This document summarizes different drugs used for treating diabetes. It discusses the types of diabetes, mechanisms and types of insulin preparations including rapid-acting, intermediate-acting, and long-acting insulins. It also covers oral antidiabetic drugs like sulfonylureas, meglitinides, DPP-4 inhibitors, metformin, thiazolidinediones, alpha-glucosidase inhibitors, and SGLT-2 inhibitors; describing their mechanisms of action, pharmacokinetics and adverse effects. It concludes by listing common oral hypoglycemic agents and their usual daily doses and frequencies.
Drugs for treatment of Diabetes MellitusNaser Tadvi
These slides contain the brief description of Insulin and the other oral drugs indicated in the treatment of Diabetes Mellitus. Their mechanism of action, effects, uses, Adverse effects etc.
Sulfonylureas for Diabetes: A deep insightRxVichuZ
This powerpoint presentation solely deals with Sulfonylureas, that come under Insulin secretagogues. Their complete pharmacological profile, with pharmacovigilance parameters, important catchpoints and mnemonics have been explained.
Drugs for treatment of Diabetes MellitusNaser Tadvi
These slides contain the brief description of Insulin and the other oral drugs indicated in the treatment of Diabetes Mellitus. Their mechanism of action, effects, uses, Adverse effects etc.
Sulfonylureas for Diabetes: A deep insightRxVichuZ
This powerpoint presentation solely deals with Sulfonylureas, that come under Insulin secretagogues. Their complete pharmacological profile, with pharmacovigilance parameters, important catchpoints and mnemonics have been explained.
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones
All diabetics irrespective of other treatment require some control of their eating and exercise patterns
Dibetics must watch their
- total caloric intake
-types of nutrients and eating schedule
50% of patients may require only diet Another 25% would need to augment their natural insulin with drugs
while the remainder will need insulin
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones
All diabetics irrespective of other treatment require some control of their eating and exercise patterns
Dibetics must watch their
- total caloric intake
-types of nutrients and eating schedule
50% of patients may require only diet Another 25% would need to augment their natural insulin with drugs
while the remainder will need insulin
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre Diet recommendations include
- discouraging fats
encouraging complex carbohydrate and fibre
The recommended diabetic diet except in a few respects is now similar to the normal healthy diet that everyone should eat. i.e regular meals, low in fats, low simple sugars, low in sodium and high in complex carbohydrate (starch) and fibre
Pancreas makes a hormone called insulin. It helps your cells turn glucose, a type of sugar, from the food you eat into energy. Diabetes happens when one or more of the following occurs:
Your pancreas does not make any insulin.
Your pancreas makes very little insulin.
Your body does not respond the way it should to insulin
A short lecture highlighting the most important aspects of pharmacological management of DM in general. It discusses the use of insulin in type I diabetes mellitus and the approach with hypoglycemic agents in type II.
Diabetes mellitus is a clinical syndrome characterized by an increase in plasma blood glucose (hyperglycemia).
Diabetes has many causes but is most commonly due to type 1 or type 2 diabetes
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
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Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
How to Create Map Views in the Odoo 17 ERPCeline George
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1. Drugs for Diabetes
Subramani Parasuraman, M.Pharm., Ph.D.,
Associate Professor
Faculty of Pharmacy
AIMST University, Malaysia
2. Diabetes
• Diabetes is a chronic disease that occurs either when
the pancreas does not produce enough insulin or when
the body cannot effectively use the insulin it produces.
• Types:
• Type I: Insulin-dependent diabetes mellitus
(IDDM)/ juvenile onset diabetes mellitus
• Cause: Loss of β-cell function in type 1 diabetes
• Treatment: Exogenous insulin to control hyperglycemia
• Type II: Noninsulin-dependent diabetes mellitus
(NIDDM)/ maturity onset diabetes mellitus
• Cause: Lack of sensitivity of target organs to insulin
• Treatment: Weight reduction, exercise, dietary
modification, hypoglycemic agents, insulin therapy
3. Diabetes
• The incidence of diabetes is growing rapidly worldwide.
• Malaysia has the highest rate of diabetes in Western Pacific
region and one of the highest in the world and costing
around 600 million US dollars per year.
• The prevalence of diabetes raised from 11.2% in 2011 to
18.3% in 2019, with a 68.3% increase. According to a
national survey report, in Malaysia in 2019, 3.6 million
adults had diabetes. Diabetes is expected to affect 7 million
Malaysian adults aged 18 and older by 2025.
Ref: PMID: 35085366
5. Insulin
• Insulin is a two-chain polypeptide having 51 amino acids
and MW about 6000. The A-chain has 21 while B-chain has
30 amino acids. Under basal condition ~1U insulin is
secreted per hour by human pancreas.
Human proinsulin
6. Insulin
• Mechanism of action: Exogenous insulin is administered to
replace absent insulin secretion in type 1 diabetes or to
supplement insufficient insulin secretion in type 2 diabetes.
• Pharmacokinetics: Insulin is a polypeptide; it is degraded in
the gastrointestinal tract if taken orally. Therefore, it is
generally administered by subcutaneous injection. Inhaled
insulin formulation is also available
• Adverse effects: Hypoglycemia, weight gain, local injection
site reactions, and lipodystrophy. Hypoglycaemia is
managed by administering glucose (or glucose yielding
carbohydrate, e.g., sugar) 15–20 g orally reverses the
symptoms.
8. Insulin preparations
• Rapid-acting and short-acting insulin preparations:
• Five preparations fall into this category: regular insulin, insulin
lispro, insulin aspart, insulin glulisine, and inhaled insulin.
• Regular insulin (peck level at 50 to 120 minutes) is a short-acting,
soluble, crystalline zinc insulin.
• Insulin lispro (peck level at 30 to 90 minutes), aspart, and glulisine
are classified as rapid- acting insulins.
• Inhaled insulin is also considered rapid-acting. This dry powder
formulation is inhaled and absorbed through pulmonary tissue,
with peak levels achieved within 45 to 60 minutes.
• Regular insulin should be injected subcutaneously 30 minutes
before a meal, whereas rapid-acting insulins are administered in
the 15 minutes proceeding a meal or within 15 to 20 minutes
after starting a meal.
• Rapid-acting insulin suspensions are commonly used in external
insulin pumps, and they are suitable for IV administration.
9. Insulin preparations
• Intermediate-acting insulin: Neutral protamine
hagedorn (NPH) insulin is an intermediate-acting insulin
formed by the addition of zinc and protamine to regular
insulin. NPH insulin is used for basal (fasting) control in
type 1 or 2 diabetes and is usually given along with
rapid- or short-acting insulin for mealtime control. NPH
insulin should be given only subcutaneously (never IV).
• Long-acting insulin preparations: It has a slower onset
than NPH insulin and a flat, prolonged hypoglycemic
effect with no peak. Eg: Insulin glargine, Insulin
degludec
10. Insulin preparations
• Insulin combinations: Various premixed combinations
of human insulins [70% NPH insulin + 30% regular
insulin/ 50% NPH insulin + 50% regular insulin]. Use of
premixed combinations decreases the number of daily
injections but makes it more difficult to adjust
individual components of the insulin regimen.
• Insulin delivery devices:
• Syringes
• Pens
• Durable pens
• Pumps
• Jet injectors
• Others
11. Oral antidiabetic drugs
• These drugs lower blood glucose levels in diabetics and
are effective orally. The main drawback of insulin is - it
must be given by injection.
13. Sulfonylureas
• Sulfonylureas more potent and clinically superior. All first-
generation compounds have been discontinued except
tolbutamide which is infrequently used.
• Mechanism of action: Sulfonylureas bind to a specific
‘sulfonylurea receptor’ (SUR1) located on the pancreatic β cell
membrane and provoke a brisk release of insulin.
• Pharmacokinetics: All SUs are well absorbed orally and are 90%
or more bound to plasma proteins: have low volumes of
distribution (0.2–0.4 L/kg). Most sulfonylureas are extensively
metabolized in the liver, primarily by the CYP2C9 isoenzyme and
excreted in urine.
• Adverse effects: Incidence of adverse effects is quite low (3–7%).
Hypoglycaemia, hypersensitivity and nonspecific side effects such
as weight gain, Nausea, vomiting, flatulence, diarrhoea or
constipation, headache and paresthesias.
14. Meglitinide/D-phenylalanine analogues
• Drugs: Repaglinide, Nateglinide
• Mechanism of action: Like the sulfonylureas, the
glinides stimulate insulin secretion. These are KATP
channel blockers with a quick and short lasting
insulinemic action.
• Pharmacokinetics: Glinides should be taken prior to a
meal and are well absorbed after oral administration.
Both glinides are metabolized to inactive products by
cytochrome P450 3A4 (CYP3A4) in the liver and are
excreted through the bile.
• Adverse effects: Although glinides cause hypoglycemia
and weight gain, the incidence is lower than that with
sulfonylureas.
15. Dipeptidyl peptidase-4 (DPP-4) inhibitors
• Drugs: Sitagliptin, Vildagliptin, Saxagliptin, Teneligliptin
• Mechanism of action: These drugs inhibit the enzyme DPP-4,
which is responsible for the inactivation of incretin hormones
such as glucagon-like peptide (GLP-1). Prolonging the activity of
incretin hormones increases release of insulin in response to
meals and reduces inappropriate secretion of glucagon.
• Pharmacokinetics: The DPP-4 inhibitors are well absorbed after
oral administration. Food does not affect the extent of
absorption. Sitagliptin are mostly excreted unchanged in the
urine. Saxagliptin is metabolized via CYP450 3A4/5 to an active
metabolite. All DPP-4 inhibitors except linagliptin require dosage
adjustments in renal dysfunction.
• Adverse effects: DPP-4 inhibitors are well tolerated, with the
most common adverse effects being nasopharyngitis and
headache.
16. Biguanide (AMPK activator)
• Drugs: Metformin, Phenformin [Phenformin is banded in
many countries because of higher risk of lactic acidosis]
• Mechanism of action: Metformin is a complex drug with
multiple sites of action. Metformin acts directly or indirectly
on the liver to lower glucose production, and acts on the gut
to increase glucose utilisation, increase GLP-1 and alter the
microbiome.
• Pharmacokinetics: Metformin is well absorbed after oral
administration, is not bound to serum proteins, and is not
metabolized. Excretion is via the urine.
• Adverse effects: Side effects with metformin are frequent,
but generally not serious. Others: Diarrhea, nausea, and
vomiting, metallic taste, tiredness. Metformin does not
cause hypoglycaemia except in overdose.
17. Thiazolidinedione (PPARγ agonist)
• Drugs: Pioglitazone, Rosiglitazone
• Mechanism of action: The thiazolidinediones (TZDs) are also
insulin sensitizers. The TZDs lower insulin resistance by acting
as agonists for the peroxisome proliferator–activated
receptor-γ (PPARγ), a nuclear hormone receptor. Activation of
PPARγ regulates the transcription of several insulin-responsive
genes, resulting in increased insulin sensitivity in adipose
tissue, liver, and skeletal muscle. The TZDs can be used as
monotherapy or in combination with other glucose-lowering
agents or insulin.
• Pharmacokinetics: Oral administration, metabolized by CYP450,
Pioglitazone- excreted in the bile and eliminated in the feces,
Rosiglitazone - primarily excreted in the urine. No dosage
adjustment is required in renal impairment.
• Adverse effects: Liver toxicity, osteopenia, Pioglitazone may also
increase the risk of bladder cancer, rosiglitazone carries a boxed
warning about the potential increased risk of myocardial infarction
and angina.
18. α Glucosidase inhibitors
• Drugs: Acarbose, Miglitol, Voglibose
• Mechanism of action: These drugs reversibly inhibit α-
glucosidase enzymes and delay the digestion of
carbohydrates, resulting in lower postprandial glucose
levels. They do not stimulate insulin release or increase
insulin sensitivity; these agents do not cause
hypoglycemia when used as monotherapy.
• Adverse effects: The most common adverse effects are
flatulence, diarrhea, and abdominal cramping.
19. Dopamine D2 agonist
• Drugs: Bromocriptine. Used as adjunctive treatment of
type 2 DM.
• Mechanism of action: Bromocriptine is thought to act
on the circadian neuronal activities in the
hypothalamus, to reset an abnormally elevated
hypothalamic drive for increased plasma glucose, free
fatty acids, and triglycerides in insulin-resistant
patients. Contraindicated in patients with renal
insufficiency.
20. Sodium-glucose co-transport-2 (SGLT-2)
inhibitor
• Drugs: Dapagliflozin, Canagliflozin
• Mechanism of action: The SGLT2 is responsible for
reabsorbing filtered glucose in the tubular lumen of the
kidney. By inhibiting SGLT2, these agents decrease
reabsorption of glucose, increase urinary glucose excretion,
and lower blood glucose. Inhibition of SGLT2 also decreases
reabsorption of sodium and causes osmotic diuresis
reduce systolic blood pressure (not indicated for the
treatment of hypertension).
• Pharmacokinetics: Before the first meal of the day,
metabolized by glucuronidation, avoided in patients with
renal dysfunction
• Adverse effects: Mycotic infections (in females), urinary
tract infections, and urinary frequency, hypotension
(elderly), Ketoacidosis
21. Bile acid sequestrant
• Drug: Colesevelam
• It is a bile acid binding resin which lowers cholesterol as
well as glucose levels in blood. It is approved as add-on
drug in type 2 DM patients who are not properly
controlled by other antidiabetic drugs. The mechanism
of action is not clear.
22. Oral hypoglycemic agents, dose range and dose frequency
MEDICINE USUAL DAILY DOSE FREQUENCY
Glibenclamide 5 mg 2.5–20 mg • Up to 10 mg as a single dose
• >10 mg in divided doses
• Taken with or immediately before food
Glipizide 5 mg 2.6–40 mg • Up to 15 mg as a single dose
• >15 mg in a twice daily dosage taken
• immediately before meals
Gliclazide 80 mg 30–120 mg • Daily
Glimepiride 1/ 2 mg 1–4 mg • 2–3 per day
Metformin 500 mg, 1g 0.5–1.5 g • 1–3 times/day taken with or immediately
after food
Repaglinide 0.5 mg, 1/ 2 mg 0.5–16 mg • 2–3 per day
Pioglitazone 15 mg, 30 mg 4–8 mg • Daily
Rosiglitazone 2 mg, 4 mg 4–8 mg • Daily
Acarbose 50/ 100 mg 50–100 mg • TDS with food thrice a day
Voglibose 0.2/ 0.3 mg 0.2–0.3 mg • TDS with food thrice a day
Sitagliptin 50/ 100 mg 100 mg per day in BD
regimen. In combination with
metformin, or a sulfonylurea
• With or without food
Vildagliptin 50 mg • With or without food
Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body.
Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body.
Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body.
Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body.