This document provides information about insulin and diabetes mellitus. It discusses that insulin is released by the pancreas in response to increased blood glucose levels and causes glucose to be taken up and stored or used for energy. It describes the two main types of diabetes - type 1 which results from immune destruction of pancreatic beta cells requiring insulin treatment, and type 2 which involves insulin resistance and relative insulin deficiency. It outlines treatments for both types including various insulin regimens for type 1 and oral hypoglycemic agents and lifestyle changes for type 2.

1. Pharmacology
Endocrine system part3
Slide 29

2. Introduction
• When blood glucose rises this will lead to release
insulin from the β-cells in the pancreas which
causes glucose to be taken up into the tissues,
where it converted into energy stored as liver
glycogen and fat or used to generate metabolic
energy.
• Insulin is the only endocrine hormone which is
hypoglycemic, the others like (glucagon,
glucocorticoids and thyroid hormones are all
hyperglycemic.

3. Introduction
• Insulin : released from pancreas as a response
to increase in blood glucose levels.
What insulin do to the body?
• Stimulate the uptake of glucose by the tissues
• Convert glucose to glycogen in the liver.
• Increase the production of fat and protein.

4. Introduction
What the mechanism of action of insulin?
• Insulin binds to a specific receptor on cell
membranes and this triggers the cell’s response.
• An important response is the transport of
glucose and other sugars away from the blood
and into the cell.
• Glucose transported to cells by glucose
transporters where the insulin increase the
activity of these transporters.

5. Diabetes Mellitus
• Is a disorder in which blood level of glucose is
abnormally high bcz the body doesn’t release or
use insulin properly.
Types of DM:
1- Insulin-dependent DM (type1)
2- Non-insulin-dependent DM (type2)

6. Insulin-dependent DM (IDDM) type1
• Is an autoimmune disease where immune
system and destroy the beta cells.
• Occur predominantly between young people
with many signs and symptoms which may
• include: polyuria, polydipsia, polyphagia,
acidosis and weight loss.
• The only treatment is the insulin.

7. Non-insulin-dependent DM (NIDDM)
type2
• Predominantly occur in middle-age and
elderly.
• In the type of diabetes appears to be resistant
to the action of insulin coupled with a
deficiency of the hormone due to exhausted
pancreas.

8. Treatment of type1
Treatment with insulin:
• 1- short-acting insulin (soluble insulin)
• (Actrapid®),(Humulin-R®):
• It is only insulin available as suitable for I.V
injection.
• Use to treat diabetic coma or in severe illness in
diabetic patients.
• Can be given S.C and it started after 30 min and up
to 8 hours
• But as I.V it’s action start rapid but still up to 30
min.

9. Treatment of type1
• 2- intermediate-acting insulin:
• A. Insulin Zinc suspension:
• Two types of insulin prepared :
• 1- amorphous were the particles are small, and
the action is rapid and short lived.
• 2- crystalline, which is formed with large
particles to get prolonged action.
• Examples: Human monotrad (30% amorphous,
70% crystalline

10. Treatment of type1
• B. Biphasic isophane-insulin:
• Consist of insulin mixed with isophane.
• Example: Human Mixtard.
• C. Insulin Glargine (Lantus®):
• Preparing insulin as acidic solution that is given
S.C once daily at bed time.
• Onset of action starts after 3-4 hours.

11. Treatment of type1
• 3- Long acting insulin:
• Protamine-Zinc insulin (PZI)
• Produced by adding zinc and protamine to insulin
and it action starts after 6 hours and still for 24-30
hour.
• Once daily dose.
• Notes:
• -insulin should be stored in the fridge, but the bottle
that is currently used can be at room temperature to
1 month.
• best site of injection: thighs, the abdomen wall,
and outer side of upper arm.

12. Sites of injection

13. Treatment of type 2
• Main objective is to prevent the late complications
which may include neuropathy, retinopathy, renal
failure, vascular diseases and M.I.
• Initial treatment is changing the diet to reduce the
patient weight.
• And regular exercises depending on patient stage
and ability to perform exercises.
• If these measured failed oral agents should be
administrated.

14. Treatment of type 2
oral hypoglycemic agents
• A. the sulphonylureas:
• Lowers blood glucose by increasing insulin
production by the pancreas and by increasing the
sensitivity of cells to insulin.
• All drugs of this class given orally.
• Examples :
• 1. Glibenclamid (Daonil®), Gliclazide
(Diamicron®), Glipizide:
• Mostly used, it effect last for about 24 hours.
• Rarely cause hypoglycemic episodes.
• Once or twice daily.

15. Treatment of type 2
oral hypoglycemic agents
• A. sulphonylureas:
• 2. Tolbutamide:
• Very safe ,and the duration is about 6 hours, it is
recommended in elderly as the risk of
hypoglycemia is high.
• 3. Choropropamide (Diabenase®):
• Longer duration than Tolbutamide.

16. Treatment of type 2
oral hypoglycemic agents
• B. Metformin (Glucophage®):
• Belong to a group called biguanides.
• Actions of metformin:
• It reduces glucose absorptions from gut.
• Inhibit gluconeogensis
• Stimulate glucose uptake by the muscle.
• Reduce glucose release from liver.
• Don’t cause weight gain

17. Treatment of type 2
oral hypoglycemic agents
• C. Thiazolidinediones:
• Work by reduce tissue resistance to insulin.
• They usually combined with either metfromin or
sulfonylureas.
• Examples :
• - Pioglitazone (Actos®)
• -Rosiglitazone (Avandia®) withdrawn from
the market in 2010 due to heart failure cases.

18. Treatment of type 2
oral hypoglycemic agents
• D. Prandial glucose regulators:
• Deal with the rise of blood glucose that happen
after meals
• Stimulate insulin release from pancreas only
when blood glucose levels are high.
• Taken orally and before meals.
• Omitted if meals are missed.
• Examples: Nateglinide, Repaglinide.

19. Treatment of type 2
oral hypoglycemic agents
• E.Acarbose:
• Inhibit an enzyme in the intestine called α-
glucosidase which convert carbohydrates into
glucose.
• Taken orally.
• Doesn’t interfere with glucose absorption.

20. Glucagon
• Is a hormone released from the alpha cells of the
pancreas.
• Action of glucagon:
• Stimulate gluconeogensis
• Inhibit glycogen synthesis
• Inhibit glucose oxidation.
• Decrease insulin release
• Increase break down of muscles
• Increase lipolysis
Taken I.V, I.M, S.C

21. Signs and symptoms of hypoglycemia
• Faintness
• Dizziness
• Tremor
• Sweating
• Convulsions
• If not treated  coma occur