Leigheas air Diabete Mellitus

Diabete Mellitus Treatment

• Diabete Mellitus is treated with insulin and oral hypoglycaemic drugs.

Types of Diabetes Mellitus

• Type 1: Insulin-Dependent Diabetes Mellitus (IDDM)
• Type 2: Non Insulin Dependent Diabetes Mellitus (NIDDM)
• Type 3: Gestational Diabetes Mellitus
• Type 4: Drug induced Diabetes Mellitus

Drugs

• Diazoxide
• Phenytoin
• Vinblastine
• Colchicine

Pancreas

• Pancreas is both an exocrine and endocrine gland.
• Endocrine pancreas consists of 1 million Islets of Langerhans.
• Islets contain four types of cells producing hormones:
  • Alpha (A) cells: 20%, Glucagon, Proglucagon
  • Beta (B) cells: 75%, Pro-insulin, Insulin, C-peptide, Islet Amyloid Polypeptide (IAPP), amylin
  • Delta (D) cells: 3-5%, Somatostatin
  • G cells: 1%, Gastrin
  • F cells: 2%, Pancreatic polypeptide (PP)

Insulin Secretion

• Insulin is released by pancreatic beta cells at a low basal rate.
• Release increases dramatically in response to various stimuli.
• Inhibitory signals also affect insulin secretion.

Chemistry of Insulin

• Insulin is a small protein.
• Molecular weight: 5808
• Contains 51 amino acids in two chains (A & B), linked by disulphide bridges.
• Entire human pancreas contains 8 mg insulin (approximately 200 biological units).

Stimulating Insulin Release

• Increased glucose concentration increases intracellular ATP levels.
• ATP dependent potassium channels close.
• This leads to depolarization of beta cells and opening of Ca2+ channels.
• Increased intracellular calcium triggers insulin secretion.

Insulin Receptors

• Insulin receptors are located on cell membranes.
• Structure: Alpha and beta subunits
• Insulin binds to the extracellular site.
• Intracellular tyrosine kinase is activated.

Insulin Receptor Substrates (IRS)

• IRS molecules are phosphorylated.
• Activating further kinases within the cell's signaling networks.
• Insulin action includes translocation of glucose transporters (especially GLUT4).

Types of Insulin

• Rapid-acting: Insulin lispro, Insulin Humalog, Insulin Aspart, Glulisine, Apidra (onset 5-15 minutes, short duration)
• Short-acting : Regular Novolin R, Regular Humulin R (rapid onset of action)
• Intermediate acting : NPH Humulin N, NPH Novolin N
• Long-acting : Insulin detemir, Levemir, Insulin glargine, Lantus (slow onset of action)

Insulin Delivery Systems

• Portable pen injections
• Continuous subcutaneous insulin infusion devices (CSII)
• Inhaled insulin (pumps)
• Transdermal patch

Insulin-Lispro, Insulin-Aspart and Insulin Glulisine

• Very fast onset (5-15 minutes)
• Short duration.
• Taken immediately before meals
• Mimic normal endogenous prandial insulin secretion, reducing risk of late post-meal hypoglycemia.
• Duration rarely longer than 3-5 hours.

Insulin Glargine

• Slow onset (1-1.5 hours)
• Maximum effect after 4-5 hours.
• Maximum activity maintained for 11-24 hours.
• Used once or twice daily.
• Acidic in nature, shouldn't be mixed with other insulins.

Pre-mixed Insulin Formulations

• 70/30, NPH and Regular
• 50/50, NPH and Regular
• Insulin Lispro and Aspart can be mixed with NPH, Lente or Ultra lente insulin.

Complications of Insulin Therapy

• Hypoglycemia (low blood sugar) due to imbalanced insulin, food intake or exercise.
• Symptoms of mild hypoglycemia include hunger, nervousness or a fast heart rate.
• More serious cases of hypoglycemia can cause confusion and loss of consciousness.
• Immuno-pathology: At least five insulin antibodies may be produced during treatment, (IgA, IgD, IgE, IgG, IgM)
• Insulin Allergy: Urticaria due to histamine release.
• Immune insulin resistance: Some IgG anti-insulin antibodies neutralize insulin actions.
• Lipo-dystrophy: At injection sites.

Emergency and Long-term Complications

• Emergency : Diabetic ketoacidosis, hypoglycemia
• Long-term : Peripheral vascular disease, Diabetic retinopathy, nephropathy, neuropathy, diabetic foot problems, skin or mucous membrane issues, hyperlipidemia, hypertension, atherosclerosis, and coronary disease.

Drugs With Hypoglycemic Effects

• β-blockers, salicylates, indomethacin, naproxen, ethanol
• Angiotensin-Converting Enzyme Inhibitors (ACEIs)
• Theophylline, bromocriptine
• Mebendazole, sulfonamides
• Sulbactam, ampicillin
• Tetracycline, pyridoxine

Drugs With Hyperglycemic Effects

• Epinephrine, glucocorticoids
• Diuretics, atypical antipsychotics
• HIV-1 protease inhibitors (ritonavir, lopinavir, aprenavir, h)
• Diazoxide, Clonidine
• β₂ Adrenergic receptor agonists
• Ca2+-channel blockers
• H₂-receptor blockers
• Morphine, heparin, phenytoin
• Nalidixic acid, sulfinpyrazone

Bheir an quiz seo sùil air leigheasan airson Diabete Mellitus agus na diofar types de ghalar. Cuiridh e an cèill na h-aireag a th' ann air insulin agus drogaichean hypoglycaemic. Bidh e cuideachd a' toirt seachad freagairtean mu dhrogaichean agus struchtair an pancreas.