Diabetes Mellitus As A Metabolic Disorder

Diabetes Mellitus As A Metabolic Disorder
Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia resulting from a lack of
insulin, a lack of Insulin effect, or sometimes both. Diabetes can lead to serious complications if not
maintained properly. Long term consequences of poorly controlled diabetes mellitus include
blindness, kidney failure, heart failure, stroke, and foot or leg amputations. There are three
classifications of Diabetes these include type 1, type 2, and gestational diabetes. .
Type diabetes is genetic and can possibly be triggered by a viral infection which makes the immune
system produce auto antibodies. These antibodies destroy beta cells; the result of this is the ultimate
lack of insulin secretion. When a diabetic is experiencing an insulin ... Show more content on
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Most people living with Type II Diabetes Mellitus are obese 2 living sedentary lifestyles. People
with type 2 may not show symptoms before they are diagnosed. There are usually no episodes of
hypoglycemia unless they are taking Insulin or other diabetic medication that may lower blood
sugar. This type of Diabetes can be prevented by maintaining a healthy lifestyle; this includes eating
right and a regular exercise regimen. Most people with Type 2 diabetes are overweight coupled with
a sedentary lifestyle and poor eating habits whereas type 1 diabetes mellitus has no relationship to
body size and eating habits. In the case of Type 2 diabetes most people do not require insulin. The
more excess weight being carried causes a decrease in sensitivity to insulin. The pancreas needs to
keep producing an increased quantity of insulin, then the insulin producing beta cells may begin to
fail, and someone with type 2 diabetes can gradually start to lose their ability to produce insulin.
There are many forms of insulin such as Rapid acting, intermediate acting, long acting, mixed
insulin, and inhaled insulin. There are three clinical properties of insulin that are characterized by
their onsets, peaks, and duration. Once a Type 2 diabetic starts using insulin they will have to
monitor themselves for symptoms of hypoglycemia. Type 2 diabetics can take oral anti–diabetic
medications. Anti–diabetic drugs, are categorized into
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Case Study : Diabetes Mellitus Type 2
Case Study #1: Diabetes Mellitus Type 2
Monay Link
The University of Tampa
Case Study #1: Diabetes Mellitus Type 2 Diabetes Mellitus (DM) is an endocrine disorder that has
the potential to affect various major organs throughout its progression. Diabetes Mellitus is divided
into three common categories: type 1 diabetes mellitus, type 2 diabetes mellitus (non–insulin
dependent), and gestational diabetes. Ninety percent of over 24 million people suffer from type 2
diabetes in the United States (Arcangelo & Peterson, 2013). The pathophysiology of type 2 diabetes
can be any combination of resistance to insulin, elevation in hepatic glucose production, or a
pancreas that secretes less insulin than needed to control glucose levels ... Show more content on
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The gold standard for diagnosing type 2 diabetes is testing the hemoglobin A1c (HbA1c), or the
average of the body's blood sugar over three months' time (Arcangelo & Peterson, 2013). Other
diagnostic testing include the fasting plasma glucose or the oral glucose tolerance test. The fasting
glucose is a lab draw taken when the patient has fasted (nothing by mouth) for eight hours or more
(Arcangelo & Peterson, 2013). Oral glucose tolerance testing is typically only used in diagnosing
gestational diabetes. Normal glucose values are variable to each diagnostic test. The fasting plasma
glucose is defined as a normal reading of < 100. Postload glucose, or the reading two hours after a
meal, is normally <140. The American Diabetes Association recommends a blood glucose log that
tests before meals and two hours after each meal (ADA, 2015). Arcangelo and Peterson (2013)
define an impaired fasting glucose as a reading above 100 but below 126, or a two hour postload
glucose of 140–200. These values indicate a pre–diabetic state. Repeat diagnostic testing at a
different time is warranted in the diagnosing of diabetes (Arcangelo & Peterson, 2013). Recognition
of drugs such as corticosteroids, thiazide diuretics, estrogen, beta blockers, and furosemide can
explain a sudden increase in glucose levels (Arcangelo & Peterson, 2013).
Case Presentation A 49 year old Caucasian female presents to the practice for her quarterly lab
review. G.C. has been a patient for

New Diagnostic Tool or Intervention for the Treatment of...
New diagnostic tool or intervention for the treatment of diabetes–A2071691 Description of the
intervention Interventions used in treatment of type 2 diabetes should be those that improve the
probability that the patient will have better long term control of diabetes. It is therefore imperative
that early diagnosis is given fast priority especially when metabolic abnormalities of diabetes are
less severe. Lifestyle interventions are key in containing type 2 diabetes. It is common knowledge
that sedentary lifestyle and over nutrition which lead to obesity and overweight increase the risk of
type 2 diabetes (Peters & Davidson, 1996). Interventions that reverse or improve these factors have
beneficial effects on control of glycemia in established type 2 diabetes. Weight loss has beneficial
effects on glycemia. Weight loss and exercise also improve coincident CVD risk factors like blood
pressure and atherogenic lipid profiles. They also ameliorate other chances of obesity. Apart from
lifestyle interventions, there are medications or glucose lowering interventions that can be used.
Their glucose lowering capabilities are predicted based on their intrinsic characteristics, duration of
diabetes, baseline glycemia, and previous therapy among other factors. Ambient level of glycemic
control is the only factor taken into consideration while selecting a class of drugs to initiate therapy.
Classes with more rapid glucose lowering effectiveness are normally administered when

Essay on Liraglutide: Novel Treatment of Type 2 Diabetes...
Substantial advancement has been built in recent years in the development of pharmacological
treatment of type 2 diabetes. The most recent developments have been around the incretin
hormones. Glucagon–like peptide 1–receptor agonists (GLP–1) have demonstrated efficacy and
safety in the treatment of type 2 diabetes. Liraglutide (Victoza) is a GLP–1 receptor agonist that has
demonstrated advantages in lower hemoglobin A1c in this class of medications and assisting
patients in reducing weight.
Liraglutide: Novel treatment of Type 2 Diabetes Mellitus
Type 2 Diabetes is rapidly becoming the top health concerns in the United States and a major
contributor to health care spending and disability. There are an estimated 22.3 million people ...
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1033).
Initial treatment of type 2 diabetes involves lifestyle modifications (American Diabetes Association
[ADA], 2014, p. S31). With obesity as the leading risk factor of type 2 diabetes, initial interventions
are based around patient education, increasing physical activity, reducing weight, and increasing
lean muscle mass. The American Diabetes Association standards of care published in 2014
recommends a moderate weight loss of 7% of total body weight and increasing activity to 150
minutes per week (ADA, 2014, p. S31). Modest loss of weight and increase of physical activity has
a significant impact on the reduction of insulin resistance, glucose metabolism, and delay in the
onset of type 2 diabetes. If lifestyle modifications and education interventions are not effective or if
the severity of illness is more advanced, the provider should consider pharmacological interventions
in addition to ongoing education and lifestyle changes.
There is growing number of medications to treat diabetes, especially type 2 diabetes. Each
medication alters the main dysfunction of diabetes, hyperglycemia through various routes. Much
like hypertension, diabetes is a multifactorial disease with multiple system dysfunctions. These
dysfunctions result in the altered metabolism of glucose, carbohydrates, lipids, and proteins.
Medications used to treat these dysfunctions works on

Benefits Of Sitagliptin
There have a lot of precautions before to take sitagliptin. Since sitagliptin was only treat type 2
diabetes, which is relative by lack of insulin. Type 1 diabetes is incapable of producing insulin in
patient's body. And Patients with diabetic ketoacidosis have extremely high blood sugar that requires
emergency medical attention. Therefore, patients with type 1 diabetes or with diabetic ketoacidosis
should not be used sitagliptin. Also, this drug is not very suitable used to patient with chronic
kidneys disease in stage 3 to 5 that because of sitagliptin would be through of kidney to excrete. So
this type of patient need to decrease the dosage intake. If patient was allergic to sitagliptin or have
other allergies. Since this medication contain

Interview A Registered Nurse From Georgia University...
In order to gain insight on the most frequently seen healthcare problem, I chose to interview a
registered nurse from Georgia Regents Medical Center, Mrs. Denead Buoy RN, MSN. I chose this
medical provider because she has had experience in her field for seventeen years. During the
interview, I gained valuable information about a disease that she mentioned she sees commonly in
her in–patient unit. The disease she noted was diabetes mellitus. During the interview, she gave me
information about the disease in terms of its causes, its frequency, and the reason she decided to
identity this disease. When speaking with healthcare provider Denead Buoy, RN, MSN, she
explained that diabetes mellitus is a condition in which one has elevated blood glucose levels due to
an inadequate insulin production or because the body responds inappropriately to the absorption of
insulin into cells. In some patients, both of these options could be the problem. On average there are
about 15 patients in her in–patient unit; out of the 15 patients that she gets, usually 8 to 10 either has
had a history of diabetes or has diabetes mellitus as their primary problem (D. Buoy, personal
communication, October 17, 2014). Buoy stated that even if the disease is not the primary reason
they were admitted into the hospital, diabetes is usually related to their primary condition. Diabetes
mellitus has a worldwide prevalence of 8.3 percent of the population with the amount of new cases
diagnosed per year

Type 2 Diabetes Research Paper
Lifestyle choices, such as exercising, losing weight and eating right are essential for diabetes
management. However, a doctor may still recommend medication to someone who is suffering from
diabetes. Below is a list of medications that are available for diabetes:
Insulin
Insulin is a hormone that the pancreas naturally secretes. However, people with type 1 diabetes
product little or no insulin. Type 2 diabetics are unable to use the insulin that the body produces
correctly. That is why insulin is often recommended to people who have diabetes. There are over 20
types of insulin. Your physician will recommend the type that is right for you.
Metformin
Metformin is a medication that works by decreasing the amount of glucose that the liver

Diabetes : What Is Diabetes?
Diabetes
What is diabetes?
Well this all starts with knowing what glucose is. Most of the sugar in your body is called glucose.
Glucose's main job is to supply the body with energy. The body breaks down glucose. Releasing
energy, water and carbon dioxide. It used by almost all tissues in the body, and is the only fuel the
brain can use. If your glucose is too high or low this is caused by diabetes.
Glucose in your body comes from three major nutrients: fat, protein, and carbohydrate. About, 10
percent of the fat and 50 percent of the protein you eat eventually brakes down into it and 100
percent of the carbohydrates you eat. When a person who does not have diabetes eats any food, their
blood glucose level rises; the beta cells detect this rise and release more insulin. The insulin goes
into the liver telling it to make less glucose and to the muscles, fat cells to take up more.
Detecting Diabetes
In a person without diabetes, the body keeps the plasma glucose level between meals in the range of
70–99 milligrams per deciliter. It will rise depending on how big your meal is, however, quickly
returns to normal. In a person with diabetes, the blood glucose level rises abnormally high after
eating, takes much longer to come down, and doesn't return to normal range. Even during periods of
fasting. Therefore. To determine if you have diabetes, a doctor must test your blood glucose levels
There are three different test available to determine if you have diabetes Fasting Plasma

Content for Glimepiride + Metformin
Content for Glimepiride + Metformin
Background:
The worldwide prevalence of diabetes mellitus (DM) has increased dramatically in the past 20
years. Insulin resistance occurs early in type 2 disease. This leads to progressive beta cell failure and
overt diabetes. Though monotherapy can slow down this process, it does not prevent the progression
of the disease. To address, both insulin resistance and beta cell dysfunction, combination therapy is
required.
Clinical evidence suggests that combination therapy using oral antidiabetic agents with
complementary mechanisms of action such as a sulfonylurea/metformin may be highly effective in
achieving and maintaining target blood glucose levels . Two most commonly used sulphonylureas in
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Glimepiride 1–mg + metformin 500–mg vs, glimepiride 2–mg + metformin 500–mg
Coadministration of glimepiride and metformin has been used to achieve glucose control. This
combination might be a suitable alternative for patients with whom compliance with a multiple
medication regimen is difficult. An earlier study found that fixed dose combination of glimepiride &
metformin is effective and safe in patients with type 2 DM. Recently one more strength of
combination tablet, glimepiride 2 mg + metformin 500 mg was developed.
This study was conducted to compare the pharmacokinetics of test and reference formulations of
glimepiride + metformin fixed–dose combination tablets under fasting conditions. 2
Methods:
This was a single–dose, randomized, open–label, 2–period, 2–way crossover study conducted study.
Patients were randomized to 1 of 2 dosing sequences: a single oral administration of a fixed–dose
glimepiride 1–mg + metformin 500–mg combination tablet (test) followed by single oral
administration of a fixed–dose glimepiride 2 mg + metformin 500 mg combination tablet
(reference), separated by a 1–week washout period between doses; or a single oral administration of
a fixed–dose glimepiride 2–mg + metformin 500–mg combination tablet followed by single oral
administration of a fixed–dose glimepiride 1 mg + metformin 500–mg combination tablet, separated
by a 1–week washout period

Insurance Companies Switching Medicine
Background
Diabetes is a growing but preventable health concern in the United States.1 It is a problem in the
body where blood glucose levels rise higher than normal.1 According to the facts released by the
American Diabetes Association in 2013, 25.8 million Americans (8.3%) have diabetes 2 and
approximately 90% of all cases of diabetes worldwide are considered type 2 diabetes.3 Type 2
diabetes is a progressive disease where the body cannot use insulin properly and the patient ends up
using an oral hypoglycemic agent.1 One of the many classes of medications to help manage diabetes
is sulfonylureas, including glyburide and glipizide. These drugs close K–ATP channels on Beta cell
membranes and cause the pancreas to release more insulin to lower blood sugar.4 Both glipizide and
glyburide are metabolized in the liver5, have high protein binding5, and can decrease hemoglobin
A1c (HbA1c) up to 1%–2%.6 According to the Health Insurance Association of America, health
insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or
injury".7 Insurance companies always strive to achieve their target glycemic goal via the most
effective and cost effective therapeutic strategy.8 A literature search was conducted to find data on
the benefits of converting patients from glyburide to glipizide to find out why insurance prefers the
switch.
Literature Search
A literature search was conducted using Pubmed for publications within the last 10 years.

Strict Glycaemic Control
T2DM is often managed with strict glycaemic control. Glycaemic control is a way of maintaining
euglycemic blood glucose levels through a balance of both biological and psychosocial factors,
including diet, exercise, supplements and medication.7 Once a patient has been diagnosed with
T2DM their doctor will put them on a strict diet and exercise regime, this alone can sometimes be
an effective method of glycaemic control for patients.
Dietary management of the patient will control the quantity and limit the amount of some types of
food that the patients will eat. Traditionally patients suffering from T2DM were originally
recommended a diet reduced in carbohydrates and refined sugars, anything that will break down
glucose quickly when metabolised and will cause glycaemic "spikes".8 More recent research has
shown that limiting saturated fat intake, this means limiting meats, high fat dairy and oils in the diet,
will help with glycaemic control because saturated fats can raise cholesterol levels. Reducing
saturated fat intake can help to reduce body fat, this makes it a little easier for insulin to function
and get glucose into cells. A vegan diet is especially recommended.9
Increased exercise is paired with a dietary plan. This is because ... Show more content on
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The biguanide class drug, metformin, is the most commonly used drug. Metformin is an
antihyperglycemic, and works by lowering blood glucose levels, therefore it is a mean of glycaemic
control. Metformin is also an insulin sensitizer, as it is known to reduce insulin resistance and
plasma fasting insulin levels.13 The insulin sensitizer effect is thought to be due to its positive
effects on insulin receptor expression and tyrosine kinase activity.14 A positive effect on tyrosine
kinase is important because the insulin receptor is a part of the tyrosine kinase

Diabetes : The Common Form Of Diabetes
1. Once known as non–insulin–dependent diabetes or adult–onset, type 2 diabetes is the most
common form of diabetes that unfortunately many can be diagnose with at any age, even during
childhood. In fact this disability has been known to affect 90% to 95% of the 26 million people who
have diabetes. Type 2 diabetes is a chronic or lifelong condition that affects the way the body
produces, maintains, and consumes glucose (sugar) which is the body's most important fuel. While
having type 2 diabetes the body will either not produce enough insulin to maintain a normal glucose
level or just resist the effects of insulin all together. Once this occurs glucose can't get into the
body's cells which leads to a buildup in the blood that will make the body's cells not function
properly. This issue associated with the buildup can cause many complications that can be harmful
to the body or even life threatening. (Type 2 diabetes WebMd) The first complication that can
happen is heart and vessel disease. Type 2 diabetes can increase the risk of various cardiovascular
problems. For example heart attacks, strokes, chest pains, and high blood pressure. The second
complication that can occur is nerve damage or neuropathy. Excess sugar can injure the wall of the
tiny blood vessels which could cause tingling, numbness, and burning first in the tips of the toes and
fingers then gradually spread upwards throughout the body. Damage to the nerves that control
digestion can also cause nausea,

Class V : Kmt 4 Inhibitors
CLASS V: DPP 4 INHIBITORS
The DPP 4 inhibitors come in the class of incretin based therapies for type 2 diabetes. The incretin
effect is generally blunted in type 2 diabetes patients.16 The two main incretin hormones
responsible for blood glucose regulation are GLP–1 (glucagon like peptide–1) and GIP ( glucose
dependent insulinotropic peptide). These two hormones are secreted when carbohydrates and fats
are consumed and they result in increased glucose dependent insulin secretion or postprandial
insulin release and decreased glucagon secretion. Both of these hormones tend to be rapidly
metabolized in the circulation by the enzyme DPP 4 (dipeptidyl peptidase). Type 2 diabetes mellitus
is characterized by decreased insulin sensitivity and progressive loss of pancreatic beta cell insulin
secretion .The DPP 4 inhibitors block the breakdown of naturally occurring GLP 1 by competitively
inhibiting the binding of GLP 1 to DPP .The DPP 4 inhibitors decrease the acitivity of the enzyme
dipeptidyl peptidase by greater than 80% for up to 24 hours, thereby augmenting the meal related
circulating concentrations of both GLP–1 and GIP.19The duration of effect of GLP 1 is thereby
increased, thus resulting in a reduction in hepatic glucose output and increase in insulin production.
DPP 4 inhibitors currently approved in the US:
Generic name Trade name Dosage Combinations
Sitagliptin Januvia 25 to 100 mg once daily Janumet( Sitagliptin+Metformin)
Saxagliptin Onglyza 2.5 to 5 mg once daily

Diabetes mellitus (DM), also known as diabetes, is a disease that directly affects the way the
endocrine system produces or uses insulin throughout the body. When a person has diabetes, the
pancreas does not produce a sufficient amount of insulin or the body becomes resistant to the insulin
produced; these factors depend on which type of diabetes the patient is diagnosed with (Hart &
Loeffler, 2015). Insulin is a vital component in the body used to convert glucose (sugar) in to
energy. If the body cannot make or use insulin properly, patients exhibit hyperglycemia, which is an
excessive amount of glucose in the blood. If diabetes is left untreated or not managed properly, the
disease can cause severe and permanent damage to vital organs, diabetic ... Show more content on
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Novilin is intermediate insulin, and it is effective throughout the body for twelve to eighteen hours
(Insulin Basics, 2015). Long–acting insulin, such as Lantus is used by patients once a day; this type
of insulin takes several hours to take effect in the bloodstream, but it can last up to twenty–four
hours or longer (Watkins, 2013). Insulin can be prescribed in premixed vials, which can be very
helpful to patients with eye impairments. Also, diabetics who maintain stable blood glucose levels
can mix different insulin categories together to achieve longer lasting results (Watkins,

Type 2 Diabetes : The Most Common Form Of Diabetes...
Type 2 diabetes is considered as the most common form of diabetes affecting many individuals. This
is a condition that is associated with a high buildup of sugar content in the blood stream. It is
accompanied by symptoms such as constant hunger, fatigue, lack of energy and frequent urination.
At milder levels, the symptoms become severe and lead to the death of an individual. In the United
States, it has been rated as one of the leading causes of death. Importantly, it also increases the rate
of the cardiovascular disease once an individual has been reported to have such symptoms. The
cardiovascular diseases lead to a greater rate of complications in patients with type two diabetes and
hence loss of life. Due to this reason, researchers have focused more on the development of
appropriate drugs to enhance treatment of the condition. Importantly, the fact that it is a big
challenge to the medical sector critical evaluation of all possible types of treatment is vital.
Therefore, the article on "semaglutide and cardiovascular outcomes in patients with type 2 diabetes"
offers beneficial knowledge to the healthcare sector. This particular research was driven by the
demand of the regulatory guidelines that deals with reduction of risks. The cases of cardiovascular
risks among patients are have been reported to increase in the recent days. The regulatory require
being presented for the cardiovascular outcomes that can be used in the therapies of type 2 diabetes
treatment.

Type 2 Diabetes: A Case Study
Date and time requested: June 16th, 2015 at 3:00 PM
Date and time answered: July 8th, 2015 at 8:00 AM
Question requested: Does Invokana provide A1c reduction when adding on to Metformin in Asian
patients with type 2 diabetes?
Background
Invokana (generic canaglifozin) belongs to drug class Sodium–Glucose Co–Transporter 2 inhibitor
(SGLT2).1 Invokana plays a role in the treatment of type 2 diabetes (T2DM) patients along with
proper diet and exercise for better glycemic control.1 Invokana is studied extensively as an add–on
to first line Metformin for T2DM.1 The mechanism of Invokana is to inhibit renal reabsorption of
glucose and increase excretion of urinary glucose via insulin–independent pathways.2 Invokana
affects both fasting blood ... Show more content on Helpwriting.net ...
For primary endpoint, there was a significant reduction in HbA1c from baseline at week 18 with
canaglifozin 100 and 300 mg compared to placebo (–0.97, –1.06, –0.47 %, respectively, p ≤
0.025).2 A greater portion of patients achieved HbA1c < 7% with canaglifozin 100 and 300 mg
compared to placebo.2 The HbA1c reductions in the two strata were significant with canaglifozin
either doses (p < 0.025).2
For secondary endpoints, there was a significant reduction in FBG at week 18 (p< 0.025 for both
doses).2 There was a dose–dependent reduction in the strata of metformin + sulfonylurea while it
was dose–independent in strata of metformin alone.2 For body weight endpoint, there was a
significant, dose–dependent body weight reductions (p< 7% with either canaglifozin doses.2 Other
benefits included significant body weight reductions, clinically important decreases in systolic blood
pressure, increases in HDL cholesterol and decreases in TG.2 The drug was well–tolerated with low
rate of

Essay On Glimepiride
Fixed dose glimepiride/metformin was available in normal and sustained release tablet. A
multicenter randomized study reported similar efficacy, hypoglycemic events and compliance
between these two formulations. Mean HbA1c reduced by
0.59% and 0.61% in sustained release group and normal group respectively. Besides, fixed dose
glimepiride/metformin was as effective as glibenclamide/metformin in reducing HbA1c but more
patients achieved HbA1c<7% at 12–month of treatment with glimiperide/metformin (44.6%
versus26.8%).
................................g56
A different study by Roberts et al (2005) evaluated the efficacy and tolerability of glimepiride in
patients with type
2 diabetes mellitus that were inadequately controlled with a combination of immediate– or ... Show
more content on Helpwriting.net ...
This study showed that in these patients with type 2 diabetes not adequately controlled by dual
combination therapy with metformin and a thiazolidinedione, the addition of glimepiride improved
glycemic control compared with placebo with an acceptable tolerability profile. Although there were
signifi – cantly more episodes of hypoglycemia with triple therapy than with dual therapy and
placebo, the risk for severe hypoglycemia was low. This study again supports the use of glimepiride
in conjunction with TZD combination therapies.
...........................................g69
The central event in these diseases is the conversion of a host encoded cellular prion protein (PrPC)
into abnormally folded,disease–associated isoforms (PrPSc) in the brains of infected animals. In this
study we report that treatment with glimepiride reduced the amount of PrPC expressed at the surface
of primary cortical neurones, neuronal cells and prion–infected neuronal cells. Subsequently,
glimepiride treatment significantly reduced the amount of PrPSc within 3 prion–infected neuronal
cell lines (ScGT1, SMB and ScN2a cells) and glimepiride treated cortical neurones showed
increased resistance to the toxic effects of PrP82–146. The protective effect of glimepiride was
accompanied by reduced binding of PrP82–146 to neurones, reduced activation of cPLA2 and PGE2
production. These effects of glimepiride were observed at physiological concentrations, however
they were not shared by 2

Differences Between Glimepiride And Hypoglycemia
Non–diabetic volunteers (age 38±2 yrs, BMI 26±1kg/m2) were studied in a single–blind fashion
during separate 2 day randomized protocols consisting of 2 hr hyperinsulinemic (9pmol/kg/min)
euglycemic (4.9±0.1mmol) and hypoglycemic (2.9±0.1mmol/L) clamps. Individuals received
biologically equivalent doses of glimepiride (4mg) or glyburide (10mg) 1 hr prior to each glucose
clamp (n=11) as well as a control group of placebo studies. Glucose kinetics were calculated using
D–Glucose–6–6d2. this study has investigated the acute physiologic in–vivo differences of
glimepiride and glyburide in healthy individuals. During hypoglycemia glyburide increased insulin
levels, but resulted in decreased glucagon, decreased combined epinephrine and ... Show more
content on Helpwriting.net ...
Niemi et al reported that gemfibrozil increases glimepiride's plasma concentrations by 23%,
presumably via CYP2C9 inhibition.(15) Appel et al reported that fluvastatin and simvastatin
(examined separately) increased glyburide's plasma concentrations by about 20%, yet concluded
that such a change was not clinically relevant.(21) Prior models found that predicted CYP2C9– and
CYP3A4–based area under the curve ratios (a measure of the change in systemic exposure to a drug
in the presence of an inhibitor) for SUs with fibrates or statins were near 1.0, suggesting that a
CYP–based interaction is unlikely.
.....................................g53
in a study comparing individuals treated with glyburide (also known as glibenclamide) or
glimepiride with repeat balloon dilation, healthy and diabetic glimepiride–treated patients had
improvements in ischemic burden which indicated continued protection by ischemic
preconditioning. Glyburide therapy abolished the cardio–protective effect of preconditioning and
demonstrated no improvements in any ischemic cardiac measures . The preservation of ischemic
preconditioning has been replicated in individuals receiving glimepiride , gliclazide and glipizide .
In two studies of patients undergoing consecutive exercise treadmill stress tests, repaglinide

Diabetes Type 2 : A Condition Of Blood Sugar Levels
What is Diabetes?
Diabetes type 2 is a condition in which blood sugar levels are too high. According to a tutorial
manufactured by Gwinnett Medical Center, "After eating foods that contain carbohydrates,
chemicals in the small intestine break down the carbohydrates into simple sugar molecules called
glucose. The cell lining of the small intestine absorbs the glucose, which then passes into the
bloodstream. When the blood reaches the pancreas, beta cells in the pancreas detect the rising
glucose levels. To reduce the glucose level, beta cells release insulin into the bloodstream. As the
blood circulates through the body, the insulin and glucose exit the bloodstream into tissue to reach
the body's cells. Most cells of the body have certain ... Show more content on Helpwriting.net ...
What are the causes of Type 2 Diabetes?
"If someone has Type 2 Diabetes their pancreas may not produce enough insulin or their cells resist
the effects of insulin, and in extreme cases it may be a combination of both". (AuthorSTREAM)
Currently there are about 29.1 million people in the United States that have diabetes; 8.1 million of
whom may be undiagnosed and/or unaware of their condition. For adults twenty years old or older,
statistics say one in every ten people suffers from diabetes; in age sixty–five and older, statistics say
that figure rises to more than one in four.
What are some symptoms of Type 2 Diabetes Mellitis?
Due to hyperglycemia and lack of insulin, many people experience some classic symptoms of
diabetes such as excessive hunger, excessive thirst, increased urine volume, and unexplained weight
loss. (Gwinnett Medical Center Health Series) Some long term symptoms of type 2 diabetes that
may appear over time include: fatigue, recurrent infections, changes in vision, itching, and possible
tingling or prickling skin sensations.
What are some complications of Type 2 Diabetes Mellitis?
People with Type 2 Diabetes Mellitis face a multitude of challenges; some challenges may be life–
threatening and others may be life altering. Life–threatening complications of type 2 diabetes
include: Diabetic Ketoacidosis, Hyperosmolar Hyperglycemic Nonketoic Syndrome, and
Hyperglycemia. Diabetic Ketoacidosis occurs when no treatment is given for

Analysis Of Charcot 's Joint ( Neuropathic Arthropathy )
Charcot's Joint (neuropathic arthropathy) most often occurs in the foot and happens when a joint
breaks down. In most cases of Charcot's Joint the foot loses most of its sensation and the muscles
lose their ability to support the joint completely. The foot becomes unstable and walking becomes
difficult. Cranial neuropathy affect the cranial nerves that control sight, eye movement, hearing and
taste. It begins with pain near the affected eye and eventually the eye muscle becomes paralyzed
leading to double vision. This usually gets better after a few months. Compression mononeuropathy,
a common type of neuropathy, occurs when one nerve is damaged. People with diabetes are further
predisposed to compression injuries. Carpal tunnel syndrome ... Show more content on
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If ketones build up in the blood it becomes more acidic and if the levels get to high people can
develop diabetic ketoacidosis (DKA). DKA is extremely dangerous and can lead to a diabetic coma
or even death. It is rare in people with type 2 diabetes, but it can occur. Diabetes affect the kidneys
as well leading to kidney disease or nephropathy.
High levels of blood sugar caused by diabetes can cause the kidneys to filter too much blood. This
overexertion can be hard on the kidneys and eventually they can start to leak and can be lost in the
urine. If this is not caught early enough the extra work the kidneys are doing can cause them to lose
their ability to filter allowing waste to build up in the blood and eventually leading to kidney failure.
Individuals with diabetes are more likely to develop certain problems and diseases along with its
effects on the different systems of the body.
Two out of three diabetics have hypertension, commonly known as high blood pressure. Diabetics
are one and a half times more likely to suffer from a stroke as those without diabetes. They also
have a higher than normal risk of developing heart disease. Two out of three diabetics die from a
stroke or cardiovascular disease. People with diabetes also have a greater risk of depression than
those without. With all of these potential problems and risk to their health it is somewhat surprising
that people with

Symptoms And Treatment Of Diabetes Mellitus Type 1
TERMINOLOGY
CLINICAL CLARIFICATION
A metabolic disease characterized by hyperglycemia resulting from decreased insulin secretion and
insulin receptor sensitivity. Chronic hyperglycemia of diabetes leads to microvascular and
macrovascular complications 1
CLASSIFICATION 1
Diabetes mellitus type 2
○ Accounts for 90–95% of cases of diabetes
○ Less common types of diabetes include: diabetes mellitus type 1, gestational diabetes, diabetes
due to genetic defects, drug–induced diabetes, endocrinopathy based diabetes, exocrine pancreas
based diabetes
DIAGNOSIS
CLINICAL PRESENTATION
History 1, 14
○ May be asymptomatic despite pathological and functional changes in target tissue; most cases are
diagnosed through routine screening or ... Show more content on Helpwriting.net ...
metabolic syndrome, non–alcoholic steatohepatitis)
– Sleep disorders (obstructive sleep apnea, chronic sleep deprivation, night shift work) in
conjunction with glucose intolerance
DIAGNOSTIC PROCEDURES
Primary diagnostic tools 1
○ Diagnosis is confirmed with one of the below tests in combination with clinical evidence of
diabetes OR one of the below tests repeated or in combination with a second test
– Fasting plasma glucose OR
– Oral glucose tolerance test OR
– Hemoglobin A1c
○ If patient is exhibits classic signs and symptoms of hyperglycemia (polyuria, polydipsia,
polyphagia, unexplained weight loss, weakness, blurred vision), a

How To Compare Different Types Of Insulin
Describe and compare different types of insulin and their therapeutic use:
There are many type of insulin which deferent in onset and duration and time of taking it include:
A–Rapid–acting insulin: the onset of it is 5–15 min and it duration about 3–5 hours . It take
immediately before eating the meal .An example : 1– Apidra (insulin glulisine) 2– Novolog (insulin
aspart ) 3– Humalog 4– Afrezza (inhaled) . it commonly prescribed to people with type 1 diabetes
and also for type 2 in some cases . – Due to rapid acting it can lead to increase the chance of
hypoglycemia to occur. – Control high blood sugar , which ... Show more content on
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B–Biguanides :
1–Metformin : duration of action ( 8–12 hrs ) and excretion in urine and faeces . dosage : 250–2500
mg
2–Metformin SR: duration of action ( 24 hrs ) and excretion in urine and feaces . dosage : 1–2 Gram
. side effect : nausea and diarrhea
C– Alpha glucosidase inhibitors :
– Acarbose : duration of action ( 4 hrs ) and excretion in faeces . dosage : 25–150 mg side effect :
may cause bloating and flatulence "gas"
D – Thiazolidinediones :
1–Rosiglitazone: duration of action ( 12–24 hrs ) and excretion in urine . dosage : 2,4 and 8 mg
2–Pioglitazone : duration of action ( 24 hrs ) and excretion in urine . dosage : 15–45 mg side effect :
weight gain , Rosiglitazone lead to increase of non fetal heart attack risk in which the Pioglitazone
increase the bladder cancer risk .
E – DDP–4 : SUCH AS –Saxagliptine –Sitgliptine –Alogliptine and Linagliptine .
Side effect : it cause a headache and pharyngitis
F– Glucagon like peptide –1 analoges (GLP–1) : such as Exanatide .
Side effect : vomiting , nausea and diarrhea .
G– Amylin analog . example : paramlintide side effect : hypoglycemia and weight loss .
Mechanism of action

Paper On Diabetes Education
research design was quantitative in nature. It was concluded that diabetes education is very effective
when it comes to improving various interventions of patients and increasing the knowledge of the
patients concerning diabetes type 2.
In a study aimed towards assessment of knowledge of diabetes among the type 2 diabetes patients in
a primary health care clinic, it was revealed that educational programs are very important when it
comes to filling the gap existing in knowledge to the various patients (Perara, DeSilva, and Perera,
2013). The gap existing in knowledge according to the study was in the symptoms of poor control
and the regular follow–ups to the various diabetic patients. There was a sample of 150 patients used
in the study ... Show more content on Helpwriting.net ...
The use of structured diabetic education can be beneficial to most of the diabetic patients when
presented in groups or in individual ways. This strategy was discovered from a study done by Sousa
et al. (2008) in their assessment of the effectiveness of using the structured teaching programs in
terms of knowledge regarding some of the selected aspects of diabetes mellitus. Some of the
selected programs used in the study included exercises, medication, caring for the feet, and the
prevention mechanisms of various complications.
According to Norris, Engelgau, and Narayan (2001) who were involved in a systematic review
using a random trial research design, it was found out that self–management initiatives in training
regarding knowledge of diabetes have a positive result to the various patients used. Out of a sample
of 72 studies carried out in 84 articles analyzed effectively within a period of less than 6 months, it
can be concluded that provision of self–management knowledge can be very important to the
diabetes patients because it provides a similar body of knowledge concerning management of the
condition from their homes. In a similar study carried out by CDC in a meta–analysis, it was
revealed that knowledge in diabetes among the various patients with type 2 diabetes showed
improvements in the self–management education (CDC, 2014).
Self–management places most of the diabetic patients at the center of care and also it empowers

A Plan Of Care For Kevin Johnson
Introduction
The main purpose of this assignment is to create a plan of care for Kevin Johnson (School of
Nursing & Midwifery 2013). By choosing one day in particular throughout his journey to recovery
and by planning that care by incorporating the information that has been provided by his case study.
The day that will be referred to care throughout this paper will be Day 1 – Post – Operative care.
This
Paper will include a brief background into Kevin's case, the plan of care that Kevin will be needing
while in hospital to make sure he is comfortable, it will also encompass the ethical, law and cultural
considerations that he is entitled to, the multidisciplinary team that is involved in the care of Kevin,
the short term and long term goals for Kevin to enable that he gets the best improved outcomes
available to him and a critical analyses will be completed based on the study.
Kevin Johnson
Kevin Johnson is a 15–year–old male pediatric patient who has type two (2) diabetes mellitus. He
lives in the southern suburbs of Adelaide with his mother (Stacey) and four (4) brothers (Codey,
John, Brad and Michael). Kevin is from an indigenous background and enjoys playing football.
Vital Signs
Gathering observations of patients is a vital task that all Nurses must complete on a regular basis,
they include Blood pressure, respiration rate, pulse, temperature and oxygen saturation. The
information gathered from the observations enable for warnings when a patient is deteriorating

Oral Anti Diabetic Agents Are Used As Pharmacotherapy Options
Introduction:
Oral anti diabetic agents are used as pharmacotherapy options mainly for type 2 diabetes patients or
as an adjuvant therapy for type 1 diabetes patients, who need an oral agent along with insulin/insulin
analogues for better glycemic control. There are a wide variety of oral anti diabetic drug classes that
are available. The choice of pharmacotherapy is patient specific and usually a stepped therapy
approach is applied and titrated as per individual patient requirements. The article here is a detailed
overview of the different classes of these oral agents, their pharmacology, comparative efficacy,
efficacy results from clinical trials, general recommendations etc.
The different classes of oral anti diabetics starting from traditional therapy to the latest
developments are as follows :
 BIGUANIDES [METFORMIN]
 SULFONYLUREAS
a. FIRST GENERATION SULFONYLUREAS.
b. SECOND GENERATION SULFONYLUREAS.
 MEGLITINIDES
 THIAZOLIDINEDIONES
 DPP–4 INHIBITORS
 ALPHA–GLUCOSIDASE INHIBITORS
 SGL2 INHIBITORS (NEWEST CLASS OF DRUGS) CLASS I: BIGUANIDES
[METFORMIN]
According to the ADA (American Diabetes Association) 2013 guidelines, metformin is considered
as first line therapy for initiation of treatment in a type 2 diabetes patient when lifestyle
modifications, diet and exercise fail to achieve glycemic control.
Mechanism of action: Metformin decreases hepatic glucose production thereby decreasing intestinal
absorption of

Patients With Type 2 Diabetes Mellitus
Cynthia is a 65 year old African American female diagnosed with type 2 diabetes mellitus, diabetic
peripheral neuropathy, hypertension, kidney disease, hyperlipidemia and hypothyroidism. She is on
glipizide 5 mg po daily to treat her type 2 diabetes. Cynthia revisited the clinic soon after the
initiation of the treatment with symptoms of shakiness, sweating, chills, clamminess,
lightheadedness and moderately severe headache. In this case study, Cynthia is exhibiting the
symptoms of hypoglycemia as she is on sulfonylurea therapy. Sulfonylureas, such as glipizide
commonly used as a second–line of therapy in patients with Type 2 Diabetes Mellitus (T2DM),
promote insulin release independent of prevailing glucose value and as a result, ... Show more
content on Helpwriting.net ...
Impaired cognitive function can cause harmful and cumulative long–term effects on intellectual
function, particularly in young children. The most common risk factor for the occurrence of
hypoglycemia is the aggressiveness of therapy applied to achieve glycemic control. The other
factors include, antecedent hypoglycemia, alcohol, increased glucose utilization, decreased glucose
production, female sex, sleep, duration of diabetes, age and progressive insulin deficiency were also
associated with an increased risk of hypoglycemia in patients with T2DM. Multiple risk factors are
associated with precipitation of hypoglycemia in the general population. When it comes to elderly
patients with diabetes, the problem of hypoglycemia is a major concern. Hypoglycemia is an
expected side effect of sulfonylurea. Hypoglycemia unawareness is a major cause of severe
hypoglycemia in patients with T2DM. Hypoglycemia awareness in patients can bring better results
in managing hypoglycemic events. Symptoms of hypoglycemia become progressively less intense
over the time or diminish.
Management of hypoglycemia consists of strategies such as prevention of hypoglycemia, use of
therapeutic agents with low or no occurrence of hypoglycemia and treatment of hypoglycemia. It is
important for the patient to understand and agree to adhere to treatment plan in terms of both
medication and lifestyle modification. Self–monitoring of the glucose is very

Metformin Case Study
If Metformin can not be used because of the patient's creatinine and renal deterioration, the next
drug of choice that could be used is sulfonylurea. It is one of the oldest class oral agents.
Sulfonylurea drugs are very effective in controlling glucose, but it can be associated with increased
weight gain and hypoglycemia (Inzucchi et al., 2012). Due to Cynthia's complaints I would
diagnosis her with hypoglycemia. I would keep her on Simvastatin and Lisinopril and and change
her medication to Januvia. Patient's often respond differently to medications so it is very important
to make sure the patient is not experiencing a risk that is associated with a certain medication.
Cynthia is experiencing a hypoglycemic event due to taking a sulfonylurea,

Diabetes : The Most Common Diseases Of Mankind Essay
Diabetes is a chronic disease that affects the body's capability to produce or respond to the hormone
called insulin. With this happening it causes irregular metabolism of carbohydrates and raise the
body's glucose levels in the urine and the blood. Although diabetes is very disturbing it is also
preventable. Diabetes is one of the greatest common diseases of mankind. A lot of people believe
that having this disease is ordinary, or even curable. Although it is not perceived to be terminal and
contagious such as other feared diseases, diabetes can cause a number of disadvantages if it is not
properly managed well.
There are a few types of diabetes however the most common types are broken down into type 1 and
type 2. Both types of diabetes affect the glucose level and in any situation if left untreated or not
managed will cause major difficulties. Type 1 is typically called juvenile diabetes in which the body
totally stops creating insulin. Insulin is a key factor as it is a hormone that allows the body to use
glucose located in foods for energy. Individuals with type 1 diabetes are required to take insulin in
the form of shots to live. Most individuals who are diagnosed with this type of diabetes are typically
children however, adults can get it is as well. Type 2 diabetes is found typically in adults who is
over the age of 40, overweight, and have a family history of diabetes, although today it is
increasingly occurring in younger people, particularly adolescents. This form

Type 2 Diabetes Mellitus Research Paper
Type 2 Diabetes Mellitus Diabetes mellitus is a disorder in which blood levels of glucose are
abnormally high because the body does not release or use insulin adequately. Type 2 diabetes
mellitus is the most common type of diabetes. It is also known as non–insulin dependent diabetes
and formerly known as adult–onset diabetes. In this crosspost, the author will elaborate on the
original threaded discussion and add additional information on Type 2 diabetes mellitus. Casto,
Cherry, Ellerbee, Gatlin, and Young thoroughly discuss the importance of obtaining a health history
on a patient that present with Type 2 DM. As mention by the authors it is important for the adult
geriatric primary care nurse practitioner (AGPCNP) to receive additional ... Show more content on
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The authors thoroughly discussion the reason for each laboratory test. In additional to the threaded
discussion there are many signs and symptoms, many of which go unnoticed until the disease is in
the late stages. Mr. Bobo is a diabetic which seems uncontrolled so focusing on education is of
importance. Education has been identified as a significant factor in the effective control of blood
glucose levels. Education is import to emphasize to the patient the importance of close monitoring
and management as diabetes can become a chronic disease with multiple health issues and a poor
quality of life. Mr. Bobo will need to know the importance of making changes to their lifestyle in
regards to nutrition, diet, and weight control. Casto, Cherry, Ellerbee, Gatlin, and Young thoroughly
discussion long term complications such as eye complications, nephropathy, neuropathy, and
cardiovascular disease. Complications from diabetes can be quite serious to life threatening,
including kidney damage, nerve damage, which cause numbness, pain or tingling sensations,
amputation due to lack of circulation or secondary infection, and retina damage, an incurable
condition that can lead to a total loss of

Diabetes is a condition caused by food intakes that are high in sugar and carbohydrates which
eventually results in high blood sugar levels. Now there are two different types of Diabetes. There is
Type 1 which is a genetic condition that requires the patient to inject insulin for the rest of their
lives. Type II Diabetes is a condition due to multiple factors: obesity, inactivity, and even through
genes. Some common symptoms caused by Type II Diabetes can be: Fatigue, excessive hunger and
thirst, foot problems, numbness, excessive use of bathroom, loss of weight and vision blur.
Managing Type II Diabetes includes:
1. Maintaining a healthy diet
2. Exercising on the daily (at least 30 minutes)
3. Monitoring blood sugar
4. If necessary, insulin

Sulfonylureas Research Paper
Sulfonylureas were among the first oral medicines available for the treatment of Type 2 diabetes.
They were discovered by accident in France by a researcher who was working on drugs for typhoid
fever. Animals that were given sulfonylureas displayed unusual behaviors and were found to have
hypoglycemia (low blood glucose). It was quickly recognized that these drugs could be used for the
treatment of diabetes. The first sulfonylurea became available in 1955. Despite the many new
diabetes therapies that have been discovered over the past 50 years, metformin and sulfonylureas are
still two of the initial choices for treatment. Medicines in the sulfonylurea class include
chlorpropamide, glyburide, glipizide and glimepiride. Sulfonylureas have gone

Type Two Diabetes
Introduction
There several different types of diabetes. Type two diabetes is a disease where your body cannot use
the sugar (glucose) it creates for energy. This causes the cells to became immune to insulin and
causes blood sugar to gradually climb. In type two diabetes the pancreas creates insulin but the body
cannot use it properly. Unlike type two of diabetes type one is caused when the body cannot create
insulin at all causing a problem within the body.
What Causes Type Two Diabetes
There many factors that can cause a person to have type two diabetes. Some of the reasons include
but do not limit: Obesity, the consumption of artificial sweeteners, lack of physical activity, stress,
depression, and genetics. ... Show more content on Helpwriting.net ...
One popular medication is metformin. This medication is usually the first to be prescribed to
patients with type 2 diabetes. It does have some side effects, but they are not that serious and tend to
go away once the body becomes accustomed to the new medication. Another medication that may
be prescribed is Sulfonylureas. This medication helps the body secrete more insulin. The side effects
are not that serious either. One last medication that works like Sulfonylureas is Meglitinides. These
medications stimulate the pancreas to secrete more insulin, but they act faster and the duration of
their effect is shorter. The side effects of this drug is a lot less than Sulfonylureas. The risks are a lot
lower, but weight gain is a

Types And Types Of Type 2 Diabetes Mellitus
Introduction Type 2 diabetes mellitus (T2DM), also known as non–insulin dependent DM, is a
chronic metabolic disorder characterized by certain symptoms such as hyperglycemia, insulin
resistance, and relative insulin deficiency [1]. Genetic, environmental and behavioural risk factors
are considered responsible for the predisposition of T2DM [2]. With the progression of this disease,
the patient eventually develops various short– and long–term complications. Thus, the patient has to
undergo multiple therapies, which reduces the quality of life as well as the life expectancy [3]. The
demographic data suggests that more than 400 million of population, across the globe are currently
suffering from this disease. In 2012, the death toll is upto 1.5 million due to T2DM and 2.2 million
people died due to high blood glucose level [4]. The major problem with this disease is that it cannot
be completely cured, but the symptoms and complications can be controlled with diet, exercise,
medicines and health monitoring. This subsequently lands the patient on lifetime medication that
involves a huge cost. In 2012, the American Diabetes Association released a letter suggesting an
annual expenditure of $245 billion for diabetes, which includes a direct medical cost of $176 billion
and $69 billion in reduced productivity [5]. In order to avoid and delay the short– and long term
complications, the patients are prescribed with multiple treatment modalities such as oral
hypoglycemic drugs and

Diagnosis Of Diabetes Mellitus ( Dm )
Diabetes or clinically referred to as Diabetes Mellitus (DM), is part of several groups of metabolic
illnesses where there are high glucose levels for an extended period of time. Diabetes happens if
there is not enough insulin produced by the pancreas or the body cells are not adequately responding
to the insulin produced. (Ciccone, 2016 p510–511).
Delving into its early history, diabetes was one of the early illnesses described, from a tablet found
in Egypt from the year 1500 BC that stated "too great emptying of the urine." The early recorded
case was about type 1 diabetes. Ancient medicine men from India around the same period identified
the disease and gave it the term Madhu Mehta "honey urine," by observing the urine of a patient
attracted ants. An early mention of diabetes or "to pass through" found in passages from poetry by
Apollonius, a
Greek philosopher from the Egyptian area of Memphis in 230BC. Diabetes was almost nonexistent
in the
Roman empire, the philosopher Galen commenting that he had observed two cases in his lifetime.
The ancient people's diet and lifestyle was an important factor and also because the symptoms
diagnosed during the late stages of the disease. Philosopher Galen called it urine diarrhea or diarrhea
urinosa. A surviving papyrus was found with written details about diabetes in the writings of
Aretaeus on 2nd or early 3rd BC. He stated that the disease, which he ascribed to the coldness of
moisture, imitating the inscriptions from

“Three-Year Efficacy of Complex Insulin Regimens in Type 2...
NTDP Cohort 7
Journal Critique
Title: "Three–Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes"
Journal: The New England Journal of Medicine, vol. 361, no. 18, pages 1736–1747
Purpose: How do complex insulin regimens affect glycated hemoglobin, rate of hypoglycemia and
weight gain in type 2 diabetic patients?
Introduction Type 2 diabetes mellitus is often treated with metformin and an oral hypoglycemic
agent (e.g. sulfonylurea); however, if this combination is not effective, insulin is often added to
replace the oral hypoglycemic agent for better blood sugar control. In type 1 diabetes, intensive
insulin therapy is designed to mimic normal insulin secretion as closely as possible.1 While the ...
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The rates of grade 2 or 3 hypoglycemia were low overall among the different groups; however, the
prandial group experienced the most hypoglycemic episodes. Weight gain was more prominent in
the biphasic and prandial groups, and the prandial group had the greatest reduction in the
postprandial glucometer readings. While the percentage of patients in the biphasic group that
replaced the sulfonylurea with a second type of insulin was 67.7%, the percentage in the prandial
and basal group was 73.6% and 81.6%, respectively. The majority of patients from all three groups
eventually required a basal–bolus (complex) regimen. The results of the trial support that the basal–
bolus insulin regimen may be beneficial for better blood sugar control in type 2 diabetes.
Strengths and Weaknesses:
The first phase of the 4–T study had several strong points. The major strengths of this study were
the randomized design and the long duration. The patients were recruited in 58 clinical centers, and
to account for center–level clustering, the study center was included as a random effect in all
regression models. There was equal distribution between the biphasic (235 patients), prandial (239
patients), and basal (234 patients) groups. There was not a statistical significant difference in the
baseline variables of the patients between the three groups. The study had several weaknesses and
limitations. It only included patients from the United

Pathophysiology And Pathophysiology Of Diabetes Mellitus...
Pathophysiology and Pharmacology of Diabetes Mellitus Type 2 Type 2 Diabetes is a chronic
condition that millions of people around the world suffer from. It is related to the hormone insulin,
which is secreted by islet of Langerhans cells in the pancreas, it regulates the level of glucose in the
bloodstream and supports the body with breaking down the glucose to be used as energy. When
people have diabetes, the body doesn't produce enough insulin or cells don't respond to the insulin
that is produced. Type 2 diabetes is one of the most common forms of diabetes that exists today.
What happens to an individual that has diabetes type 2 is that the individual would not be able to
produce enough insulin, which is needed for the body in order to be able to use sugar effectively, or
perhaps he does produce insulin but his cells would ignore the insulin and will not bind to the right
receptors in the cells. Glucose is the fuel for the body that provides energy for functioning, glucose
needs to be broken down and be absorbed and taken into the cells of the body, if this process doesn't
happen the individual would suffer from hyperglycemia (high levels of glucose in the bloodstream).
If this happens the cells may become starved for sugar, since sugar is not being processed in a
proper manner sugar doesn't get to the cells. This will cause an individual to feel hungry and eat
more (polyphagia). On the other hand, the higher levels of blood glucose may harm the internal
organs of the

Meglinide Research Paper
Class III: Meglitinides
The meglitinides are short–acting drugs. They are similar to sulfonylureas in that they augment
insulin secretion or insulin release from pancreatic beta cells. They are only slightly less effective
than sulfonylureas in reducing glycemia. They are not sulfonylureas and can be used in patients
allergic to sulfonylureas. They cause less hypoglycemia as compared to sulfonylureas .They have a
similar risk for weight gain though as the sulfonylureas.
The 2 meglitinides that are available are Repaglinide and Nateglinide.
Pharmacology of the meglitinides: The meglitinides work almost similiarly just as the sulfonylureas
by increasing the release of insulin from the pancreatic beta cells. They act on a different binding
site on the sulfonylurea receptor of the beta cell ... Show more content on Helpwriting.net ...
When the kidneys' functionality is reduced, the active metabolizers accumulate and hypoglycemia
occurs.That is why nateglinide needs to be administered cautiously or not at all in patients with
impaired kidney function.
Repaglinide is also mostly metabolized in the liver, but less than 10% of the drug is excreted by the
kidneys. Patients with renal failure do not need to have dose adjustments. Repaglinide can be
chosen for a patient with chronic kidney disease who is allergic to sulfonylureas.
Repaglinide is also shown to be more effective than nateglinide in decreasing

An Alternative Medication For Diabetes Mellitus
INTRODUCTION
Type–two diabetes mellitus (Insulin independent diabetes mellitus) is a metabolic disease
characterized by constant hyperglycemia (Haghani et al, 2016). Elevated blood glucose can cause
lasting problems such as cardiovascular and renal disorders, retinopathy, and poor blood flow (Ríos
et al. 2015). The progression of diabetes mellitus can be avoided or deferred in people with impaired
glucose tolerance by introducing lifestyle changes and/or the use of therapeutic agents. Currently,
there are many medications are used to treat or stop the complications of type–two diabetes mellitus.
The purpose of this research is to discuss the use Fenugreek bread (Trigonella foenum–graecum) as
an alternative medication for treating type–two diabetes mellitus since Fenugreek seeds have a
therapeutic effect on the improvement of diabetic parameters, blood lipids, and has antioxidant
effects.
Fenugreek seeds are known for their characteristic smell of soup seasoning and as an ingredient of
Indian curry. The first recorded use of fenugreek dates all the way back to 1500 B.C.E., in ancient
Egypt and across the Middle East and South Asia, the seeds were traditionally used as both a spice
and a medicine (Goldman, 2014). Usually, the seeds are used to treat diabetes, cough, and
flatulence, to increase breast milk secretion, and for anti–inflammatory and aphrodisiac effects
(Koupý et al., 2015).
DIABETES MELLITUS
Diabetes mellitus is a metabolic illness that has become a main

Essay on Type 2 Diabetes
Type II Diabetes Mellitus: An Emerging Epidemic
Diabetes mellitus is a group of metabolic disorders characterized by inadequate insulin secretion by
the pancreas or cellular destruction leading to an insulin deficiency. Depending on the cause of the
insulin shortage, diabetes can be subcategorized into type I and type II. Type I diabetes (T1DM) is
usually mediated by the destruction of b–cells in the pancreas resulting in decreased insulin
production and secretion. Type II diabetes (T2DM) is the failure of these b–cells to secrete adequate
amounts of insulin to compensate for insulin resistance and increased gluconeogenesis combined
with an overall resistance to the insulin action (8., 1997). T2DM accounts ... Show more content on
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Other symptoms such as damage to the kidneys, eyes, nerves, heart, and blood vessels can occur if
the diabetes goes unnoticed for a prolonged period of time and glucose levels are not controlled
(Novitt–Moreno, 1996).
The detection of T2DM can be difficult because the patient may or may not have many of the
symptoms depending on how severe their case is. Many of the symptoms are very similar to those of
type I diabetes making classification difficult. Some patients are found to have glucosuria upon
routine urinalysis, which could lead to the diagnosis. Ketouria can also be detected but usually only
occurs in only one forth of patients who have type II diabetes. Simple clinical features of T2DM can
assist doctors diagnosing and classifying the disease. More than 85 percent of patients diagnosed are
overweight or obese. A family history of type II diabetes is found in the majority of patients who are
known to have T2DM. A skin condition known as aconthosis nigricans is also common and can be
detected by routine physical examination. It is characterized by hyperpigmentation and a velvety
texture caused by long–standing hyperinsulinism and usually is found around the neck, inner thighs,
and antecubital areas (Nesmith 2001).
In addition to clinical signs, laboratory tests and evaluations are necessary to classify a person
accurately. Diagnostic tests include fasting plasma glucose, random plasma

Diabetes Mellitus As A Metabolic Disorder

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