The document summarizes information about diabetes mellitus and oral hypoglycemic agents. It defines diabetes as a chronic metabolic disease characterized by high blood glucose levels according to WHO. It then provides global facts about the rising prevalence of diabetes. It describes the main types of diabetes - type 1, type 2 and gestational diabetes - and their causes. It discusses the signs, complications and diagnostic criteria for diabetes. Finally, it describes various classes of oral hypoglycemic agents used to treat diabetes, including their mechanisms of action, efficacy, adverse effects and contraindications.
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.
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.
Diabetic drugs is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Manish yadav .M Pharm First year
Pharmacology . Under -guidence of
Professor Dr. Govind Singh .
M.D.University Rohtak
Department Pharmaceutical science
A Study of Prescription Patterns of DPP-4 inhibitors..Samya Sayantan
Diabetes Mellitus (DM) is a metabolic disorder of which inappropriate hyperglycemia is the hallmark. For this reason, several classes of oral hypoglycemic drugs like Sulfonylurea, Biguanides, Meglitinides, Thiazolidinediones, α-glucosidase inhibitors are prescribed to treat Diabetes Mellitus. But at present Dipeptidyl Peptidase (DPP-4) Inhibitors have attracted attention as oral hypoglycemic agents that recently introduced to Bangladesh. This study aims to evaluate the current prescribing pattern of DPP-4 inhibitors at BIRDEM hospital, Bangldesh.during the survey, 150 prescriptions were collected and investigated where only 49% DPP-4 inhibitors – Sitagliptin, Linagliptin, Vildagliptin are prescribed even along with other conventional oral hypoglycemic drug. According to this survey, it is clear that Dipetidyl Peptidase (DPP-4) inhibitors is becoming more popular day by day in the management of hyperglycemia in Type-2 Diabetes without causing weight gain or hypoglycaemia in Bangladesh.
VILDAGLIPTIN: DPP-IV INHIBITOR
Generic name: Vildagliptin
Brand name: Galvus
Treatment for: type 2 diabetes
selective inhibitor of dipeptidyl-
peptidase IV (DPP-IV)
- the first in a new class of oral antidiabetic agents
- known as dipeptidyl peptidase IV inhibitors
(DPP-IV) inhibitors
introduction to oral hypoglycemic agents with description about sulphonylurea and glinides along with their MOA, indication, side effects and brand name
These slides contain the information about Estrogen, its basic pharmacology, its synthesis in human body, Functions of estrogen, role in female puberty, Agonists of estrogen and antagonists of estrogen, also contain detail of the receptors associated with the estrogen functioning.
Non-pharmacological Management of Diabetes Mellitus.pptxSamson Ojedokun
Diabetes mellitus DM, is a metabolic disorder of biomolecules characterized by chronic hyperglycemia due to defects in insulin synthesis or utilization or both
DM requires lifelong therapy. A multidisciplinary approach is needed to control glycemia, as well as to limit the development of its devastating complications and manage such complications when they do occur.
Increases cost of living and reduces life expectancy
Diabetic drugs is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Manish yadav .M Pharm First year
Pharmacology . Under -guidence of
Professor Dr. Govind Singh .
M.D.University Rohtak
Department Pharmaceutical science
A Study of Prescription Patterns of DPP-4 inhibitors..Samya Sayantan
Diabetes Mellitus (DM) is a metabolic disorder of which inappropriate hyperglycemia is the hallmark. For this reason, several classes of oral hypoglycemic drugs like Sulfonylurea, Biguanides, Meglitinides, Thiazolidinediones, α-glucosidase inhibitors are prescribed to treat Diabetes Mellitus. But at present Dipeptidyl Peptidase (DPP-4) Inhibitors have attracted attention as oral hypoglycemic agents that recently introduced to Bangladesh. This study aims to evaluate the current prescribing pattern of DPP-4 inhibitors at BIRDEM hospital, Bangldesh.during the survey, 150 prescriptions were collected and investigated where only 49% DPP-4 inhibitors – Sitagliptin, Linagliptin, Vildagliptin are prescribed even along with other conventional oral hypoglycemic drug. According to this survey, it is clear that Dipetidyl Peptidase (DPP-4) inhibitors is becoming more popular day by day in the management of hyperglycemia in Type-2 Diabetes without causing weight gain or hypoglycaemia in Bangladesh.
VILDAGLIPTIN: DPP-IV INHIBITOR
Generic name: Vildagliptin
Brand name: Galvus
Treatment for: type 2 diabetes
selective inhibitor of dipeptidyl-
peptidase IV (DPP-IV)
- the first in a new class of oral antidiabetic agents
- known as dipeptidyl peptidase IV inhibitors
(DPP-IV) inhibitors
introduction to oral hypoglycemic agents with description about sulphonylurea and glinides along with their MOA, indication, side effects and brand name
These slides contain the information about Estrogen, its basic pharmacology, its synthesis in human body, Functions of estrogen, role in female puberty, Agonists of estrogen and antagonists of estrogen, also contain detail of the receptors associated with the estrogen functioning.
Non-pharmacological Management of Diabetes Mellitus.pptxSamson Ojedokun
Diabetes mellitus DM, is a metabolic disorder of biomolecules characterized by chronic hyperglycemia due to defects in insulin synthesis or utilization or both
DM requires lifelong therapy. A multidisciplinary approach is needed to control glycemia, as well as to limit the development of its devastating complications and manage such complications when they do occur.
Increases cost of living and reduces life expectancy
Diabetes is fast gaining the status of a potential epidemic in India with more than 65 million diabetic individuals currently diagnosed with the disease. Ranked second in the world, the burden of the disease is expected to compound in the years to come. Worryingly, diabetes is now being shown to be associated with a spectrum of complications and to be occurring at a relatively younger age within the country.
It is a known fact that most of the diabetes cases in our country is managed by primary care Physicians(PCP) who have a pivotal role to play in ensuring that diabetes patients receive effective care by practicing evidence based management. This said, the sad fact is that health care providers-primary care and specialists alike are not managing our patients with diabetes as well as we should be.
The complexities of the disease and its association with lot of other medical conditions make the management of diabetes more challenging to the PCPs. Patients feeling of frustration and denial about having the chronic condition often are a challenge to the practitioners in convincing the patients for initiation of treatment. With no clear cut national policy guidelines for management of diabetes, we rely on western guidelines which have certain pitfalls and fallacies in our setting.
the slide is presentation of World Health Day. It has a very concise information touching various aspects of diabetes with the latest statistics. We hope this will be useful to everyone.
What is diabetes mellitus, Epidemiology of diabetes, Diabetes diagnosis, Features of diabetes, WHO classification of Diabetes Mellitus, Complications of diabetes, Metabolic alterations of diabetes, Oral glucose tolerance test, WHO criteria of OGTT interpretation, Classification of diabetes mellitus, Gestational diabetes, Pre-diabetes, Insulin, Biosynthesis of insulin, Insulin actions, Hypoglycemia, Impaired fasting glucose, Insulin structure
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
Oral hypoglycemic agents with complications
1. ORAL HYPOGLYCEMIC AGENTS
WITH
COMPLICATIONS
Prepared by
Sanjay Kumar (PhD Scholar)
Minshu Prashant (PhD Scholar)
Dr. B. Ram (Associate Professor)
Department of Dravyaguna
Faculty of Ayurveda
Institute of Medical Sciences, Banaras Hindu University Varanasi
2. WHO define “Diabetes is a chronic, metabolic disease
characterized by elevated levels of blood glucose (or
blood sugar)”, which leads over time to serious damage
to the heart, blood vessels, eyes, kidneys, and nerves.
3. GLOBAL FACTS ON DIABETES
• The number of people with diabetes has risen from 108 million in
1980 to 422 million in 2014.
• The global prevalence of diabetes among adults over 18 years of
age has risen from 4.7% in 1980 to 8.5% in 2014.
• Diabetes prevalence has been rising more rapidly in middle- and
low-income countries.
• Diabetes is a major cause of blindness, kidney failure, heart attacks,
stroke and lower limb amputation.
• In 2015, an estimated 1.6 million deaths were directly caused by
diabetes.
• Almost half of all deaths attributable to high blood glucose occur
before the age of 70 years.
• WHO projects that diabetes will be the seventh leading cause of
death in 2030.
4. • Diabetes might be one of the most talked about diseases across the world and
especially in India
• In India, today have more people with type-2 diabetes (more than 50 million) than
any other Nation.
• According to World Health Organization (WHO) fact sheet on diabetes, an
estimated about 3.4 million deaths are caused due to high blood sugar.
• The WHO also estimates that 80 percent of diabetes deaths occur in low and
middle-income countries and projects that such deaths will double between 2016
to 2030.
• It has been further estimated that the global burden of type-2 diabetes is expected
to increase to 438 million by 2030 from 285 million people recorded in 2010.
• In India, this increase is estimated to be 58%, from 51 million people in 2010 to 87
million in 2030.
5. TYPES OF DIABETES MELLITUS (DM)
• Type 1 DM
• Type 2 DM
• Gestational diabetes mellitus (GDM)
6. TYPE 1 DIABETES MELLITUS
• Due to an absolute insulin deficiency
• Previously called Insulin-Dependent Diabetes Mellitus
(IDDM) or Juvenile-Onset DM
• Originally diagnosed in children and youth but now can be
diagnosed in adults.
• Exogenous insulin must be used for these individuals.
DIAGNOSIS:
Accounts for 5-10% of all diabetes cases
FASTING BLOOD GLUCOSE > 126 mg/dl
RANDOM BLOOD GLUCOSE > 200 mg/dl
ORAL GLUCOSE TOLERANCE TEST > 200 mg/dl
HbA1c > 6.5 %
7. CAUSES OF TYPE 1 DIABETES MELLITUS
• Genetics
• Environment
• Viruses
These can trigger an autoimmune response in which the
body's immune system attacks and destroy the insulin
producing beta cells of the pancreas
8. TYPE 2 DIABETES MELLITUS
• Due to a combination of ineffective insulin and/or
insufficient insulin production.
• Previously called Non-Insulin-Dependent DM
(NIDDM) or Adult-Onset DM.
• Historically linked to abdominal adiposity.
• It used to be seen in only adults but is now seen in
youth.
Accounts for 90-95% of all diabetes cases
9. CAUSES FOR TYPE 2 DIABETES MELLITUS
• Insulin resistance is the primary cause of type
2 DM.
• The pancreas secretes insulin but this insulin is
not 100% effective to helping glucose move
into muscle, fat and liver cells.
• The body “resists” the effect of insulin, and
consequently sugar remains in the blood.
10. Gestational Diabetes
• During pregnancy, women can develop insulin
resistance.
• Affects about 4% of all pregnant women.
• Gestational diabetes usually disappears after
pregnancy.
• Gestational diabetes increases risk for Type 2
diabetes later in life.
GESTATIONAL DIABETES (GD)
11. • Hormones from the placenta may block the
action of the mother's insulin in her body
causing insulin resistance
• The stress of the pregnancy may also cause
insulin resistance
CAUSES OF GESTATIONAL DIABETES
12. OTHER CAUSES FOR DIABETES MELLITUS
• Genetic defects of β-cell function
– Maturity onset diabetes of the young (MODY)
– Mitochondrial DNA mutations
• Genetic defects in insulin processing or insulin action
– Defects in pro-insulin conversion
– Insulin gene mutations
– Insulin receptor mutations
• Exocrine pancreatic defects
– Chronic pancreatitis
– Cystic fibrosis
– Pancreatic neoplasea
16. Insulin resistance
Hyperinsulinemia
(Normal glucose tolerence)
Impaired insulin secretion
(beta cell failure)
Type 2 DM
Medicines
Hyperglycemia
Obesity
Diseases (HIV)
hyperlipidemia
Sedentary life style
Environmental factorDiet
17. SIGN AND SYMPTOMS OF DIABETES
MELLITUS
• Increased thirst
• Increased hunger
• Polyurea
• Glycosurea
• Dry mouth
• Frequent urination
• weight loss
• Fatigue
• Blurred vision
• Headaches
• Slow-healing sores or cuts (Diabetic foot)
• Itching
• Numbness and tingling of the hands and feet
• Erectile dysfunction (impotency)
18. COMPLICATIONS OF TYPE 2 DIABETES
MELLITUS
I. Acute complications:
– Diabetic Ketoacidosis
– Hypoglycemia
II. Chronic complications:
a. Microvascular
– Retinopathy
– Nephropathy
– Neuropathy
– Diabetic foot
b. Macrovascular
– Cerebrovascular.
– Cardiovascular.
– Peripheral vascular disease.
19. WHO DIABETES DIAGNOSTIC CRITERIA FOR BLOOD SUGAR LEVELS
Blood glucose Normal Prediabetes Diabetes
Random
80 - 159 mg/dl 160 – 199 mg/dl 200 mg/dl or more
Fasting
Below 110 mg/dl 110 to 125 mg/dl
(IFG)
126 mg/dl or more
2 hour post-
prandial Below 140 mg/dl 140 to 199 mg/dl
(IGT)
200 mg/dl or more
HbA1c Below 6.0 % 6.0 to 6.5 % More than 6.5 %
20. ORAL HYPOGLYCEMIC DRUGS
“Agents that are given orally to reduce the
blood glucose levels in diabetic patients are
called oral hypoglycemic agents”.
21. 1. Age – between 35 – 70 years
2. BMI - < 36 kg/m2
3. Random blood glucose(RBG)– 200 – 400mg/dl,
fasting blood glucose(FBG) – >126 mg/dl,
post prandial glucose(PPG) – > 200 mg/dl
4. Insulin requirement - < 40 U /day
5. HbA1c - < 11%
Oral hypoglycemics
22. EXCUSION CRITERIA FOR ORAL
HYPOGLYCEMIC AGENTS
• Treatment with insulin.
• 2 or more hypoglycemic episodes within the
past years.
• Severe cardiovascular, respiratory, hepatic,
renal, gastrointestinal and neurological
disorders.
• Positive hepatitis B & C
Oral hypoglycemics
25. Efficacy
– Reduces FBG by 60-70 mg/dl
– Reduces HbA1c by 1.5-2.0%
– Reduction in: TGs by 16%, LDL by 8%, and increases HDL by 2%
– Weight loss of 2-5 kg
Adverse effects
– GI: bloating, nausea, diarrhea, cramping
– Metallic taste in the mouth
– Lactic acidosis
– Hypoglycemia if used in combination with insulin or sulphonylurea
– Headache
Contrindications
– Renal impairment: Serum Creatinine ≥ 1.5mg/dl for men and ≥1.4mg/dl for
women
– Cardiac or respiratory insufficiency
– lactic acidosis
– Severe infection
– Liver diseases
– Alcohol abuse
26. Drug interactions:
– Drugs that are eliminated through renal
tubular secretion can potentially interact with
metformin such as digoxin, morphine,
procainamide, vancomycin, ranitidine
– Furosemide and nifedipine can potentially
increase metformin plasma concentrations
Dosing:
– start with 500mg or 850mg QD or BID
28. Pharmacokinetics:
• Well absorbed orally
• 90% plasma protein bound
• Low volume of distribution
• Metabolized in liver and excreted through urine
Interactions
• Clofibrate, phenylbutazone, salicylates, sulfonamides →
displace Sulphonylureas from protein binding
• Chloramphenicol, MAOIs, phenylbutazone →reduce hepatic
Sulphonylurea metabolism
• Allopurinol, probenecid →decrease urinary excretion of
Sulphonylurea
29. Who is a candidate:
• Normal weight type 2 DM patients
• Onset of DM after age of 30 year
• Initial Blood Glucose < 250mg/dl
• Relatively normal renal and hepatic function
Who is not a candidate:
• Pregnant and lactating women
• Ketosis-prone patients
Efficacy:
• HbA1c ↓1.5%-2%
• FBG ↓50-60mg/dl
• Dose can be increased every 1-2 weeks for glycemic
control
Adverse effects: hypoglycemia, weight gain, GI upset
30. SULPHONYLUREA DRUGS
First
generation
Second
generation
Tolbutamide Glibenclamide Glipizide Gliclazide Glimperide
Half life 6 hr 2-4 hr 3-5 hr 8-20 hr 5-7 hr
Duration of
action
6-8 hr 24 hr 12 hr 12 – 24 hr 24 hr
Daily dose
required
0.5-3 gm 2.5-15 mg 5-20mg 40-240 mg 1-6 mg
No of doses 2-3/day 1-2/day 1-2/day 1-2/day 1-2/day
Draw back Prolong
hypoglycemia,
sweating, rapid
breathing, fast heart
rate, weight gain
Weight gain,
hypoglycemia
Weight gain,
skin changes,
hypoglycemia
Hypoglycemia,
numbness and
tigling
Lower incidence of
hypoglycemia
31. MEGLITINIDES
(Repaglinide, Nateglinide)
• Non-sulfonylurea
• Also bind the ATP –dependent K channel to release insulin
secretion.
• Used for management of meal-related glucose loads
• Less hypoglycemia than with sulphonylurea
Efficacy:
HbA1c ↓ 0.6%-1%
Adverse reaction
Low incidence of hypoglycemia (0.3%)
Slight weight gain
Contraindications
Pregnancy, DKA, severe infection
32. Repaglinide
Pharmacokinetics:
• Metabolized by Cyt P450
• Half-life: 1 hr
• Excreted in bile
• Dose: 0.5-4mg QD, max 16mg/day
• Take 30 min before meal, if meal is skipped,
skip the dose as well
33. THIAZOLIDINEDIONE
(Rosiglitazone, Pioglitazone)
Mechanism of action
• Thiazolidinedione act by -
activating PPARϒ (peroxisome proliferator-
activated receptors)
• Which is expressed in fat cells but also in
muscles and other cells.
• Reverse insulin resistance by enhancing GLUT-4
expression and translocation
34.
35. Efficacy
• Rosiglitazone
Decreases: FBG by 30-60mg/dl, HbA1c by 0.8-1.5%, TGs
by7-14%
• Pioglitazone
Decreases: FBG by 39-65mg/dl, HbA1c by 1.0-1.6%, TGs by
5-26%
Adverse effect
• Fluid retention
• Weight gain
• Hypoglycemia if combined with other agents
• Liver injury
• Cardiac injury
Contraindication
• In cardiac complications
36. ALPHA – GLUCOSIDASE INHIBITOR
Acarbose : An inhibitor of intestinal α-
glucosidase enzyme
Mechanism of action : It delays carbohydrate
metabolism, absorption, reducing the
postprandial increase in blood glucose .
Adverse effect: flatulence, loose stools or diarrhea,
abdominal pain and bloating.
Contraindications : in pregnancy, liver disease,
kidney disease, breast feeding women and in
hypersensitivity
38. • Efficacy: DPP-4 inhibitors lowered HbA1c
values by 0.74%, comparable to other anti-
diabetic drugs.
• Side effects: Pancreatitis, nausea, vomiting,
loss of appetite, fast heart rate; or urinating
less than usual or not at all; swelling, weight
gain, feeling short of breath.
• Contraindications: renal impairment,
hypersensitivity, pancreatitis, heart failure.
44. Options for monotherapy
Biguanide
(Metformin)
Sulphonylurea
(Glibenclamide,
tolbutamide,
glipizide etc)
Meglitinide
(Repaglinide,
Nateglinide)
Thiazolidinedione
(Rosiglitazone,
Pioglitazone)
Alpha
glucosidase
inhibitors
(Acarbose)
Target population Target population Target population Target population Target population
Over weight/obese
Insulin resistance
Normal weight Elevated PPG Insulin resistance Elevated PPG
Advantages Advantages Advantages Advantages Advantages
No weight gain
↓ risk of
hypoglycemia
Effectiveness at
reducing glycemia
levels,
Low cost
↓ risk of
hypoglycemia,
Short acting
Meal adjusted
dosing
Hyperinsulinemia,
↓ risk of hypoglycemia
↓ risk of
hypoglycemia
Disadvantages Disadvantages Disadvantages Disadvantages Disadvantages
GI side effects
Rare lactic acidosis
Weight gain,
↑ risk of
hypoglycemia
High cost Weight gain
Slow onset of action
Liver toxicity
Cardio-toxicity
High cost
Hypersensitivity reactions
GI side effect,
High cost
If a single agent is inadequate, initiate combination therapy
46. REFERENCES
1. Mathers CD, Loncar D. Projection of global mortality and burden of disease from 2002 to 2030.
PLoS Med, 2006, 3(11)
2. American Diabetes Association. Standards of medical care in diabetes – 2017. Diabetes Care.
2017;40(1):1-98.
3. Joslin’s. Diabetes Mellitus. Fourteenth edition, Published by Lippincott Williams and Wilkins,
Page no-449-463.
4. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of
WHO/IDF consultation. World Health Organization. 2006. Page no 21-23.
5. Diabetes Fact Sheet. WHO. March 2014.
6. Gilman AG, Goodman LS, The Pharmacological Basis of Therapeutics. 13th edition, Macmillan,
New York.1985; 1490- 1516.
7. Tripathi K D. Essential of Mediacal Pharmacology. 7th Edition, Jaypee Publication. Page no: 258-
280.