conference
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• Act as GLP-1 Receptor Agonists
• Improve Glucose Depende...
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Diabetes MellitusDiabetes Mellitus
Oral Agents: DPP-IV
Inh...
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Diabetes MellitusDiabetes Mellitus
GLP-1
Dipeptidyl
Peptid...
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Diabetes MellitusDiabetes Mellitus
A 54-year-old woman is ...
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Clinico-Pharmacological Conference
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Diabetes MellitusDiabetes Mellitus
4th
Clinico-Pharmacological Conference
Frontier Medical College
Diabetes MellitusDiabetes Mellitus
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Diabetes Mellitus and Insuline analogs

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This presentation was delivered by 3rd year MBBS students of Frontier Medical College during 4th Clinico-Pharmacological Conference held in the Pharmacology Dept of College. The Presentation aims at providing key features in detail about diabetes and its Pharmacological treatment. The Presentation was well applauded by the Faculty and students of Medical College. (Abbottabad, Pakistan).

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  • Arial Bold, 24 Save every 5 minutes. Notes Lippincott Wikipedia SlideShare
  • 400-500AD type 1, type 2 separate identification-Indian physicians sushruta and churukha (type 1 youth-type 2 obese) 1700-mellitus was added (honey) Briton John rolle, 20 th century canadians fredrick banting and charles herbert isolated and purified Insuline 1921,1922. –Long acting Insuline NPH 1940s
  • Greek Areatus of cappacdocia who described the course and symptoms of disease- linked to pneumatic school
  • Using nanopumps may allow insulin to be delivered from pumps the size of skin patches. Pumps deliver controlled amounts throughout the day.
  • Diabetes mechanism jpg, type 1 mechanism jpg, type 2 mechanism jpg, difference table, images,
  • Transcript of "Diabetes Mellitus and Insuline analogs"

    1. 1. 1605 Abubakkar Raheel 1553 Nazia Hassan 1652 Abrar Afridi 1638 Kehkashan Alam Diabetes Mellitus 4th Clinico-Pharmacological Conference Frontier Medical College 3rd year MBBS
    2. 2. 4th Clinico-Pharmacological Conference Frontier Medical College Learning Objectives Diabetes MellitusDiabetes Mellitus  Define the term Diabetes mellitus.  Discuss brief History of Diabetes  Identify the incidence and prevalence of diabetes mellitus.  Discuss the Etiology of diabetes  Discuss the Biostatical analysis of Diabetes  Differentiate between Type 1 Diabetes and Type 2 Diabetes  Know the drugs used for its treatment
    3. 3. 4th Clinico-Pharmacological Conference Frontier Medical College  Discuss the mechanism of action of Proto-Type Drugs  Understand the Adverse Affects of mentioned Drugs  Learn the Treatment and Management of Diabetes  Discuss a Clinical Scenario  Brief Question/Answer Session Diabetes MellitusDiabetes Mellitus Learning Objectives
    4. 4. 4th Clinico-Pharmacological Conference Frontier Medical College • In Simple terms, Diabetes Mellitus is a disease marked by high levels of sugar in the blood. Mellitus is Latin for “sweet as honey”. • According to our Textbook Lippincott’s Pharmacology, “Diabetes is not a single disease rather it is a heterogeneous group of Syndromes characterized by elevation of blood glucose caused by a relative or absolute deficiency of Insulin.” Diabetes MellitusDiabetes Mellitus Definition
    5. 5. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus History
    6. 6. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus
    7. 7. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus
    8. 8. 4th Clinico-Pharmacological Conference Frontier Medical College • There are currently over 2 million people diagnosed with diabetes in the UK and there are up to another 1 million people with diabetes who have the condition and don’t know it! • The global incidence of diabetes is rising and the number of people affected is projected to exceed 300 million by the year 2025. (www.diabetes.org.uk) Diabetes MellitusDiabetes Mellitus Incidence of Diabetes
    9. 9. 4th Clinico-Pharmacological Conference Frontier Medical College • Estimated 245 million people globally • 20% of adult population • 5% of all deaths each year • 80% of people with diabetes live in low and middle income countries Diabetes MellitusDiabetes Mellitus Incidence of Diabetes
    10. 10. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Biostatical Analysis
    11. 11. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus
    12. 12. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus
    13. 13. 4th Clinico-Pharmacological Conference Frontier Medical College • A parent, brother, or sister with diabetes • Obesity • Age greater than 45 years • Some ethnic groups • Gestational diabetes or delivering a baby weighing more than 9 pounds • High blood pressure • High blood cholesterol level • Not getting enough exercise Diabetes MellitusDiabetes Mellitus Risk Factor which predispose to Diabetes
    14. 14. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Normal Metabolism of Glucose
    15. 15. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Type 1 Diabetes
    16. 16. Type 1 Diabetes • Insulin not produced due to non fuctional beta-cell  Hence no maintainance of basal secretion level of Insuline and no response to variations in circulating fuels. • No insulin to ‘unlock’ the receptors  • Glucose cannot enter the cell  • Glucose re-enters the blood stream  • Extent of glycemic control  related to metabolic complications 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus
    17. 17. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Type 1 Diabetes
    18. 18. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Blood Sugar & Spine connection • Journal of Vertebral Subluxation research • Vagus, T-8, T-9 • Disturbed Nerve supply • Loss of pancreatic function & insuline production
    19. 19. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Symptoms of type 1 Diabetes • Polyuria • Polydipsia • Weight loss in spite of polyphagia • Fatigue • Nausea • Vomiting • Coma • Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting.
    20. 20. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Morbidity/Complications Complications of diabetes can be divided into three categories •Metabolic complications of low blood glucose levels (hypoglycaemia) and of high blood glucose levels (hyperglycaemia) e.g. Diabetic coma. •Damage to small blood vessels (microvascular) leading in turn to damage of: retina (retinopathy) kidney (nephropathy) nerves (neuropathy)
    21. 21. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Morbidity/Complications • Damage to the larger arteries (macrovascular) leading to damage of: brain (leading to stroke) heart (leading to coronary heart disease) legs and feet (leading to peripheral vascular disease)
    22. 22. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Associated with aging, obesity, Peripheral Insuline resistance rather than by auto-immune processes or viruses. • Metabolic alterations are less (Non-ketotic) • Occurs mostly in people over 40 • Type 2 diabetes is the most common of the two main types and accounts for between 85 - 95% of all people with diabetes.
    23. 23. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Pancreas retain some beta-cell function but variable insuline production is insufficient and there is a decrease in the number of receptors (insulin resistance) Lack of sensitivity of target organs to either endogenous or exogenous insuline  Glucose does not enter the cell effectively Glucose re-enters the blood stream  Blood glucose levels rise.
    24. 24. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Slower onset • Polydipsia • Polyuria • Polyphagia • Fatigue • Blurred vision • Slow-healing infections • Impotence in men Symptoms of Type 2 Diabetes
    25. 25. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Hyperglycemia • Diabetic Ketoacidosis / DKA • Microvascular complications • Macrovascular complications Complications of Diabetes
    26. 26. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Polyuria • Polydipsia • Fatigue • Nausea and vomiting • Muscular stiffness or aching • Mental stupor/ decreased consciousness may progress to coma • Rapid breathing • Fruity breath (pear drops / nail varnish smell) • Headache • Low blood pressure • Decreased appetite • Abdominal pain Symptoms of DKA
    27. 27. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Microvascular Complications
    28. 28. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Microvascular Complications
    29. 29. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Microvascular Complications
    30. 30. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Microvascular Complications
    31. 31. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Macrovascular Complications
    32. 32. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Macrovascular Complications
    33. 33. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Macrovascular Complications
    34. 34. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Macrovascular Complications
    35. 35. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Treatment: Dugs Classification
    36. 36. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Insuline and its Preparations By Nazia Hassan
    37. 37. 4th Clinico-Pharmacological Conference Frontier Medical College Insuline is a polypeptide hormone, consisting of two peptide chains that are connected by disulphide bonds. It is synthesized as a precursor insuline (pro-insuline) that undergoes proteolytic cleavages to form insuline and C-peptide, both of which are secreted by the Beta-Cells of the pancreas. Diabetes MellitusDiabetes Mellitus Insuline
    38. 38. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Insuline is secreted from pancreatic B-Cell at a low basal rate and at a much higher stimulated rate in response to a variety of stimuli, especially glucose. Other stimulants include •Sugars (Mannose) •Certain Amino acids (Leucine, Arganine) •Hormones (Glucagon like polypeptide) •Glucose dependent insulinotropic polypeptide •Glucagon •Cholecystokinin •Vagal activity Secretion
    39. 39. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Insuline and Glucagon
    40. 40. 4th Clinico-Pharmacological Conference Frontier Medical College • Insulin is stored in beta cells of pancreas in the form of granules as crystals. • Each crystal consist of 6 molecules of insulin binding with 2 atoms of Zn. • Human pancreas can store 8gm of inuslin. Diabetes MellitusDiabetes Mellitus Storage
    41. 41. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Because insuline is a polypeptide, it is degraded in the gastrointestinal tract if taken orally. Therefore it is generally administered by subcutaneous injection. During Hyperglycemic emergency, it is injected Intravenously. Administration
    42. 42. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Liver and kidney remove insulin from circulation • Liver clears 60% while kidney removes about 40% of the insulin • This ratio is inverted for exogenous subcutaneous insulin • Half life of insulin is 3-5min in the blood Degradation
    43. 43. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Insulin is measured in units u/ml • 1mg is equal to 28u • Basal insulin value is 5-15microU/ml • Peak concentration can rise to 60-90microU/ml during meals Circulating insuline
    44. 44. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus The symptoms of hypoglycemia are the most serious and common adverse reactions to an excessive dose of Insuline. Other adverse affects include •Weight gain •Lipodystrophy •Allergic reactions •local Injection site reactions Adverse reactions to Insuline
    45. 45. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • S.t therapy involves twice injections daily • Int.t therapy involves three or more times injection daily • Frequency of hypogylcemic episodes, coma and seizures are higher in Int.t than st.t therapy due to insulin excessiveness • Patient with Int.t therapy has significant reduction in nephropathy, neuropathy and retinopathy Standard and Intensive Therapy
    46. 46. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Insuline Preparations
    47. 47. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Treatment: Drugs Classification Insuline Preparations (Combinations)
    48. 48. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Treatment: Drugs Classification Insuline Preparations (Combinations)
    49. 49. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • This group includes lispro, aspart and glulisine • They have rapid onset of action and short acting duration • Peak levels can be seen within 30-90min after injection • Short acting insulin includes regular insulin Rapid acting Insuline
    50. 50. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • It includes Neutral protamine hagedron or Isophane • They act intermediately because of delayed absorption due to formation of less soluble complexes • Can be used in all type of diabetes except ketoacidoses and emergency diabetes Intermediate acting Insuline
    51. 51. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • This group include glargine and detemir • Its has slower onset of action and no peak level • These can be used in combination with rapid acting insulins Long acting Insuline
    52. 52. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Plasma Insuline Levels/Hours
    53. 53. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Synthetic Amylin Analogs & Insulin Secretagogues By Kehkashan ALam
    54. 54. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Pramlintide is indicated as an adjunct to mealtime insulin therapy in patients with Type 1 & Type 2 Diabetes by acting as amylinomimetic. • Pramlintide delays gastric emtying & delays postprandial Glucagon secretion. Synthetic Amylin Analogs: Pramlintides
    55. 55. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Pharmacokinetics
    56. 56. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Inhibits Glucagon release from pancrease • Delays Gastric Emptying • Also causes Anorexia by acting on CNS Mechanism of action
    57. 57. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Along with insulin in Type 1 & Type 2 Diabetes Mellitus to control Blood Glucose level after meal • May help in weight loss Clinical Uses
    58. 58. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Hypoglycemia • Nausea • Vomiting • Anorexia Adverse Effects
    59. 59. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Gastroparesis( delayed stomach emtying) • Cresol Hypersensitivity • History of Hypoglycemic unawareness Contraindications
    60. 60. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus 1) Sulfonylureas 2) Glinides 1st Generation Repaglinide • Tolbutamide Nateglinide • Tolazamide • Acetohexamide • Chlorpropamide 2nd Generation • Glibenclamide • Glyburide • Glipizide • Glimepiride Insulin Secretagogues
    61. 61. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Given Orally before meals • Bind to serum proteins • Metabolized by liver • Excreted by liver or kidney • Duration of Action ranges from 12-24 hours Sulfonylureas: Pharmacokinetics
    62. 62. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Tolbutamide 4-5 hours Chlorpropamide 32 hours Tolzamide 7 hours Glipizide 2-4 hours Glimepiride 5 hours Note: Chlorpropamide in contraindicated in elder patients because it may prolong Hypoglycemia. Half Life
    63. 63. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Mechanism of action • Blockage of ATP sensitive Potassium channels • Depolarization • Calcium ion Influx • Stimulation of Insulin Release from Beta cells of Pancreas • Resulting in decrease Glucose level in body
    64. 64. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus •Hyperinsulinemia •Prolonged Hypoglycemia •Increase in Body Weight •Nausea, Vomiting, Diarrhea •Allergic Reactions like Skin Rashes •Rarely Bone Marrow depression can occur Adverse affects
    65. 65. 4th Clinico-Pharmacological Conference Frontier Medical College • Severe Hepatic & Renal Failure • Pregnancy • Lactation • Porphyria • Ketoacidosis Diabetes MellitusDiabetes Mellitus Contraindications
    66. 66. 4th Clinico-Pharmacological Conference Frontier Medical College • Orally administered • Well absorbed after being taken 1-30 minutes before meal • Metabolized to inactive products by cytochrome p450 3A4 in the liver • Excreted through bile • Repaglinide should be used courtiously in individuals with renal and hepatic impairment Diabetes MellitusDiabetes Mellitus Glinides: Pharmacokinetics
    67. 67. 4th Clinico-Pharmacological Conference Frontier Medical College • Bind to sulphonylurea receptor of ATP sensitive potassium channels • Initiate the release of insulin • Lowers the blood glucose level Diabetes MellitusDiabetes Mellitus Mechanism of action
    68. 68. 4th Clinico-Pharmacological Conference Frontier Medical College • Hypoglycemia in patients who are also taking lipid lowering drugs like Gemfibrozil • Weight gain Diabetes MellitusDiabetes Mellitus Adverse affects
    69. 69. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus
    70. 70. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Insulin Sensitizers: Oral AgentsInsulin Sensitizers: Oral Agents
    71. 71. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Biguanides
    72. 72. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Mechanism of action
    73. 73. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Pharmacokinetics
    74. 74. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Used in insulin resistant patient. i-e, insulin resistance syndrome • It does not increase weight, useful in obese diabetic patient. • Can be given as monotherapy OR with combination of insulin secretogogues drugs. Clinical Uses
    75. 75. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Adverse affects • Lactic acidosis • Reduce B12 absorption • GIT disturbance • anoxia • nausia • vomitting • Diarrhea
    76. 76. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Contraindications • Renal disease • Alcohalism • Hepatic disease • Acute M.I
    77. 77. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • These are also insulin sensitizers. • Also known as glitazones. • Rosiglitazone & pioglitazone are currently available agents. • Does not promote insulin release from pancrease. Thiazolidinediones
    78. 78. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Tissues to be targeted are adipocytes, liver & skeletal muscles. • It binds with peroxisome proliferator activated receptor gamma, a nuclear hormone receptor. • These receptors regulate metabolism of glucose, production of free fatty acids. • Ultimately increasing sensitivity of insulin. M.O.A
    79. 79. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Both pioglitazone and rosiglitazone are well absorbed orally. • Bound extensively to plasma protein. • Metabolized by cytochrome p450 enzymes in liver. • Excreted through urine. Pharmacokinetics
    80. 80. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Hepatotoxicity • Weight gain • Osteopenia • M.I • Anemia • Headache Adverse Effects
    81. 81. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • This group includes acarbose and Miglitol • They don’t have any effect on insulin production Alpha glucosidase inhibitors
    82. 82. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Inhibits glucosidases located on the intestinal brush boarder • So oligosaccharrides cant be converted to glucose • In addition these also inhibit pancreatic amylase • Postprandial hyperglycemia does not occure M.O.A
    83. 83. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • These agents are intermediatly absorbed • They don’t have any systemic affects • Excrected by kidneys in unchanged form Pharmacokinetics
    84. 84. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus • Diarrhea • Abdominal cramp • Inflammatory bowl syndrome • Colonic ulceration Adverse affects
    85. 85. 4th Clinico-Pharmacological Conference Frontier Medical College What is an Incretin affect? Oral glucose results in a higher secretion of insulin than occurs when equal load of glucose is given IV. This effect is referred to as Incretin effect. And is markedly reduced in diabetes type 2. Diabetes MellitusDiabetes Mellitus Incretin Mimetics
    86. 86. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Incretin hormone
    87. 87. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Classification
    88. 88. 4th Clinico-Pharmacological Conference Frontier Medical College LIRAGLUTIDE EXENATIDE ADMINISTRATION S/C S/C HALF LIFE LONG SHORT INJECTION ONCE DAILY TWICE DAILY EXCRETION - RENAL AVOIDANCE - RENAL IMPAIRED ADVERSE AFFECTS N.V.D.C, PANCREATITIS, ABD PAIN N.V.D.C, PANCREATITIS, ABD PAIN Diabetes MellitusDiabetes Mellitus Liraglutide vs Exenatide
    89. 89. 4th Clinico-Pharmacological Conference Frontier Medical College • Act as GLP-1 Receptor Agonists • Improve Glucose Dependent Insuline Secretion • Slow gastric Emptying time • Decrease Food Intake • Decrease post-prandial Glucagon secretion • Promote Beta-Cell proliferation Diabetes MellitusDiabetes Mellitus Mechanism of action
    90. 90. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Oral Agents: DPP-IV Inhibitors
    91. 91. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus GLP-1 Dipeptidyl Peptidase- IV Inhibitors inactivates inhibit enzyme Glucagon like peptide-1 Mechanism of Action Oral Agents: DPP-IV Inhibitors
    92. 92. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus A 54-year-old woman is diagnosed with type 2 diabetes mellitus after a routine follow-up for impaired fasting glucose showed that her hemoglobin A1C is now 7.6%. She has attempted to lose weight and to exercise with no improvement in her hemoglobin A1C, and drug therapy is now recommended. She has mild systemic hypertension that is well controlled and no other medical conditions. Which of the following is the most appropriate first-line therapy? A. Acarbose B. Exenatide C. Glyburide D. Metformin E. Sitagliptin Short Clinical Scenario
    93. 93. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus
    94. 94. 4th Clinico-Pharmacological Conference Frontier Medical College Diabetes MellitusDiabetes Mellitus Thank you for your patience 
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