Insulin pumps provide patients with type 1 diabetes a method of continuous subcutaneous insulin infusion as an alternative to multiple daily insulin injections. Insulin pumps can help improve glycemic control and reduce hypoglycemic episodes compared to multiple daily injections. The document discusses different insulin types used in pumps, how pumps work, and guidelines for when insulin pump therapy is recommended.
International journal-of-diabetes-and-clinical-research-ijdcr-5-083Marwan Assakir
This document reviews different insulin initiation regimens for patients with type 2 diabetes. It discusses starting patients on basal insulin like NPH or long-acting analogues like glargine or detemir, administered once or twice daily. Insulin can be initiated at 10 units/day or 0.1-0.2 units/kg/day and titrated up every 1-2 weeks based on fasting plasma glucose levels. Premixed insulins are also reviewed for initiation, starting at 10 units/once daily or 0.3-0.5 units/kg/day. A basal-bolus regimen adding rapid-acting insulin before meals is discussed for intensifying treatment if targets are not met with basal insulin alone
This document provides an overview and update on treatment strategies for diabetes mellitus type 2 (DM2). It discusses the progressive nature of DM2 and impact of uncontrolled hyperglycemia on microvascular and macrovascular disease. It summarizes the results of major clinical trials on the impact of intensive therapy for diabetes. It also reviews glycemia targets and notes that many patients are not meeting the recommended A1c goal of less than 7%. The document discusses various classes of anti-hyperglycemic medications including their mechanisms of action, efficacy, and side effects. It provides guidance on initiating and adjusting injectable therapies.
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
Type 2 dm gdm new updates & guidelinesSachin Verma
Type 2 diabetes is a multifactorial disorder characterised by progressive pancreatic beta-cell dysfunction and insulin- resistance, leading to relative insulin deficiency, chronic hyperglycaemia, and various complications.
The treatment options for this disorder, which aim at correcting one or other of the two major pathophysiological mechanisms, have been hamstrung by unacceptable side-effects, lack of patient acceptability, and loss of efficacy over time.
Dr Jeenal Mistry_Recent Advances in DM_8th Sept 2022.pptxDr Jeenal Mistry
The pharmacotherapy of DM has evolved tremendously in the last
100 years since the successful extraction of insulin in 1921. The efficacy of multiple drugs has been established for microvascular and
macrovascular outcomes. Despite manufacturing successful insulinanalogues, newer analogues such as icodec and newer automated
insulin delivery pumps are in the pipeline to further improve glycaemic
control. CVOTs were initiated to establish the safety of antidiabetics;
however, apart from establishing efficacy as well, some drugs have
grown to the extent of establishing efficacy and safety in nondiabetic
patients as well. Current research must be directed towards new therapeutic options for TIDM and evaluating efficacy of antidiabetics for
diseases concomitantly associated with DM, such as cerebrovascular
diseases, neuropathies, retinopathies and cancers. Diabetes with
COVID-19 provides a therapeutic dilemma for establishing adequate
glycaemic control as well as managing complications. Numerous
hypotheses exist for the management of COVID-19 with diabetics,
which need to be evaluated. Various new drug delivery systems and
drugs with novel mechanisms of action, are in the pipeline for the
management of TIDM and TIIDM, with some of them demonstrating
adequate promise in clinical trials or other diseases.
Ueda2015 lilly.the art of insulin dr.mesbah sayedueda2015
This document discusses the treatment of a 52-year-old patient with type 2 diabetes who has an HbA1c of 9.4% despite treatment with oral medications. It considers adding insulin therapy to help control the patient's blood glucose levels and reach treatment targets. Specifically, it compares the effectiveness of premixed insulin versus basal insulin when initiating insulin in type 2 diabetes patients. A study is summarized that found premixed insulin administered twice daily in combination with metformin was more effective at reducing HbA1c and post-prandial blood glucose compared to a basal insulin administered once daily plus metformin. The document advocates for patient-centered treatment approaches and discusses factors to consider when choosing between premixed versus basal-bolus insulin reg
Approach to case of type 2 DM
lifestyle modificatios
indications to start drug therapy
classification of antidiabetic drugs , mechanism of action , adeverse drug effects , doses , drug interactions , how to add differents class of drugs to give combination therapy . over view insulin therapy
ueda2013 basal insulin versus premixed insulin-d.salahueda2015
This document discusses the use of basal insulin versus premixed insulin for the treatment of type 2 diabetes mellitus (T2DM). It provides background on insulin analogues and their properties. For initiating insulin therapy in T2DM, guidelines recommend starting with basal insulin and titrating doses to reach blood glucose targets, rather than starting with premixed insulin. Premixed insulin combines basal and prandial insulin but does not mimic physiological insulin action and requires structured meal plans. The document concludes that a stepwise approach starting with basal insulin and progressing to basal-bolus regimens if needed provides the best approach for intensifying insulin therapy in T2DM.
International journal-of-diabetes-and-clinical-research-ijdcr-5-083Marwan Assakir
This document reviews different insulin initiation regimens for patients with type 2 diabetes. It discusses starting patients on basal insulin like NPH or long-acting analogues like glargine or detemir, administered once or twice daily. Insulin can be initiated at 10 units/day or 0.1-0.2 units/kg/day and titrated up every 1-2 weeks based on fasting plasma glucose levels. Premixed insulins are also reviewed for initiation, starting at 10 units/once daily or 0.3-0.5 units/kg/day. A basal-bolus regimen adding rapid-acting insulin before meals is discussed for intensifying treatment if targets are not met with basal insulin alone
This document provides an overview and update on treatment strategies for diabetes mellitus type 2 (DM2). It discusses the progressive nature of DM2 and impact of uncontrolled hyperglycemia on microvascular and macrovascular disease. It summarizes the results of major clinical trials on the impact of intensive therapy for diabetes. It also reviews glycemia targets and notes that many patients are not meeting the recommended A1c goal of less than 7%. The document discusses various classes of anti-hyperglycemic medications including their mechanisms of action, efficacy, and side effects. It provides guidance on initiating and adjusting injectable therapies.
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
Type 2 dm gdm new updates & guidelinesSachin Verma
Type 2 diabetes is a multifactorial disorder characterised by progressive pancreatic beta-cell dysfunction and insulin- resistance, leading to relative insulin deficiency, chronic hyperglycaemia, and various complications.
The treatment options for this disorder, which aim at correcting one or other of the two major pathophysiological mechanisms, have been hamstrung by unacceptable side-effects, lack of patient acceptability, and loss of efficacy over time.
Dr Jeenal Mistry_Recent Advances in DM_8th Sept 2022.pptxDr Jeenal Mistry
The pharmacotherapy of DM has evolved tremendously in the last
100 years since the successful extraction of insulin in 1921. The efficacy of multiple drugs has been established for microvascular and
macrovascular outcomes. Despite manufacturing successful insulinanalogues, newer analogues such as icodec and newer automated
insulin delivery pumps are in the pipeline to further improve glycaemic
control. CVOTs were initiated to establish the safety of antidiabetics;
however, apart from establishing efficacy as well, some drugs have
grown to the extent of establishing efficacy and safety in nondiabetic
patients as well. Current research must be directed towards new therapeutic options for TIDM and evaluating efficacy of antidiabetics for
diseases concomitantly associated with DM, such as cerebrovascular
diseases, neuropathies, retinopathies and cancers. Diabetes with
COVID-19 provides a therapeutic dilemma for establishing adequate
glycaemic control as well as managing complications. Numerous
hypotheses exist for the management of COVID-19 with diabetics,
which need to be evaluated. Various new drug delivery systems and
drugs with novel mechanisms of action, are in the pipeline for the
management of TIDM and TIIDM, with some of them demonstrating
adequate promise in clinical trials or other diseases.
Ueda2015 lilly.the art of insulin dr.mesbah sayedueda2015
This document discusses the treatment of a 52-year-old patient with type 2 diabetes who has an HbA1c of 9.4% despite treatment with oral medications. It considers adding insulin therapy to help control the patient's blood glucose levels and reach treatment targets. Specifically, it compares the effectiveness of premixed insulin versus basal insulin when initiating insulin in type 2 diabetes patients. A study is summarized that found premixed insulin administered twice daily in combination with metformin was more effective at reducing HbA1c and post-prandial blood glucose compared to a basal insulin administered once daily plus metformin. The document advocates for patient-centered treatment approaches and discusses factors to consider when choosing between premixed versus basal-bolus insulin reg
Approach to case of type 2 DM
lifestyle modificatios
indications to start drug therapy
classification of antidiabetic drugs , mechanism of action , adeverse drug effects , doses , drug interactions , how to add differents class of drugs to give combination therapy . over view insulin therapy
ueda2013 basal insulin versus premixed insulin-d.salahueda2015
This document discusses the use of basal insulin versus premixed insulin for the treatment of type 2 diabetes mellitus (T2DM). It provides background on insulin analogues and their properties. For initiating insulin therapy in T2DM, guidelines recommend starting with basal insulin and titrating doses to reach blood glucose targets, rather than starting with premixed insulin. Premixed insulin combines basal and prandial insulin but does not mimic physiological insulin action and requires structured meal plans. The document concludes that a stepwise approach starting with basal insulin and progressing to basal-bolus regimens if needed provides the best approach for intensifying insulin therapy in T2DM.
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
This document summarizes the key properties of 8 DPP-4 inhibitor drugs used to treat type 2 diabetes: alogliptin, anagliptin, gemigliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin, and vildagliptin. It provides details on their mechanism of action, pharmacokinetic properties like bioavailability and half-life, FDA approval status, and evidence from clinical trials demonstrating their efficacy in reducing HbA1c levels and safety. The document concludes that DPP-4 inhibitors are a promising class of antidiabetic drugs that improve glycemic control without weight gain or hypogly
The document discusses type 2 diabetes mellitus (T2DM) and strategies for achieving glycemic targets. It notes the increasing complexity of T2DM management given the variety of treatment options available and concerns about intensive control. The document summarizes guidelines recommending individualized glycemic targets and avoidance of hypoglycemia. It also reviews studies showing that sitagliptin added to metformin or insulin therapy was effective at lowering blood sugar levels compared to other agents, with a lower risk of hypoglycemia and weight gain.
Here are some key points about adding another agent best suited to the individual:
- α-glucosidase inhibitors like acarbose lower A1C moderately, rarely cause hypoglycemia, are weight neutral or may cause weight loss, and have shown improved postprandial glucose control and cardiovascular outcomes in some studies. They require multiple daily doses with meals.
- DPP-4 inhibitors like sitagliptin, saxagliptin and linagliptin lower A1C moderately, have a low risk of hypoglycemia, are weight neutral, and have generally shown neutral cardiovascular outcomes. They are well tolerated with once daily dosing.
- GLP-1 receptor agonists like exen
This Presentation Give You A brief Information About DPP4 And New Recommendations .This Presentation Guide You How To Treat Patients With Safety.
For Further Contact:03354999496
The document discusses guidelines for initiating insulin therapy in patients with type 2 diabetes not controlled on oral antidiabetic drugs (OADs). It recommends starting with either bedtime intermediate-acting insulin or bedtime or morning long-acting insulin, beginning at a dose of 10 units or 0.2 units/kg. The insulin dose is then titrated up based on fasting blood glucose levels until the target range is achieved. Additional injections of rapid-acting insulin may be added if pre-meal blood glucose levels remain out of range.
Insulin degludec is an ultralong-acting basal insulin analogue administered via once daily subcutaneous injection to help control blood sugar levels in diabetes. It has a duration of action of up to 40 hours, making it suitable as a once-daily treatment. Clinical trials found it to be as effective as insulin glargine at reducing HbA1c levels while having a lower risk of hypoglycemia, especially nocturnal hypoglycemia. Insulin peglispro is an experimental basal insulin consisting of insulin lispro covalently attached to polyethylene glycol. Phase II clinical trials found it reduced blood glucose variability compared to insulin glargine while maintaining similar HbA1c lowering and hypoglycemia rates,
This document discusses the peri-operative management of patients with diabetes who require surgery. It notes that 30-50% of patients with diabetes will require surgery in their lifetime. Key considerations for pre-operative evaluation include assessing diabetes control, complications, medications, and associated conditions. The "threatening trio" of silent heart issues, renal dysfunction, and neuropathy are also discussed. Guidelines are provided for continuing oral medications, insulin and glucose management during the peri-operative period. Evidence around tight glycemic control in the ICU is summarized, noting the risk of hypoglycemia. Maintaining blood glucose between 140-180 mg/dl is now recommended for critically ill patients.
Ueda2016 symposium -t2 dm management - lobna el toonyueda2015
Sitagliptin improves glycemic control in a glucose-dependent manner by increasing concentrations of active incretin hormones like GLP-1. It targets the metabolic defects of type 2 diabetes by improving markers of beta-cell function, reducing hepatic glucose overproduction, and having insulin-sensitizing properties. Studies show sitagliptin is associated with a lower risk of hypoglycemia and less weight gain compared to sulfonylureas when added to metformin. It also provides durable glycemic control with a lower risk of requiring additional antihyperglycemic medications over time.
This document summarizes the management and treatment of diabetes. It discusses:
1) The classification of type 1 and type 2 diabetes, their typical presentations, and diagnostic criteria.
2) Guidelines for initial treatment including lifestyle changes and metformin for type 2 diabetes. Adding sulfonylureas or insulin if glycemic goals are not met.
3) Treatment of type 1 diabetes focuses on intensive insulin therapy to control blood glucose and reduce complications.
4) Screening and treatment of complications like nephropathy, retinopathy, and neuropathy are also covered.
- The patient has type 2 diabetes and stage 3 chronic kidney disease, so metformin was discontinued.
- Liraglutide treatment has been shown to decrease the risk of cardiovascular death but not cause significant weight loss or increase cancer risk.
- Glyburide should be avoided given the patient's low GFR, while linagliptin can be used.
- Most insulins can be used but doses may need adjusting to avoid hypoglycemia risk from prolonged half-lives in kidney disease. Glucagon-like peptide-1 receptor agonists are also options but can increase hypoglycemia risk if used with insulin.
The document discusses the role of DPP-4 inhibition and sitagliptin in the management of type 2 diabetes. It provides evidence that sitagliptin increases active GLP-1 and GIP levels, resulting in improved glycemic control through increased insulin secretion, decreased glucagon levels, and reduced glucose levels. Studies show sitagliptin to be an effective monotherapy and when added to other oral medications, with benefits seen within days and a generally well-tolerated safety profile compared to sulfonylureas.
The document summarizes newer oral hypoglycemic agents (OHAs) and insulin for the treatment of diabetes. It discusses the evolution of OHAs from the first drugs introduced in the 1920s to newer drug classes in the 1990s and 2000s, including thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists. It also reviews the history of insulin therapy from its discovery in 1921 to newer insulin analogs. The document provides details on the mechanisms of action, uses, side effects and trial results of these newer diabetes drugs.
Imeglmin Slides agents in Types 2 Diabetes Mellitusameetrathod4
1) Imeglimin is a novel oral anti-diabetic drug approved in Japan for the treatment of type 2 diabetes. It has a unique dual mechanism of action of increasing insulin secretion and improving insulin sensitivity.
2) Clinical trials have shown imeglimin to be effective in reducing HbA1c both as monotherapy and in combination with other oral anti-diabetic drugs. It has also demonstrated efficacy when added to insulin therapy.
3) Imeglimin was generally well tolerated in clinical trials. The most common side effects reported were hypoglycemia, gastrointestinal disorders, and upper respiratory tract infections.
- The document discusses the use of incretin-based therapies like DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes who are not achieving adequate glycemic control on oral medications alone.
- It presents guidelines that recommend starting with basal insulin for patients still above HbA1c targets on dual or triple oral therapy, and then considering adding mealtime insulin, GLP-1 RA, or continuing uptitration of basal insulin if still above targets.
- The case examples show patients started on basal insulin with good initial response but still above goal, so the document discusses options of further uptitrating basal, adding mealtime insulin, or switching to a GLP-1
Glucagon-like peptide 1 (GLP-1) is an incretin hormone that enhances glucose-dependent insulin secretion from pancreatic beta cells. GLP-1 levels are reduced in patients with type 2 diabetes. Therapeutic strategies that augment the GLP-1 pathway include GLP-1 receptor agonists such as exenatide and liraglutide, as well as dipeptidyl peptidase-4 (DPP-4) inhibitors which prevent the breakdown of endogenous GLP-1. These incretin-based therapies lower blood glucose levels with a low risk of hypoglycemia and promote weight loss, offering an important treatment option for patients with type 2 diabetes.
DIABETES MELLITUS AND ANAESTHETIC IMPLICATIONS.pptxrijjorajoo
The document discusses diabetes mellitus and its implications for anesthesia, covering the different types of diabetes, diagnostic criteria, pathophysiology, complications, treatment regimens, and recommendations for perioperative management including maintaining normoglycemia, monitoring blood glucose levels intraoperatively, and using intravenous insulin infusions for patients fasting for longer periods. Special considerations are given to risks of hypoglycemia, infections, and other complications in diabetic surgery patients.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
This document summarizes the key properties of 8 DPP-4 inhibitor drugs used to treat type 2 diabetes: alogliptin, anagliptin, gemigliptin, linagliptin, saxagliptin, sitagliptin, teneligliptin, and vildagliptin. It provides details on their mechanism of action, pharmacokinetic properties like bioavailability and half-life, FDA approval status, and evidence from clinical trials demonstrating their efficacy in reducing HbA1c levels and safety. The document concludes that DPP-4 inhibitors are a promising class of antidiabetic drugs that improve glycemic control without weight gain or hypogly
The document discusses type 2 diabetes mellitus (T2DM) and strategies for achieving glycemic targets. It notes the increasing complexity of T2DM management given the variety of treatment options available and concerns about intensive control. The document summarizes guidelines recommending individualized glycemic targets and avoidance of hypoglycemia. It also reviews studies showing that sitagliptin added to metformin or insulin therapy was effective at lowering blood sugar levels compared to other agents, with a lower risk of hypoglycemia and weight gain.
Here are some key points about adding another agent best suited to the individual:
- α-glucosidase inhibitors like acarbose lower A1C moderately, rarely cause hypoglycemia, are weight neutral or may cause weight loss, and have shown improved postprandial glucose control and cardiovascular outcomes in some studies. They require multiple daily doses with meals.
- DPP-4 inhibitors like sitagliptin, saxagliptin and linagliptin lower A1C moderately, have a low risk of hypoglycemia, are weight neutral, and have generally shown neutral cardiovascular outcomes. They are well tolerated with once daily dosing.
- GLP-1 receptor agonists like exen
This Presentation Give You A brief Information About DPP4 And New Recommendations .This Presentation Guide You How To Treat Patients With Safety.
For Further Contact:03354999496
The document discusses guidelines for initiating insulin therapy in patients with type 2 diabetes not controlled on oral antidiabetic drugs (OADs). It recommends starting with either bedtime intermediate-acting insulin or bedtime or morning long-acting insulin, beginning at a dose of 10 units or 0.2 units/kg. The insulin dose is then titrated up based on fasting blood glucose levels until the target range is achieved. Additional injections of rapid-acting insulin may be added if pre-meal blood glucose levels remain out of range.
Insulin degludec is an ultralong-acting basal insulin analogue administered via once daily subcutaneous injection to help control blood sugar levels in diabetes. It has a duration of action of up to 40 hours, making it suitable as a once-daily treatment. Clinical trials found it to be as effective as insulin glargine at reducing HbA1c levels while having a lower risk of hypoglycemia, especially nocturnal hypoglycemia. Insulin peglispro is an experimental basal insulin consisting of insulin lispro covalently attached to polyethylene glycol. Phase II clinical trials found it reduced blood glucose variability compared to insulin glargine while maintaining similar HbA1c lowering and hypoglycemia rates,
This document discusses the peri-operative management of patients with diabetes who require surgery. It notes that 30-50% of patients with diabetes will require surgery in their lifetime. Key considerations for pre-operative evaluation include assessing diabetes control, complications, medications, and associated conditions. The "threatening trio" of silent heart issues, renal dysfunction, and neuropathy are also discussed. Guidelines are provided for continuing oral medications, insulin and glucose management during the peri-operative period. Evidence around tight glycemic control in the ICU is summarized, noting the risk of hypoglycemia. Maintaining blood glucose between 140-180 mg/dl is now recommended for critically ill patients.
Ueda2016 symposium -t2 dm management - lobna el toonyueda2015
Sitagliptin improves glycemic control in a glucose-dependent manner by increasing concentrations of active incretin hormones like GLP-1. It targets the metabolic defects of type 2 diabetes by improving markers of beta-cell function, reducing hepatic glucose overproduction, and having insulin-sensitizing properties. Studies show sitagliptin is associated with a lower risk of hypoglycemia and less weight gain compared to sulfonylureas when added to metformin. It also provides durable glycemic control with a lower risk of requiring additional antihyperglycemic medications over time.
This document summarizes the management and treatment of diabetes. It discusses:
1) The classification of type 1 and type 2 diabetes, their typical presentations, and diagnostic criteria.
2) Guidelines for initial treatment including lifestyle changes and metformin for type 2 diabetes. Adding sulfonylureas or insulin if glycemic goals are not met.
3) Treatment of type 1 diabetes focuses on intensive insulin therapy to control blood glucose and reduce complications.
4) Screening and treatment of complications like nephropathy, retinopathy, and neuropathy are also covered.
- The patient has type 2 diabetes and stage 3 chronic kidney disease, so metformin was discontinued.
- Liraglutide treatment has been shown to decrease the risk of cardiovascular death but not cause significant weight loss or increase cancer risk.
- Glyburide should be avoided given the patient's low GFR, while linagliptin can be used.
- Most insulins can be used but doses may need adjusting to avoid hypoglycemia risk from prolonged half-lives in kidney disease. Glucagon-like peptide-1 receptor agonists are also options but can increase hypoglycemia risk if used with insulin.
The document discusses the role of DPP-4 inhibition and sitagliptin in the management of type 2 diabetes. It provides evidence that sitagliptin increases active GLP-1 and GIP levels, resulting in improved glycemic control through increased insulin secretion, decreased glucagon levels, and reduced glucose levels. Studies show sitagliptin to be an effective monotherapy and when added to other oral medications, with benefits seen within days and a generally well-tolerated safety profile compared to sulfonylureas.
The document summarizes newer oral hypoglycemic agents (OHAs) and insulin for the treatment of diabetes. It discusses the evolution of OHAs from the first drugs introduced in the 1920s to newer drug classes in the 1990s and 2000s, including thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists. It also reviews the history of insulin therapy from its discovery in 1921 to newer insulin analogs. The document provides details on the mechanisms of action, uses, side effects and trial results of these newer diabetes drugs.
Imeglmin Slides agents in Types 2 Diabetes Mellitusameetrathod4
1) Imeglimin is a novel oral anti-diabetic drug approved in Japan for the treatment of type 2 diabetes. It has a unique dual mechanism of action of increasing insulin secretion and improving insulin sensitivity.
2) Clinical trials have shown imeglimin to be effective in reducing HbA1c both as monotherapy and in combination with other oral anti-diabetic drugs. It has also demonstrated efficacy when added to insulin therapy.
3) Imeglimin was generally well tolerated in clinical trials. The most common side effects reported were hypoglycemia, gastrointestinal disorders, and upper respiratory tract infections.
- The document discusses the use of incretin-based therapies like DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes who are not achieving adequate glycemic control on oral medications alone.
- It presents guidelines that recommend starting with basal insulin for patients still above HbA1c targets on dual or triple oral therapy, and then considering adding mealtime insulin, GLP-1 RA, or continuing uptitration of basal insulin if still above targets.
- The case examples show patients started on basal insulin with good initial response but still above goal, so the document discusses options of further uptitrating basal, adding mealtime insulin, or switching to a GLP-1
Glucagon-like peptide 1 (GLP-1) is an incretin hormone that enhances glucose-dependent insulin secretion from pancreatic beta cells. GLP-1 levels are reduced in patients with type 2 diabetes. Therapeutic strategies that augment the GLP-1 pathway include GLP-1 receptor agonists such as exenatide and liraglutide, as well as dipeptidyl peptidase-4 (DPP-4) inhibitors which prevent the breakdown of endogenous GLP-1. These incretin-based therapies lower blood glucose levels with a low risk of hypoglycemia and promote weight loss, offering an important treatment option for patients with type 2 diabetes.
DIABETES MELLITUS AND ANAESTHETIC IMPLICATIONS.pptxrijjorajoo
The document discusses diabetes mellitus and its implications for anesthesia, covering the different types of diabetes, diagnostic criteria, pathophysiology, complications, treatment regimens, and recommendations for perioperative management including maintaining normoglycemia, monitoring blood glucose levels intraoperatively, and using intravenous insulin infusions for patients fasting for longer periods. Special considerations are given to risks of hypoglycemia, infections, and other complications in diabetic surgery patients.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Presentation10insulin (1).pptx
1.
2. Insulin and Insulin Pumps
Dr Waqar Malik
Consultant Diabetologist
Blakesley Hall, Blakesley Road, Birmingham
9th Jan. 2017
3. Lay Out
• Why glycaemic control is important and what role insulin plays
• Different insulins old and new
• Some tips about dose titration
• Different devices
• Continuous subcutaneous insulin infusion (CSII or 'insulin pump')
4. 1
3
5
7
9
11
13
15
6 7 8 9 10 11 12
Retinop
Neph
Neurop
DCCT Research Group, N Engl J Med 1993, 329:977-986.
RELATIVE
RISK
Mean A1C
6. Effect of A1C On Complications in the UKPDS Study
A1C
Stratton IM et al. BMJ 2000;321:405
0
10
20
30
40
50
60
Myocardial Infarction Microvasc Disease
5.5%
6.5%
7.5%
8.5%
9.5%
10.5%
7. Lessons from the DCCT and UKPDS:
Sustained Intensification ofTherapy is Difficult
DCCT EDIC
(Type 1)
UKPDS (Type 2),
Insulin Group
DCCT/EDIC Research Group. New Engl J Med 2000; 342:381-389
Steffes M et al. Diabetes 2001; 50 (suppl 2):A63
UK Prospective Diabetes Study Group (UKPDS) 33
Lancet 1998; 352:837-853
4
6
8
10
9.0
8.1
7.3
7.9
0 6.5 + 4 + 6 yrs
DCCT EDIC
0
6
7
8
0 2 4 6 8 10 yrs
A1C (%)
Normal
Baseline
A1C (%)
8. 0
2
4
6
8
10
12
14
16
<150 150-175 175-200 200-225 225-50 >250
Mortality
Average Post-operative glucose (mg/dl)
Cardiac-related mortality
Noncardiac-related mortality
Mortality of DM Patients Undergoing CABG
Furnary et al JThoracCardiovasc Surg 2003;123:1007-21
9. 0
5
10
15
20
25
30
35
40
45
0 50 100 150 200 250
Days after inclusion
Cumulative
%
Mortality
(in
hospital
death)
P=0.0009
P=0.026
BG<110
110<BG<150
BG>150
Surgical ICU Mortality
Effect of Average BG
Van den Berghe et al (Crit Care Med 2003; 31:359-366)
13. Adapted from: Atkinson. Lancet. 2002;358:221-229.
Age (y)
Precipitating Event
Beta-cell
mass Genetic
predisposition
Normal insulin
release
Glucose
normal
Overt diabetes
No C-peptide
present
Progressive loss
of insulin release
C-peptide
present
Antibody
17. Adapted from Type 2 diabetes in
adults: management. NICE
Clinical guideline update (NG28)
2015 [Accessed Dec 2015].
a. When prescribing pioglitazone, exercise particular caution if the person is at high risk of the adverse effects of the drug. Pioglitazone is associated with an increased risk of heart failure, bladder cancer and bone fracture. Known risk factors for these conditions, including
increased age, should be carefully evaluated before treatment: see the manufacturers’ summaries of product characteristics for details. Medicines and Healthcare products Regulatory Agency (MHRA)guidance (2011) advises that ‘prescribers should review the safety and
efficacy of pioglitazone in individuals after 3–6 months of treatment to ensure that only patients who are deriving benefit continue to be treated’.
b. Treatment with combinations of drugs including sodium–glucose cotransporter 2 inhibitors may be appropriate for some people at first and second intensification; see NICE technology appraisal guidance 288, 315 and 336 on dapagliflozin, canagliflozin and empagliflozin
respectively. All three SGLT-2 inhibitors are recommended as options in dual therapy regimens with metformin under certain conditions. All three are also recommended as options in combination with insulin. At the time of publication, only canagliflozin and empagliflozin
are recommended as options in triple therapy regimens. The role of dapagliflozin in triple therapy will be reassessed by NICE in a partial update of TA288. Serious and life-threatening cases of diabetic ketoacidosis have been reported in people taking SGLT-2 inhibitors
(canagliflozin, dapagliflozin or empagliflozin)or shortly after stopping the SGLT-2 inhibitor. MHRA guidance (2015) advises testing for raised ketones in people with symptoms of diabetic ketoacidosis, even if plasma glucose levels are near normal.
c. Only continue GLP-1 mimetic therapy if the person has a beneficial metabolic response (a reduction of HbA1c by at least 11 mmol/mol [1.0%] and a weight loss of at least 3% of initial body weight in 6 months).
d. Be aware that, if metformin is contraindicated or not tolerated, repaglinide is both clinically effective and cost effective in adults with type 2 diabetes. However, discuss with any person for whom repaglinide is being considered, that there is no licensed non-metformin-
based combination containing repaglinide that can be offered at first intensification.
e. Be aware that the drugs in dual therapy should be introduced in a stepwise manner, checking for tolerability and effectiveness of each drug.
f. MHRA guidance (2011) notes that cases of cardiac failure have been reported when pioglitazone was used in combination with insulin, especially in patients with risk factors for the development of cardiac failure. It advises that if the combination is used, people should be
observed for signs and symptoms of heart failure, weight gain, and oedema. Pioglitazone should be discontinued if any deterioration in cardiac status occurs.
g. The recommendations in this guideline also apply to any current and future biosimilar product(s) of insulin glargine that have an appropriate Marketing Authorisation that allows the use of the biosimilar(s) in the same indication.
h. A consultant-led multidisciplinary team may include a wide range of staff based in primary, secondary and community care.
- Recommendations that cover
dipeptidyl peptidase-4 inhibitors (DPP-
4i), glucagon-like peptide-1 (GLP-1)
mimetics and sulfonylureas (SUs) refer
to these groups of drugs at a class level
- SGLT-2, sodium-glucose
cotransporter-2
34. Morning vs Bedtime Insulin
Baseline: 9.11.0
Morning
Glargine
Bedtime
Glargine
Bedtime
NPH
-2
-1
0
A1C
Change
From
Baseline
(%)
–1.24
–0.96
–0.84
P<0.001
P=0.008
Adapted from Fritsche A et al, and the 4001 Study Group. Ann Intern Med. 2003:138:952
35.
36.
37.
38.
39. Large push button with low
resistance
Large-scale numbers
1 unit increments
Support shoulder
Maximum dose 50 units
Clear & uncomplicated dial,
dials forward and back
Contains 300 units Novolin®
70/30, NPH, or R
Audible clicks
NovoFine®
disposable needle
Needle storage
compartment
40.
41.
42.
43.
44.
45. Intermediate
NPH/Isophane insulins
Insulatard
Humulin-I
Insuman Basal
Never withdraw insulin from a prefilled pen. Use 50unit (0.5mL) insulin syringes or
attach a safety needle to the insulin pen to administer insulin to patients.
Short-acting
Soluble insulins
Actrapid
Humulin-S
Insuman Rapid
Insulin analogues
Novorapid (insulin aspart)
Apidra (insulin glulisine)
Humalog (insulin lispro)
Long-acting
Abasaglar (insulin glargine)
Lantus (insulin glargine)
Levemir (insulin detemir)
Tresiba (insulin degludec)
Pre-mix/biphasic
Biphasic
NovoMix30
Humalog Mix25
Humalog Mix50
Humulin-M3
Insuman Comb15
Insuman Comb25
Insuman Comb50
INSULIN GUIDE
Combination: Xultophy (liraglutide + degludec)
Standard strength insulin: 100 units/ml. High strength insulin:
Humalog (lispro) 200units/ml and Toujeo (glargine) 300units/ml
55. Bode, et al. Diabetes 52,(Suppl 1), 2003 Abstract 438.
Mean ± 2 SEM
200
160
140
120
100
180
Self-
monitored
BG
(mg/dL)
BB AB BL AL BD AD Midnight 3 AM
CSII (n=93)
MDI (n=91)
56. n=63 in each treatment
0
500
1000
1500
2000
2500
3000
CSII MDI
p = 0.0027
Novo Nordisk, data on file (Study 2155/US)
Measurement of AUC(glu) ≥80 mg/dL
during the 48-hour continuous glucose
monitoring period
†
AUCglu
(mg•hr/dL)
†
58. Continuous subcutaneous insulin infusion (CSII or 'insulin
pump') therapy is recommended as a treatment option for
adults and children 12 years and older with type 1 diabetes
mellitus provided that:
attempts to achieve target haemoglobin A1c (HbA1c) levels
with multiple daily injections (MDIs) result in the person
experiencing disabling hypoglycaemia. For the purpose of this
guidance, disabling hypoglycaemia is defined as the repeated
and unpredictable occurrence of hypoglycaemia that results in
persistent anxiety about recurrence and is associated with a
significant adverse effect on quality of life
or
HbA1c levels have remained high (that is, at 8.5% [69
mmol/mol] or above) on MDI therapy (including, if
appropriate, the use of long-acting insulin analogues) despite a
high level of care.
NICE GUIDANCE
59. CSII therapy is recommended as a treatment option for
children younger than 12 years with type 1 diabetes mellitus
provided that:
MDI therapy is considered to be impractical or inappropriate,
and
children on insulin pumps would be expected to undergo a trial
of MDI therapy between the ages of 12 and 18 years.