Insulin & Oh Gs(10 13)

DR.UMA KADAM M.B.B.S. MD ASSOCIATE PROFESSOR PHARMACOLOGY SKNMC DR.UMA K.

Insulin and Oral Hypoglycemics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Insulin and Oral Hypoglycemics ,[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Prototype Drugs: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Pancreas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

INSULIN: Polypeptide hormone secreted by the pancreatic Islets of Langerhans essential for the metabolism of carbohydrates and is used in the treatment and control of diabetes mellitus DR.UMA K.

Insulin Biosynthesis and Secretion ,[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Three Biosynthetic Products: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

B. C-peptide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

C. Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Insulin needs ,[object Object],[object Object],[object Object],DR.UMA K.

Endogenous Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Normal Insulin Production ,[object Object],[object Object],DR.UMA K.

Normal Insulin Profiles After a meal Just to function normally Basic Requirements What happens when you eat and a background level of insulin and extra insulin is needed the blood sugar rises the body needs a constant level of sugar in the blood

Normal Insulin Profiles Mealtime insulin Background insulin Blood sugar Daily Requirements Breakfast Lunch Evening Meal

Physiological Insulin Levels DR.UMA K. Breakfast Lunch Dinner Insulin Levels

Factors Affecting Insulin Secretion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

DR.UMA K.  subunit  subunit

Type 2 Diabetes Etiology ,[object Object],[object Object],[object Object],DR.UMA K.

As a result, the glucose circulating cannot enter the cells, so that the glucose cannot be used for energy!!!!!! Therefore, there is INSULIN RESISTANCE!!! DR.UMA K.

DR.UMA K. NORMAL GLUCOSE UPTAKE INSULIN RESISTANCE

Insulin is like the key that cannot get fit into the lock (cells)!!!! DR.UMA K.

Insulin Resistance: Causes and Associated Conditions Medications Aging INSULIN RESISTANCE Atherosclerosis Genetics Obesity and inactivity Rare disorders PCOS Dyslipidemia Hypertension Type 2 diabetes

Type 2 Diabetes Signs and Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Type 2 Diabetes ,[object Object],[object Object],[object Object],DR.UMA K.

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Summary 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Insulin Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Insulin Preparations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Flexible insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Short-Acting Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object]

Intermediate Acting Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pre-mixed Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Long-Acting Insulin Glargine (Lantus) ,[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

DR.UMA K. Lispro Lente Insulin Regular Insulin NPH Insulin Ultralente Insulin 70/30 (human isophane sus./NPH& human insulin-DNA origin) 50/50 (human isophane sus.& human insulin-DNA origin)

Species of Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object]

Insulin regimes ,[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

DR.UMA K. Twice daily injections e.g. Humulin M3 Breakfast Lunch Dinner Insulin Levels Soluble insulin Long/intermediately acting insulin

DR.UMA K. 3-4 daily injections - more physiological profile Breakfast Lunch Dinner Insulin Levels

Storage of Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object]

Insulin Delivery ,[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Insulin Devices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Who is a good candidate for an Insulin Pump? DR.UMA K.

Insulin Pumps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Adverse effects of insulin: DR.UMA K.

Drug interactions and diabetes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Nateglinide: ,[object Object],[object Object],[object Object],[object Object],DR.UMA K.

DR.UMA K. /Miglitol Antihyperglycemic

OTHER ANTIHYPERGLYCEMICS: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Nursing Assessment for All Diabetic Clients ,[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Lab Assessment for All Diabetic Clients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Checking Blood Glucose ,[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Hemoglobin A 1c ,[object Object],[object Object],DR.UMA K. Hb A1c

Values for HbA 1c ,[object Object],[object Object],[object Object],DR.UMA K.

ADA Treatment Goals ,[object Object],[object Object],[object Object],DR.UMA K.

HbA 1c Predicts CHD in Type 2 CHD mortality Incidence (%) in 3.5 years All CHD events Incidence (%) in 3.5 years HbA 1c HbA 1c Low <6% Middle 6-7.9% High >7.9% Low <6% Middle 6-7.9% High >7.9% 0 5 10 15 20 25 0 5 10 15 20 25

Effects of EXERCISE on Blood Glucose ,[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Effects of ILLNESS on Blood Glucose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Being sick usually makes blood sugar HIGH! ,[object Object],[object Object],DR.UMA K.

Interventions for ILLNESS ,[object Object],[object Object],[object Object],DR.UMA K.

Treatment of diabetes DR.UMA K.

DR.UMA K. Diabetic Ketoacidosis/ ketotic coma Hyperosmolar/ Nonketotic coma Type-1(IDDM) Type-2 (NIDDM)

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Treatment for Diabetic Ketoacidosis DR.UMA K. Osmotic diuresis Hyperglycemia Glycosuria Hyperventilation Impairment of consciousness Hypotension Shock Tachycardia Vomitting Dehydration

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Treatment for Diabetic Ketoacidosis DR.UMA K.

[object Object],[object Object],[object Object],Treatment for Diabetic Ketoacidosis DR.UMA K.

Hyperosmolar (Nonketotic /hyperglycemic) coma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

Management of Hypoglycemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DR.UMA K.

DR.UMA K. Complex internalised Drugs used to treat diabetes mellitus Gut Food Absorption Glucose Insulin Pancreas Insulin stored in  -islet cells Liver ,[object Object],[object Object],[object Object],Receptor (tyrosine kinase) Muscle/fat cell Stimulates glucose uptake Adipose cell Insulin receptor Peroxisome proliferator-activated receptor Insulin Sulfonyl- ureas Metformin Acarbose Glitazones

Insulin & Oh Gs(10 13)

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Insulin & Oh Gs(10 13)