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Managment of type 2 diabetes mellitus

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  • 1. PresenterAli Mahamoud Al-madani Supervisor Dr. Lokesh Shetty
  • 2. Diabetes mellitus (DM) is a metabolic diseases in which a person has high blood sugar Level (Fasting plasma glucose level more than 126 mg/dl).May due to,pancreas does not produce enough insulin (Type 1 DM), or because cells do not respond (Resistant) to the insulin that is produced (Type 11 DM)
  • 3. If left untreated, Diabetes can cause many life threatening complications: • Blindness • Chronic Renal Failure= kidney failure • Atherosclerosis= heart attacks and stroke • Diabetic Neuropathy= numbness and pain to hands and feet • Foot Ulcers • Diabetic Retinopathy & Cataract etc
  • 4. Type 2 diabetes makes up about 90% of cases of diabetes of DM.Obesity is thought to be the primary cause of type 2 diabetes in people who are genetically predisposed to the disease.Type 2 diabetes is initially managed by increasing exercise and dietary modification.If blood glucose levels are not adequately lowered by these measures, medications such as metformin or insulin or other Therapeutics may be needed.
  • 5. A proper diet and exercise are the foundations of diabetic care, with a greater amount of exercise yielding better results.Aerobic exercise (Exercise generates energy) leads to a decrease in HbA1c and improved insulin sensitivity.A diabetic diet that promotes weight loss is important.A low glycemic index diet has been found to improve blood sugar control.If changes in lifestyle in those with mild diabetes has not resulted in improved blood sugars within six weeks, medications should then be considered
  • 6. MEDICATIONThere are several classes of anti-diabetic.medications availableMetformin is generally recommended as a first linetreatment as there is some evidence that it decreases.mortalityA second oral agent of another class may be used if.metformin is not sufficientOther classes of medications include: sulfonylureas,nonsulfonylurea secretagogues, alpha glucosidaseinhibitors, thiazolidinediones, glucagon-like peptide-1.analog, and dipeptidyl peptidase-4 inhibitors
  • 7. Metformin should not be used in those with severekidney or liver problems.Injections of insulin may either be added to oralmedication or used alone in Type II DM Most people do not initially need insulin forManagement Type II DM. When Insulin used, a long-acting Insulin formulation is typically to be added atnight, with oral medications being continued. When nightly insulin is insufficient twice daily insulinmay achieve better control. In those who are pregnant.insulin is generally the treatment of choice
  • 8. Brief Review on Oral Hypoglycemic Agents They are indicated only in Type II DM, when not controlled by diet & exercise.They are best used in Patients with,1. Age above 40 years at onset of disease.2. Obesity at the time of presentation3. Duration of disease more than 5 years when starting treatment.4. Fasting blood glucose level more than 200mg/dl5. Insulin requirement more than 40 U per day.6. No ketoacidosis or history of it or any other complication.
  • 9. (Sulphonylureas (SUsInteract with receptors on ß cell surface, •closes K+ channels in the membrane, causingdepolarisation allowing Ca to enter cellstriggering release of insulinMore insulin released • •Reduces hepatic glucose production •Increases glucose uptake in the peripheral •tissues
  • 10. Common SulphonylureasGeneric Tolbutamide Gliclazide Glibenclamide GlimepiridenameBrand Rastinon Diamicron Euglucon AmarylnameSize of 500mg 80mg 2.5mg, 5mg 1,2,3 andtablet 4mgDoses 250mg bd – 40mg- 2.5mg od – 1mg od – 1gram tds 160mg bd 10mg bd 6mg odWhen With or after Just before Just before or With the first taken food or during during food meal of the food dayDuration 6-10 hours 10-15 20-24 hours 12-24of action hours hours
  • 11. Biguanides - MetforminTablet size – 500mg, 850mgDose range – 250mg bd to 1gram tdsWhen to take – with or after food Mechanism of Action •Inhibits gluconeogenesis – Stimulates peripheral glucose uptake –Enhances insulin receptor binding –Reduces intestinal glucose absorption –
  • 12. Alpha Glucosidase Inhibitor - AcarboseTablet size – 50mg, 100mg Dose range – 50mg od up to 100mg tds •When to take – with the first mouthful of •food, swallowed or chewed:Mechanism of ActionSlows absorptions of starchy foods from theintestineHas no effect on insulin production
  • 13. Meglitinide – RepaglinideTablet size – 0.5mg, 1mg and 2mgDose range – starting dose 0.5mg per meal up to qds, to amaximum dose of 4mg per meal; total daily dose not.exceed 16mgDuration of action 3-4 hours. Maximum plasma concentration occur 60 minutes after taking tablet:Mechanism of Action Rapidly absorbed, fast acting, short duration insulinsecretagogueDerived from the meglitinide portion of glibenclamide bindswith a different site on beta cell
  • 14. Amino Acid DerivativesGeneric name - Nateglinide •Brand name - Starlix •Tablet size – 60mg, 120mg or 180mg •Dosage – start 60mg before meals (1-30mins). •Usual maintenance dose is 120mg before meals,.maximum 180mg TDSMechanism of Action •Restores early phase of insulin release –For use in people already taking Metformin where •a sulphonylurea may be inappropriate
  • 15. (Thiazolidinediones (glitazonesGeneric names –Pioglitazone Rosiglitazone •Brand name –Actos Avandia •Tablet size –15mg, 30mg 4mg, 8mg •Dose range –15mg – 30mg od 4mg od – 8mg od •
  • 16. (Thiazolidinediones (glitazones Mechanism of Action Targets insulin resistance at adipose tissue, skeletalmuscle and liver by binding to specific nuclearreceptors - peroxisome proliferators-activatedreceptor gamma agonists. Thus increases.transcription of several insulin responsive genesImprove sensitivity to insulin in muscle, fat tissuesand liver Does not stimulate pancreatic insulin secretion
  • 17. Management of Type II DM with Surgery. Weight loss surgery in those who are obese is aneffective measure to treat diabetes.  Many are able to maintain normal blood sugarlevels with little or no medications following surgeryand long term mortality is decreased. The body mass index cutoffs for whensurgery is appropriate are not yet clear. It however is recommended that this option beconsidered in those who are unable to get both their weight and blood sugar under control