Diabetes Management: Insulin & Oral Hypoglycemics

Definition: Insulin therapy involves the administration of insulin to manage blood glucose levels in diabetic patients.
Types of Insulin:
- Rapid-acting (e.g., Lispro, Aspart): Onset within 15 minutes, duration of 3-5 hours.
- Short-acting (e.g., Regular insulin): Onset 30 minutes, duration 5-8 hours.
- Intermediate-acting (e.g., NPH): Onset 1-2 hours, duration 10-16 hours.
- Long-acting (e.g., Glargine, Detemir): Onset 1-2 hours, duration up to 24 hours.
Administration: Subcutaneous injection is the most common route.
Monitoring: Requires regular blood glucose monitoring and adjustment of doses based on carbohydrate intake and activity levels.

Classes of Medications:
- Sulfonylureas (e.g., Glipizide, Glyburide): Stimulate insulin release from the pancreas.
- Biguanides (e.g., Metformin): Decrease hepatic glucose production and increase insulin sensitivity.
- Thiazolidinediones (e.g., Pioglitazone): Improve insulin sensitivity in muscle and adipose tissue.
- DPP-4 Inhibitors (e.g., Sitagliptin): Increase incretin levels, promoting insulin secretion and decreasing glucagon levels.
- SGLT2 Inhibitors (e.g., Canagliflozin): Increase glucose excretion in urine by inhibiting SGLT2 in the kidneys.
Side Effects: Can include hypoglycemia, gastrointestinal upset, weight gain, and risk of heart failure with some classes.

Acute Complications:
- Hypoglycemia: Low blood sugar leading to confusion, dizziness, and potential unconsciousness.
- Diabetic Ketoacidosis (DKA): Occurs mainly in Type 1 diabetes, characterized by high blood sugar, ketones in urine, dehydration, and acidosis.
- Hyperglycemic Hyperosmolar State (HHS): More common in Type 2 diabetes, severe high blood sugar without ketosis.
Chronic Complications:
- Microvascular: Nephropathy (kidney damage), retinopathy (eye damage), neuropathy (nerve damage).
- Macrovascular: Increased risk of cardiovascular disease, stroke, and peripheral artery disease.

Blood Glucose Monitoring: Importance of regular self-monitoring of blood glucose levels.
Diet and Nutrition: Emphasis on balanced diet, carbohydrate counting, and healthy food choices.
Exercise: Regular physical activity to improve insulin sensitivity and overall health.
Medication Adherence: Importance of taking medications as prescribed and understanding their side effects.
Recognizing Symptoms: Training on recognizing symptoms of hyperglycemia, hypoglycemia, and other complications.

GLP-1 Receptor Agonists: New classes of medications that enhance glucose-dependent insulin secretion and promote weight loss (e.g., Liraglutide, Semaglutide).
Novel Insulin Formulations: Development of biosimilar insulins and more stable insulins for flexible dosing.
Combination Therapies: Use of fixed-dose combinations to simplify treatment regimens.
Smart Insulin Delivery Devices: Advancements in insulin pens and pumps that allow for better control and convenience.
Bariatric Surgery: Emerging evidence supporting its efficacy in treating Type 2 diabetes in obese patients.

Multiple classes of medications are available to manage blood sugar.
Sulfonylureas stimulate the pancreas to release insulin.
Biguanides decrease liver glucose production and improve insulin sensitivity.
Thiazolidinediones improve insulin sensitivity in muscle and fat.
DPP-4 inhibitors increase incretin levels, promoting insulin secretion and decreasing glucagon levels.
SGLT2 inhibitors increase glucose excretion in urine.
Side effects include hypoglycemia, gastrointestinal upset, weight gain, and potential heart failure risk.

Acute complications include hypoglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar state (HHS).
Hypoglycemia occurs when blood sugar is too low.
DKA is a dangerous condition mainly in Type 1 diabetes characterized by high blood sugar, ketones in the urine, dehydration, and acidosis.
HHS is more common in Type 2 diabetes and involves severe high blood sugar without ketosis.
Chronic complications include microvascular and macrovascular complications.
Microvascular complications involve nephropathy (kidney damage), retinopathy (eye damage), and neuropathy (nerve damage).
Macrovascular complications include increased risks of cardiovascular disease, stroke, and peripheral artery disease.

Blood Glucose Monitoring: Regular self-monitoring of blood glucose levels is essential.
Diet and Nutrition: A balanced diet, carbohydrate counting, and healthy food choices are paramount.
Exercise: Regular physical activity is crucial to improving insulin sensitivity and overall health.
Medication Adherence: It is important to take medication as prescribed and understand its side effects.
Recognizing Symptoms: Learning to recognize symptoms of hyperglycemia, hypoglycemia, and other complications is key.

GLP-1 receptor agonists are a new class of medications that enhance glucose-dependent insulin secretion and promote weight loss.
Development of biosimilar and more stable insulins for flexible dosing.
Fixed-dose combination therapies simplify treatment regimens.
Smart Insulin Delivery Devices improve control and convenience.
Bariatric surgery is emerging as a potentially effective treatment for Type 2 diabetes in obese patients.