diabetes, its types, insulin, hyperglycemia, advancement in diabetes.

1. DIABETES
By:
Sachin kumar
M.Pharm. (Pharmacology)
Deptt. of Pharma. Sciences
M.D.U. Rohtak, 124001

2. CONTENTS
• INTRODUCTION
• SIGNS AND SYMPTOMS OF DIABETES
• TYPES OF DIABETES
• INSULIN
• HYPERGLYCEMIA
• ORAL HYPOGLYCEMIC AGENT
• RECENT ADVANCEMENT IN DIABETES
• REFERENCES

3. DIABETES
• It is a chronic, life long condition that affects your
body‘s ability to use the energy found in food due
to high blood glucose level.
• High blood glucose level can damage the tiny
blood vessels in kidney, heart, eye or nervous
system. Hence, it cause heart disease, stroke,
kidney disease, blindness and nerve damage.
• Normal blood glucose level is 70 to 100 mg/dL
when fasting and upto 140 mg/dL two hours after
eating.
• In diabetes, 100 to 125 mg/dL in prediabetes,
more than 140 mg/dL when fasting and more than
200 mg/dL two hours after eating.

4. SIGNS & SYMPTOMS OF DIABETES
• Polydipsia
• Always tired
• Polyurea
• Sudden weight loss
• Wound that won’t heal
• Polyphagia
• Numb and tingling hands or feet
• Blurry vision

5. TYPES OF DIABETES
1. Type 1 diabetes- also called insulin
dependent diabetes.
2. Type-2 diabetes- also called non-insulin
dependent diabetes.
3. Gestational diabetes
4. Pre-diabetes

6. TYPE-1 DIABETES
• It caused by body attacking its own pancreas with
antibodies. They damage pancreas and does not
make insulin.
• Pancreas have beta cell which store and release
insulin.
• It is also caused by genitically or damage of beta
cell of pancreas by viruses such as mumps virus &
coxsackie virus , by toxic chemical agent.
• Only about 5% of people with diabetes have
type- 1.

7. TYPE-2 DIABETES
• About 95% of people with diabetes have
type-2 diabetes.
• In this, pancreas usually produce insulin but
either the amount produce is not enough for
the body’s need or the body cell are resistant
to insulin.
• Main cause of type-2 diabetes is obesity.

8. GESTATIONAL DIABETES
• It triggered by pregnancy.
• High blood sugar level in a mother are
circulated through placenta to the baby.
• It usually resolve itself after pregnancy but
mother have risk for developing type-2
diabetes later in life.
• According to National Institutes of health, the
reported rate of GD is between 2% to 10% of
pregnancies.

9. PRE-DIABETES
• It is the condition when blood glucose level is
above from normal blood glucose level but
not high enough to be classified under Type-1
& Type-2 diabetes.
• The diagnosis of prediabetes allows doctors
and patients to catch diabetes earlier in its
development and take steps to avoid the
progression to diabetes.

10. INSULIN
• Insulin firstly
extracted in 1921
from the dog’s
pancreas.
- Fredrick G. Banting
- Charles H. Best

11. • A peptide hormone produce by
beta cells of pancreatic islets.
• It regulates the metabolism of
carbohydrate, fats and protein
by promoting the absorption of
glucose from blood into fat,
liver and skeletal muscle.
• Inhibit conversion of fatty acid
and amino acid to keto acids.

12. SECRETION OF INSULIN

13. INSULIN ACTION ON CELL

15. HYPERGLYCEMIA

16. HYPERGLYCEMIA
increase NADH production
increase ROS increase OXIDATIVE STRESS
ENDOTHELIAL DAMAGE
1. DIABETIC RETIONPATHY
2. DIABETIC NEUROPATHY
3. DIABETIC NEPHROPATHY

17. ORAL HYPOGLYCEMIC AGENT
• Sulfonylureas- tolbutamide, chlorpropamide,
tolazamide, glyburide, glipizide, glimepiride.
• Repaglinide
• Nateglinide
• Biguanides- metformin, phenformin and
buformin.
• Thiazolidinediones- troglitazone, rosiglitazone
and pioglitazone.

18. SULFONYLUREAS, REPAGLINIDE &
NATEGILINIDE
-

19. BIGUANIDES
• Metformin and phenoformin were introduced in
1957 and buformin were introduced in 1958.
• 1n 1970 phenoformin was withdrawn in many
countries because of an association with lactic
acidosis.
• These are anti-hyperglycemic, not hypoglycemic.
It does not cause insulin release from pancreas.
• Reduce glucose level by decreasing hepatic
glucose production and by increasing insulin
action in muscle and fat.

22. RECENT ADVANCEMENT
IN DIABETES

23. 1. ISLET TRANSPLANTATION

24. • In 1970, islets transplant were conducted with
great success in laboratory. But initial attempts
to reproduce that success in human were
largely disappointing.
• After many years some transplant recipients
were able to stay diabetes free but after few
month the islets failed.
• Islets needs lots of oxygen and blood supply
and they need protection from immune attack
and waste product.

25. • After this, a new research come from university
of Alberta in Edmonton, Canada.
• These scientist used a new procedure called
Edmonton protocol.
• They use specialized enzyme (collagenase) to
remove islets.
• The islets are then injected through the
catheter into liver.
• Immunosuppresive or anti-rejection drugs are
needed to keep the transplanted islets
functioning.

26. • βAIR- A bio-artificial pancreas developed by
Israel based med tech company Beta-O2
Technology Ltd. In 2004.
• The first implantation to human patient was
carried out in 2012 with a medical follow up in
Dresden’s Technical University (Germany) for
10 month.
• βAIR’s phase 1 study started in 2014 at
Uppsala University Hospital in Sweden.
• βAIR implanted patient will still need to daily
dose of oxygen into the implant to sustain the
cell there.

27. • BIOHUB- According to DRI, when islets are put
into the liver, inflammation develops and
threatens the life of cell. Because liver processes
most of our waste.
• They transplant the isletes into the omentum (the
lining covering abdominal organs).
• Omentum is rich in blood vessels that is key for
developing oxygen to islets cells.
• They use a gel made out by blood plasma and an
enzyme called thrombin. Beta cells are placed in
this gel, which is attached to a piece of omentum,
that is then folded over a pouch.
• They also deliver a low dose immune supressing
drug into pouch to protect immune attack.

28. • Major hurdel for islet implantation-
A recipient need millions of islets for successful
transplant. It usually takes two donor pancreases
to get enough beta cells for one transplant.
- It is hoped that stem cell can replace donor cell at
some point, but not yet.
- DRI and many other centers are looking at stem
cells from embryos, from bone marrow and other
sources.

29. 2. BCG VACCINE RESEARCH

30. • Dr. Denise Faustman found that BCG can
eliminate disease causing T-cell and restore
insulin.
• She found that BCG increase the level of
substance called TNF and high level of TNF can
eliminate the damaging T-cell in the blood.
• Phase-1 is completed and found that BCG is
safe for type-1 diabetes patient.
• Phase-2 is under trial.

31. REFERENCES
• Davis SN. Insulin, Oral hypoglycemic agent and the
pharmacology of the endocrine pancreas. In: Brunton LL,
Lazo JS, Parker KL, editors. Goodman and Gilman’s
pharmacological basics of therapeutics. 11th ed. New York:
McGraw-Hill: Medical Publishing Division; 2006: 1613-
1642.
• Couper JJ, Prins JB. Recent advances in therapy of diabetes.
Med J Aust. 2003: 179 (8): 441447.
• Hoskins M. Diabetes cure talk: Research update from ADA
2016. Published on 27 june 2016. Available from:
http://www.healthline.com (accessed on: 17-02-17)
• Belisomo R. FDA approves mid stage trail of vaccine to
reverse type 1 diabetes. June 8, 2015. Available from:
http://www.reuters.com (accessed on: 17-02-17)

32. • Setter SM, White JR, and Campbell RK. Diabetes. In: Helms
RA, Herfindal ET, Quan DJ, Gourley DR, editors. Text book of
therapeutics: drug and disease management. 8th ed.
Philadelphia: Lippincott Williams and Wilkins; 2006: 1042-
1075.
• Piemonte L. Diabetes treatment > latest advances.
International Diabetes Federation; 2015. Available from:
http://www.idf.org (accessed on: 17-02-17)
• “Clinical trials”. Beta-O2 Technologies. Retrieved Feb20,
2015.