Diabetes Management Quiz

Anti-Diabetic Drugs

• Anti-diabetic drugs are used to manage diabetes.
• Diabetes mellitus involves elevated blood glucose levels.
• Types of diabetes include Type 1, Type 2, and gestational diabetes.
• Diabetic comas include hypoglycemic coma and diabetic ketoacidosis.

Diabetes Mellitus: Definition

• Diabetes mellitus is characterized by either absent or inadequate pancreatic insulin secretion or impairment of insulin actions.
• Elevated blood glucose levels are a key indicator of diabetes mellitus.

Diabetes Mellitus: Classification

• Type 1 diabetes is also known as IDDM (Insulin-Dependent Diabetes Mellitus).
• Type 2 diabetes, also known as NIDDM (NonInsulin-dependent Diabetes Mellitus) is the most common type and often related to the long-term use of corticosteroids.
• Gestational diabetes occurs during pregnancy.
• Diabetes can also be caused by drugs, such as glucocorticoids.

Diabetes Mellitus: Management

• Diet regulation with caloric restriction, especially for obese Type II patients, is a key component of management.
• Physical exercise plays an important role.
• Medications, including insulin therapy and oral antidiabetic agents, are a crucial part of diabetes management.

Insulin Release

• Glucose triggers insulin release from pancreatic beta cells.
• Sulfonylurea drugs facilitate insulin release by blocking potassium channels, leading to depolarization.
• The process involves ATP, potassium channels, calcium influx, and exocytosis.

Insulin Therapy: Mechanism of Action

• Insulin acts on tyrosine kinase receptors.
• This action affects metabolic enzymes, controlling carbohydrate, fat, and protein metabolism.

Insulin Therapy: Pharmacological Actions

• Insulin regulates carbohydrate metabolism by decreasing hepatic glucose production and increasing glucose uptake in muscles and fat cells.
• Insulin influences fat metabolism by promoting fat storage.
• Protein metabolism is also affected by insulin, stimulating protein storage.

Insulin Preparations

• Different types of insulin preparations exist with varied durations of action (e.g., ultra-short-acting, short-acting, intermediate-acting, long-acting).
• Ultra-short-acting insulins, such as Lispro, Aspart and Glulisine, typically have a rapid onset and shorter duration of action.
• Intermediate-acting insulin include Isophane NPH insulin.
• Long-acting preparations, such as Insulin glargine, and Detemir insulin, have a prolonged duration of action.
• The duration of action of an insulin preparation is important for adjusting dosages to maintain optimal blood sugar levels.

Insulin Delivery Systems

• Insulin can be delivered by various methods including standard subcutaneous injections, portable pen injectors, continuous subcutaneous infusion devices, and inhaled insulin.
• Portable pen injectors are a convenient method for self-administered insulin.
• Continuous subcutaneous infusion devices, or insulin pumps, offer a more continuous delivery of insulin.
• Inhaled insulin is a recent alternative delivery method.

Indications of Insulin Therapy

• Insulin therapy is indicated in several situations, particularly when dietary regulation and oral medication are ineffective in managing diabetes.
• It may be needed in cases of diabetes with stress, surgery, infection, pregnancy, lactation, severe renal or liver disease, or hyperkalemia.

Adverse Effects of Insulin

• Hypoglycemia, a decrease in blood glucose level, is a significant adverse effect.
• Insulin resistance can occur and weight reduction is often prescribed to overcome this resistance.
• Lipodystrophy is a local effect where fat changes occur at the injection site.
• Allergy is a rare but possible adverse effect, especially with some insulin types.
• Some studies have suggested that there is increased risk of certain types of cancers in individuals using insulin.

Oral Antidiabetic Agents

• Different classes of oral anti-diabetic agents exist including those that enhance insulin action In peripheral tissues, and those that enhance endogenous secretions.

Sulfonylureas (SU)

• Sulfonylureas are a class of oral antidiabetic drugs that enhance insulin secretion.

Sulfonylureas (SU): Mechanism of Action

• Sulfonylureas stimulate insulin release by closing ATP-sensitive potassium channels.
• This action depolarizes the cell membrane, leading to calcium influx, and ultimately insulin release.

Sulfonylureas (SU): Indications

• Sulfonylureas are used to treat non-obese individuals with Type 2 diabetes who do not respond sufficiently to other treatments or who have had diabetes for 5-10 years.

Sulfonylureas (SU): Adverse Effects

• Common adverse effects include hypoglycemia, hypersensitivity, and weight gain.
• Some individuals might experience cholestatic jaundice, disulfiram-like effects (e.g., vomiting, flushing), or dilutional hyponatremia, with certain drugs in this class.

Non-SU Secretagogues (Glinides)

• These drugs are like sulfonylureas, but they have a quicker onset and shorter duration of action.
• They are helpful for controlling post-meal blood sugar spikes.

Biguanides (Metformin)

• Metformin is an antidiabetic that impacts hepatic glucose production, improves glucose use in muscle and adipose tissues, and enhances intestinal glucose absorption.

Biguanides (Metformin): Side Effects

• Common side effects include gastrointestinal issues such as metallic taste, nausea, bloating, and diarrhea.
• Lactic acidosis, a serious but less frequent side effect, potentially occurs in individuals with renal impairment.
• Metformin may also interfere with vitamin B12 absorption and can cause deficiencies.

Thiazolidinediones (TZDs):

• Thiazolidinediones, or TZDs, enhance insulin action in peripheral tissues, particularly in skeletal muscle and adipocytes.

Thiazolidinediones (TZDs): Mechanism of Action

• TZDs work by activating peroxisome proliferator-activated receptor gamma (PPAR-γ) receptors, which improves insulin sensitivity.

Thiazolidinediones (TZDs): Adverse Effects & Precautions

• Common adverse effects include weight gain, edema, heart failure, and anemia.
• TZDs should generally be avoided in individuals with compromised liver function.

Incretin Therapy

• Incretins are gut hormones that enhance insulin secretion in response to food intake.
• The incretin effect is reduced in individuals with Type 2 diabetes.
• Drugs stimulating incretin effects and slowing down the enzyme (DPP4) are used to address this reduction.

Comas in DM: Hypoglycemic Coma

• Warning signs include elevated heart rate, sweating, tremors, and hunger pain.
• Neurological signs include weakness, irritability, dizziness, confusion, and convulsions.
• Treatment involves rapid administration of 50% glucose intravenously or glucagon subcutaneously.

Comas in DM: Diabetic Ketoacidosis (DKA)

• DKA is characterized by severe insulin deficiency, often resulting from stopping insulin therapy or increased stress (e.g., infection, illness).
• Warning signs include polyuria, vomiting, and dehydration, and ultimately progressing to coma.
• Investigations typically measure blood glucose, ketones, and other metabolic parameters.
• Management includes fluid replacement, regular insulin infusions, potassium replenishment, and addressing acidosis if needed.

Test your knowledge on diabetes management strategies, the differences between Type 1 and Type 2 diabetes, and the roles of insulin in treatment. This quiz covers essential topics regarding diabetes, including causes, complications, and therapy methods.