Type 2 Diabetes Mellitus with Hemodylasis

1. Type 2
diabetes
mellitus
(Hemodylasis)
BY- ISHPREET SINGH BEDI
17SMAS102024
BPHARMA 7TH SEM

2. Introduction
▪ Type 2 diabetes is a chronic disease. It is characterized by
high levels of sugar in the blood. Type 2 diabetes is also
called type 2 diabetes mellitus and adult-onset diabetes.
That's because it used to start almost always in middle- and
late-adulthood. However, more and more children and teens
are developing this condition. Type 2 diabetes is much more
common than type 1 diabetes, and is really a different
disease.
▪ Type 2 diabetes used to be known as adult-onset diabetes,
but today more children are being diagnosed with the
disorder, probably due to the rise in childhood obesity.
There's no cure for type 2 diabetes, but losing weight, eating
well and exercising can help manage the disease. If diet and
exercise aren't enough to manage your blood sugar well, you
may also need diabetes medications or insulin therapy.

3. Pathophysiology of type 2 diabetes mellitus
▪ The pathophysiology of type 2 diabetes mellitus is
characterized by peripheral insulin resistance, impaired
regulation of hepatic glucose production, and declining β-cell
function, eventually leading to β -cell failure.

4. Symptoms of diabetes mellitus
▪ Frequent urination.
▪ Excessive thirst.
▪ Unexplained weight loss.
▪ Extreme hunger.
▪ Sudden vision changes.
▪ Tingling or numbness in the hands or feet.
▪ Feeling very tired much of the time.
▪ Very dry skin.

5. What is Hemodialysis
▪ -Hemodialysis- It is a treatment to filter wastes and water from
our blood to outside of the body. It also helps control blood
pressure and balance important minerals such as potassium,
sodium and calcium in our blood.
▪ Hemodialysis has been successful for treating metformin
associated lactic acidosis, but prolonged hemodialysis (more
than 15 hours) is required to reduce the metformin levels
sufficiently. Patients who take an overdose of metformin should
therefore be carefully monitored even if dialysis is deemed
unnecessary.

6. Management of diabetes in hemodialysis patients
▪ Oral Hypoglycemic Drugs
▪ Insulin

7. Oral Hypoglycemic Drugs
▪ Majorly used drug for Oral Hypoglycemic category is- Metformin
▪ Generally, metformin is the first medication prescribed for type
2 diabetes. It works by lowering glucose production in the liver
and improving your body's sensitivity to insulin so that your
body uses insulin more effectively.
▪ Metformin is the most commonly prescribed as oral
antidiabetic drug.
▪ Metformin is often considered safer than either insulin or
sulphonylureas because of the lower risk of hypoglycaemia.
Metformin can cause potentially life-threatening metabolic
acidosis with an increased blood lactate level.
▪ Metformin can also decrease Gluconeogenesis.

8. MOA of Metformin
▪ Decrease Hepatic glucose produvtion
▪ Decrease intestinal absorption of glucose
▪ Improve insulin sensitivity by increasing peripheral glucose
uptake and utilization.

9. Doses
▪ Metformin blood levels ranging from 0.5 to 2.0 mg/L are
considered to be within the therapeutic range, whereas
concentrations over 5.0 mg/L are generally considered to be
toxic
▪ Doses of metformin- If twice a day -500mg
If once a da-800mg

10. Adverse Effect
▪ Nausea
▪ Vommiting
▪ Stomach upset
▪ Diarrhea
▪ Weakness or metalic taste in the mouth

11. Common Side Effect
▪ Physical weakness
▪ Muscle Pain
▪ Low blood Sugar or Hypoglycemia
▪ Abdominal Pain
▪ Lactic Acidosis
▪ Block absorption of Vitamin B12
▪ Cause Anemia

12. Contraindications
▪ Hypersensitivity
▪ Chronic Heart Failure
▪ Diabetic Ketoacidosis
▪ Renal disease
▪ Myocardial infraction
▪ Consumption of alcohol

13. Insulin
▪ Insulin is used rather than oral agents
▪ Insulin doses may change substantially during the transition
from earlier stages of Chronic kidney disease to dialysis.
▪ Chronic kidney disease, also called chronic kidney failure,
describes the gradual loss of kidney function. Your kidneys
filter wastes and excess fluids from your blood, which are then
excreted in your urine.
▪ Chronic kidney disease occurs when a disease or condition
impairs kidney function, causing kidney damage to worsen
over several months or years.

14. Conditions that cause chronic kidney disease
include:
Diseases and conditions that cause chronic kidney disease
include:
▪ Type 1 or type 2 diabetes
▪ High blood pressure
▪ Glomerulonephritis an inflammation of the kidney's filtering
units
▪ Interstitial nephritis an inflammation of the kidney's tubules
and surrounding structures
▪ Polycystic kidney disease
▪ Prolonged obstruction of the urinary tract, from conditions
such as enlarged prostate, kidney stones and some cancers.

15. Stages of chronic kidney disease and GFR
for each stage
▪ Stage 1 with normal or high GFR (GFR > 90 mL/min)
▪ Stage 2 Mild CKD (GFR = 60-89 mL/min)
▪ Stage 3 A Moderate CKD (GFR = 45-59 mL/min)
▪ Stage 3 B Moderate CKD (GFR = 30-44 mL/min)
▪ Stage 4 Severe CKD (GFR = 15-29 mL/min)
▪ Stage 5 End Stage CKD (GFR <15 mL/min)
▪ You need dialysis when you develop end stage kidney failure
--usually by the time you lose about 85 to 90 percent of your
kidney function and have a GFR of <15.

16. Insulin dosing in chronic kidney disease
▪ >50 ml/min= No Dose Adjustment
▪ 10-50ml/min= Decreased to 75% of baseline
▪ <10ml/min= Decreased by 50%

17. Type of Insulin Preferred For Type 2 Diabeties
▪ Intensive insulin analogue treatment provided better
glycaemic control without long-term hypoglycaemia risk
▪ Although the cost is a disadvantage, insulin analogues can be
preferred in selected haemodialysis patients with diabetes
mellitus.
▪ Insulin Degludec- Insulin Degludec is a new generation based
insulin with an ultra long duration of action. Pharmacokinetic
properties of insulin degludec with normal renal function is
mild, moderate or severe renal impairment or end stage renal
disease undergoing hemodialysis