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Diabetes Complications Treatment

Hypoglycemia

- Sweating, tremor, tachycardia, anxiety, hunger- MOA: dec. blood glucose  (+ !pi- "ost#prandial (low blood glucose a$ter lunch- %asting (impro&es w' sugar

nsulinoma Hyperinsulinism: benign insulin#producingtumor

- serum insulin ) ug'm* blood glucose - mg'd*(inappropriate high insulin despite low blood glucose

- ele&ated plasma insulin and insulin:glucose- ele&ated proinsulin and / peptide

%actitious Hyperinsulinism: sel$#ingestion o$ insulin(0*"12!

- 3riad o$ Hypoglycemia + Antibodies + Suppressed

plasma / peptide- ele&ated plasma insulin and insulin:glucose ratio

0lucagon:Use:

- Hypoglycemia- Severe hypoglycemia (1mg IV)- n!ocrine !iagnosis- 4eta#bloc5er O2 (inc" c#$% in heart) 

increase! ins&lin release  Hypoglycemia- 'a!iology o boel (rela*es intestine)

2extrose: Use: Hypoglycemia+ D,#

2ia6oxide: To*icity: hyperglycemia+ etoacitosis

$ patient is conscious (78 40*  oral

glucose

$ patient is unconscious (- 40*  

0lucagon

Surgery: remove ins&linoma

2iabetic 9etoacidosis   2M type

- nc. plasma glucose (- mg'd*, H+, 5etones, 9+- 2ec. H/O, ntracellular 9+

- "recipitated by: insu;cient insulin therapy, in$ection,emotional stress, excess alcohol use- "resents w' $ruity odor o$ acetone on breath

< regular insulin

< =uids

2extrose

4alance electrolytes, 9+

Hyperosmolar coma' Hyperosmolar Hyperglycemic >on#9etotic Syndrome (HH>S   2M type

- "recipitated by: in$ections, stro5es, M, elderly, 2M- 2iagnosis: blood glucose 7? mg'd*, high serum osmolality, high 4@>, no 5etosis- 2ue to 2ecreased nsulin ncreased 0lucagon

0lut  beta cell

- Higher 9m (lower a;nity allows the muscles to utili6ed glucose

Brst.o >eed high amount o$ glucose to stimulate

0lut -  muscle cells

- *ower 9m (higher a;nity allows muscles to utili6e any small

amount o$ glucose.

0lucose  0*@3  enters beta cell  glucose metabolism inside

cell  inc. A3"  closure o$ 9+ channels  inc. 9+ inside cell

depolari6ation stimulation' opening o$ /a++ channels  /a++ into beta cell  degranulation  

release insulin into circulation

- CD'D >"H'regular insulin

- ED'ED >"*'*ispro insulin

- CED'ED >"*'*ispro insulin

- CD'D >"A'Aspart insulin

Note: insulin glargine and detemir must be gi&en as

separate inFections.

nsulin indications:- 2M (?' gestational  2rug o$ choice $or

0estational- 29A

- Hyperglycemia ' >on#9etotic /oma

How do you gi&e the insulin shotG $ u want to gi&e

units' day you ha&e to gi&e ' o$ the daily dose in the morning and gi&e the remaining ?' at

night. 3his is to a&oid hypoglycemia which could be caused by inc. acti&ity and $ood during the day

Dr&g &se! to treat

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 Type II D$ Dr&gs:

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1st  gen.

Sulfonylurease

(not used

clinically due to

A!

 Tobl&tami!e Short t1./" In!icate! . el!erly an!

renal !ys&nction

MOA: 4loc5 9+ channels

beta cells  cell

depolari6ation /a+ in=ux

 nsulin granule release

@se: 3ype 2M (need wor5ing4eta cell

/ontraindication: hepatic

renal insu;ciency

A!: hypoglycemia w' long#

acting drugs, weight gain,

rashes, hypersensiti&ityIx nteractions: inc.

hypoglycemia w' /imetidine,

nsulin, Salicylates,

Sul$onamides

 Tol0ami!e Short t1./

Chlorproprami!e ong !&ration (23h)

#: Dis&l4ram-lie r*n5 SI#DH+

 6a&n!ice+ le&copenia+ 7

thrombocytopenia

2nd  gen.

Sulfonylurease0lipi6ide Short-acting

Sa$e w' mild to mod. renal

dys$unctionDec" !ose in hepatic !ys&nction

0lyburide ong-actingSa$e w' mild#mod. hepatic

dys$unction

Dec" !ose in renal !ys&nction

0limepiride ong-acting+ once.!aily !ose

Meglitinides

(may be ta5en

alone or w'

biguanides

Iepaglinide

>ateglinide (D-phenylalanine)

$8#: Same as Sul$onylureas but mainly stimulates the Brst phase

o$ insulin secretion

Use: %ost-pran!ial hyperglycemia in type / D$" In!icate! in pt" . s&l&r

allergy

9ateglini!e: sae in renal ins&ciency+ loer ris o hypoglycemia

Insulin

sensitizers

4iguanide:

Met$ormin

;&glycemic '* (!oes

not ca&se

hypoglycemia)

;9o eight gain

$8#: (-phosphate DH  (-)

gl&cose o&tp&t rom liverUse: !ec" ins&lin resistance in obese type / !iabetics

#: anorexia, nausea, &omiting, diarrhea+ lactic aci!osis (anion gap)+

vit" ?1/ !e4ciency

Contrain!ications: alcoholism+ renal 7 hepatic !isease+ chronic

car!iop&lmonary !isease+ ra!iographic contrast+ aci!osis

3hia6olidinedion

es:

"ioglita6one'osiglita0one

(#,# =IT#@89S)

$8#: bind ""AI#gamma in nucleus  !ec" ins&lin resistance  inc"

gl&cose &ptae !ec T= levels

#: =uid retention, edema+ inc" ris o HA (especially 'osiglita0one)+

weight gain+ !ec" bone mineral !ensity+ bone ract&res in omen+

hepato!o*iticy

'* interactions: !ec" ecacy o 8C b.c is metaboli0e! by cyt pB3

 Alpha-

glucosidaseinhibitors

Acarbose

Miglitol

$8#: (# J#glucosidase in 03  !ec" gl&cose absorption  !ec"

!eman! or ins&linUse: control post-pran!ial hyperglycemia

#: =I !iscomort+ at&lence+ !iarrhea+ hepatoto*icity

D-!

inhibitorsSitagliptin

Saxagliptin

$8#: (# 2""-  (# 0*"? inacti&ation  inc" =%1 action  inc"

gl&cose-me!iate! ins&lin secretion 7 !ec" gl&cagon lvls

#: naso-pharyngitis+ &pper respiratory inections+ hea!aches+

hypoglycemia+ ac&te pancreatitis+ Foint pain

"#-1 agonist  !xenatide (IV)

*iraglutide (IV)

$8#: (