Ppt.pres.-Word File_dm New Drugs

8/15/2019 Ppt.pres.-Word File_dm New Drugs

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PRESENTATION ON AAN3: DIABETES NURSING

St. Paul University Philippines

Tuguegarao City, Cagayan 3500

GRADUATE SCHOOL PROGRAM

Mater o! S"ien"e in Nuring

DIABETES URSIG

!"ST CETUR# ATI$ DIABETEC DRUGS AD ALTERATI%E DRUGS USED TO

MAAGE DIABETES MELLITUS

DOAH &AI MADRIAGA AGUSTI' R

MSN STUDENT

ELI(ABETH C. BAUA' DS

PRO#ESSOR


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1


21st Century Anti-Diabetic Drugs

Diferent kinds o diabetes pills work in diferent ways to control

your blood sugar (blood glucose).

Combining two diferent kinds o diabetes pills can work better tolower your blood sugar than a single medicine.

But combining two kinds o diabetes pills can make it more likely

that your blood sugar will drop too low (hypoglycemia).

Agents used in diabetic therapy include the following:

1 Sulfonylureas

• Stimulate your pancreas to make more insulin which helps

lower your blood glucose.

Available sulfonylureas include:

• !maryl (glimepiride)

• DiaBeta (glyburide)

• Diabinese (chlorpropamide)

• "lucotrol (glipi#ide)

• "lucotrol $% (glipi#ide long&acting)

• "lynase (glyburide)

• 'icronase (glyburide)• tola#amide

• tolbutamide

o Possible side eects of the sulfonylureas are:

o %ow blood

glucose

o pset stomach

o Skin rash

o eight gain

•

2 Biguanides

• *hese agents are considered the +rst choice or oral type ,

diabetes treatment. *hey reduce hyperglycemia by

decreasing hepatic gluconeogenesis (primary efect) and

increasing peripheral insulin sensiti-ity (secondary efect).

•

• Biguanides are absorbed rom the intestines and are not

bound to plasma proteins. *hey are not metaboli#ed and arerapidly eliminated by the kidneys.

•

•

•


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1


• Available Biguanides include:

• "lucophage

(metormin)

• "lucophage $

(metormin long&acting)

• iomet (metormin

li/uid)


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•

o 0ossible side efects o the biguanides are nausea and Diarrhea

when you are +rst start taking this type o 'edicine.

•

3 Alpha-glucosidase inhibitors

• & !lpha&glucosidase inhibitors work by slowing down the

digestion o oods high in carbohydrate such as

rice potatoes bread milk and ruit.

• !-ailable alpha&glucosidase inhibitors include

• "lyset (miglitol)

• 0recose (acarbose)

•

o Possible side eects of the alpha-glucosidase inhibitors are:

stomach pain, gas, bloating, or diarrhea – these symptoms

usually go away gradually

•

4 Thiazolidinediones (TZs!

• 'ake you more sensiti-e to insulin.

•

• !-ailable thia#olidinediones include

• !ctos (pioglita#one)

• !-andia (rosiglita#one)

•

NOTE:

f you ha!e heart failure" you should not ta#e this type of pill$

This type of pill can cause congesti!e heart failure$ %tudies ha!e shown that A!andia is associated with an

increased ris# for heart attac#s and chest pain or disco&fort

fro& bloc#ed blood !essels$

o Possible side eects of include:

o congestive heart failure is the most serious side eect,

o Anemia,

o an increased risk of getting pregnant even if youre taking birth

control pillso increased risk of bone fracture in women

•

•

•

•

' (eglitinide deri!ati!es

& 'eglitinides stimulate your pancreas to make more

insulin.


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•

• *he only a-ailable meglitinide is

• 0randin (repaglinide)

•

o Possible side eects of Prandin are:

o low blood glucoseo weight gain

o upset stomach

o back pain or a headache

•

) D-*henylalanine Deri!ati!es

& 2elp your pancreas make more insulin /uickly or a short

period o time right ater meals. *he only a-ailable D&

phenylalanine deri-ati-e is Starli3 (nateglinide)•

o Possible side eects of !tarli" are:

o low blood glucose

o weight gain

o di##iness

+ D**-, nhibitors

& %ower your blood glucose by helping your body make

more insulin when it4 s needed especially right ater meals.

5t also helps keep your li-er rom putting stored glucose

into your blood.& Dipeptidyl 0eptidase&6 (D00&6) 5nhibitors are usually

prescribed or people with type , diabetes who ha-e not

responded well to drugs such as metormin and

sulonylureas.

• *he only a-ailable D00&57 5nhibitor is 8anu-ia (sitagliptin)

o *ossible side eects of .anu!ia are:

o runny nose

o sore throat

o 2eadache

•

•

•

•

•

• 2ow do they work9


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• *hey work by blocking the action o D00&6 an en#yme

which destroys a group o gastrointestinal hormones called #ncretins$

*his incretins help stimulate the production o insulin when it is needed

(e.g. ater eating) and reduce the production o gucagon by the li-er

when it is not needed (e.g. during digestion). *hey also slow down

digestion and increase appetite. So by protecting incretins rom

damage D00&6 inhibitors help regulate blood glucose le-els.

/ Co&bination Diabetes *ills

• %$ Actoplus "et is a combination o !ctos (pioglita#one)

and "lucophage (metormin)

• &$ A#anda$et is a combination o !-andia (rosiglita#one)

and "lucophage (metormin)

• '$ A#andaryl is a combination o !-andia (rosiglita#one)

and !maryl (glimepiride)

• ($ uetact is a combination o !ctos (pioglita#one) and

!maryl (glimepiride)

• )$ %luco#ance is a combination o "lucophage

(metormin) and 'icronase (glyburide)

• *$ &anu$et is a combination o 8anu-ia (sitagliptin) and

"lucophage (metormin)

• +$ "etaglip is a combination o "lucotrol (glipi#ide) and

"lucophage (metormin)

ote: one pill helps your body make more insulin$ he other pill

lowers the amount of glucose made by your liver and helps your

insulin work the way it should$

0 ile acid seuestrants

• & Colese-elam is :D! appro-ed as an ad;uncti-e therapy to

impro-e glycemic control in adults with type , diabetes mellitus.

• & Colese-elam is a high&capacity bile acid se/uestrant. 5t is

indicated as an ad;unct to diet and e3ercise to impro-e

glycemic control in adults with type , diabetes mellitus. *he

precise mechanism by which colese-elam impro-es glycemic

control is largely unknown.

13 nsulins

Antidiabetics" 4apid-Acting nsulins

•

4apid-acting insulins ha!e a short duration of action

and are appropriate for use before &eals or when

blood glucose le!els e5ceed target le!els and


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correction doses are needed$ These agents are

associated with less hypoglyce&ia than regular insulin$

•

#nsulin aspart . ovo/og 0• & 5nsulin aspart has a short onset o action o &?> minutes. 5nsulin aspart

is :D! appro-ed or use in insulin pumps.

•

#nsulin glulisine . Apidra 0

• & 5nsulin glulisine has a rapid onset o action o &?> minutes. 5nsulin glulisine is

:D! appro-ed or use in insulin pumps.•

5nsulin inhaled ( !re##a )

• & @rally inhaled rapid&acting insulin in powder

orm.

•

5nsulin lispro (2umalog)

• & 5nsulin lispro has a rapid onset o action o


8/17

• & 5nsulin detemir is indicated or once&

or twice&daily dosing in patients with type 1 or , diabetes

mellitus. *he duration o action is up to ,6 hours.

•

5nsulin "largine (%antus)

• & 5nsulin glargine has an onset o action

o 6&F hours and duration o action o ,6 hours. 0eak

efects occur within 1&1F hours.

Alternati!e (edicines

• So ar scienti+c support or the claim that any

remedy can treat diabetes is lacking. 5tGs important to note

that sel&treating with alternati-e medicine and a-oiding or

delaying standard care may be harmul or your

health. 2ere are some natural treatments that are being

e3plored.

1. "inseng

,. Cinnamon

=. !loe 7era

6. Bitter 'elon

>> study published in Archives of #nternal

2edicine. 5n a small e3periment in-ol-ing nine diabetes

patients and 1> people without diabetes researchers ound

http://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://altmedicine.about.com/od/ginseng/a/american_ginseng.htmhttp://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://altmedicine.about.com/od/ginseng/a/american_ginseng.htm


9/17

that taking !merican ginseng supplements prior to eating

helped keep post&meal blood sugar le-els in check.I

•

2$ Cinna&on& H! couple o studies ha-e ound that

cinnamon impro-es blood glucose

control in people with type ,

diabetes. 5n the +rst study > people

with type , diabetes were di-ided

into si3 groups. *hree groups took

1 = or g o cinnamon a day and

the remaining three groups

consumed 1 = or g o placebo capsules. !ter 6> days all

three doses o cinnamon signi+cantly reduced astingblood glucose triglycerides %D% cholesterol and total

cholesterol.I& H5n another study ? people with type , diabetes (not on

insulin therapy but treated with other diabetes

medication or diet) took either a cinnamon e3tract

(e/ui-alent to = g o cinnamon powder) or a placebo

capsule three times a day. !ter our months there was a

slight but statistically signi+cant reduction in asting blood

glucose le-els in people who took the cinnamon (1>.=)

compared with the placebo group (=.6) howe-er there

was no signi+cant diference in glycosylated hemoglobin

or lipid pro+les.I

•

$ Aloe ,era& !lthough aloe 7era gel is better

known as a home remedy or

minor burns and other skin

conditions recent animal studies

suggest that aloe 7era gel mayhelp people with diabetes.

•

& ! 8apanese study e-aluated the

efect o aloe 7era gel on blood

sugar. esearchers isolated a

number o acti-e phytosterol

compounds rom the gel that were ound to reduce blood

glucose and glycosylated hemoglobin le-els.

•

• Aloe has also been lin#ed with:• J Decreased blood lipids (ats) in patients with

abnormally high le-els o these molecules in the blood (e.

g. some people with type , diabetes) andEor acute

hepatitis (li-er disease)

•


10/17

• J Decreased swelling and aster healing o

wound in;uries.

• . /eg wounds and ulcers are common

complications of diabetes, and they typically take longer

time to heal than in healthy non-diabetic individuals$0

•

• *hese positi-e efects are thought to be due to the

presence o compounds such as lectins mannans and

anthra/uinones.

•

;$ itter (elon$ Bitter melon also known as bitter gourd

or karela (in 5ndia) is a uni/ue

-egetable&ruit that can be used as ood

or medicine.$ 5t is the edible part o the plant

'omordica Charantiawhich is

considered the most bitter among

all ruits and -egetables.

•

• & *he plant thri-es in tropical and subtropical regions

including

• South !merica !sia parts o !rica and the

Caribbean

•

• & *he bitter melon itsel grows of the -ine as a green

oblong&shaped ruit with a distinct warty e3terior & though

its si#e te3ture and bitterness -ary between the

diferent regions in which it grows & and is rich in

-ital -itamins and minerals.

•

8ow does it aect diabetes<

• & 5n addition to being a ood ingredient bitter melon

has also long been used as a herbal remedy or a

range o ailments including type , diabetes.

• & *he ruit contains at least three acti-e substances

with anti&diabetic properties including charantin which

has been con+rmed to ha-e blood glucose&

lowering efect vicine and an insulin&like compound

known as polypeptide-p.

$ *hese substances either work indi-idually or together to

help reduce blood sugar le-els.

• & 5t is also known that bitter melon contains

a lectin that reduces blood glucose concentrations by

http://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.html


11/17

acting on peripheral tissues and suppressing appetite &

si&ilar to the eects of insulin in the brain.

• & *his lectin is thought to be a ma;or actor behind

the hypoglycemic efect that de-elops ater eating bitter

melon.

%cienti9c e!idence

• & 5n 8anuary ,>11 the results o a our&week clinical trial were

published in the 8ournal o Kthno pharmacology which showed

that a ,>>> mg daily dose o bitter melon signi+cantly reduced

blood glucose le-els among patients with type , diabetes

although the hypoglycemic efect was less than a 1>>> mgEday

dose o metormin. LFM

• & @ther older studies ha-e also suggested an association

between bitter melon intake and impro-ed glycemic control while

a report published in the 'arch ,>>F issue o Chemistry and

Biology ound that bitter melon increased cellular uptake o

glucose and impro-ed glucose tolerance. L?M

•

http://www.diabetes.co.uk/body/brain.htmlhttp://www.diabetes.co.uk/body/brain.html


12/17

'$ =enugree#

• & :enugreek is an aromatic plant that has

many uses both culinary N (enugreek is a

key ingredient o curries and other

5ndian recipes) & and medicinal.

• &*he plant which is widely grown in South

!sia Aorth !rica and parts o the

'editerranean has small round lea-es and

also produces long pods that contain

distincti-e bitter&tasting seeds.

• &*he lea-es are either sold as a -egetable (resh lea-es sprouts

and microgreens) commonly known as methi or as an herb

(dried lea-es) while the seeds are used both whole and in

powdered orm as a spice.

• &!s well as being a popular cooking ingredient enugreek has a

number o health bene+ts and is used in both !yur-edic and

traditional Chinese medicine.

•


•

& :enugreek seeds (trigonella oenum graecum) are high insoluble +bre which helps lower blood sugar by slowing down

digestion and absorption o carbohydrates. *his suggests they

may be efecti-e in treating people with diabetes.

• & 'ultiple studies ha-e been carried out to in-estigate

the potential anti&diabetic bene+ts o enugreek.

• & @ these se-eral clinical trials showed that enugreek

seeds can impro-e most metabolic symptoms associated with

both type % and type & diabetes in humans by lowering bloodglucose le-els and impro-ing glucose tolerance.

•

%cienti9c e!idence

• 5n one study researchers in 5ndia ound that adding 1>> grams o

deatted enugreek seed powder to the daily diet o patients with

insulin&dependent (type 1) diabetes signi+cantly reduced

their asting blood glucose le-els impro-ed glucose tolerance and

also lowered total cholesterol %D% or Obad4 cholesterol and

triglycerides.

• 5n another controlled trial incorporating 1< grams o powdered

enugreek seed into a meal eaten by people with type , diabetes

reduced the rise in post&meal blood glucose while a separate

http://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/Diabetes-and-Carbohydrate-diets.htmlhttp://www.diabetes.co.uk/diabetes-and-metabolic-syndrome.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/Diabetes-and-Carbohydrate-diets.htmlhttp://www.diabetes.co.uk/diabetes-and-metabolic-syndrome.htmlhttp://www.diabetes.co.uk/diabetes-and-metabolic-syndrome.html


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study ound that taking ,.< grams o enugreek twice a day or

three months lowered blood sugar le-els in people with mild

but not se-ere type , diabetes.

•


14/17

)$ 7inger

•

$ "inger is the thick knotted underground stem (rhi#ome) o the

plant HPingiber oQcinaleI that has been used or

centuries in !sian cuisine and medicine.

•

$ Aati-e to !rica 5ndia China !ustralia and

8amaica it is commonly used as a spice or

Ra-ouring agent in cooking as an alternati-e

Oherbal4 treatment or -arious ailments such as

nausea and indigestion and or ragrance in soaps and

cosmetics.

•

$ "inger rhi#ome can be used resh dried and powdered or as a

;uice or oil. 5t has a pungent and sharp aroma and adds a strong

spicy Ra-or to ood and drink.

•

•


• 7lyce&ic control

• ! study published in the !ugust ,>1, edition o the natural

product ;ournal 0lanta 'edica suggested that ginger may impro-e

long&term blood sugar control or people with type , diabetes.

• esearchers rom the ni-ersity o Sydney !ustralia ound that

e3tracts rom Buderim "inger (!ustralian grown ginger) rich in

gingerols & the ma;or acti-e component o ginger rhi#ome & can

increase uptake o glucose into muscle cells without using insulin

and may thereore assist in the management o high blood sugar

le-els.

• nsulin secretion

• 5n the December ,>>? issue o the Kuropean 8ournal o 0harmacology researchers reported that two diferent

ginger e3tracts spissum and an oily e3tract interact with

serotonin receptors to re-eres their efect on insulin secretion.

*reatment with the e3tracts led to a =< per cent drop in blood

glucose le-els and a 1> per cent increase in plasma insulin

le-els.

•

+$ O#ra•

$ @kra is ast gaining a reputation as a so&called GsuperoodG or

people with or at risk o diabetes or cancer.

http://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.htmlhttp://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.html


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•

$ @kra is a tall&growing -egetable that traces its

origin rom ancient Kthiopia (!byssinia) through

to Kastern 'editerranean 5ndia the !mericas

and the Caribbean.

•

$ Commonly reerred to as lady+ngers or by its

biological names !belmoschus esculentus and 2ibiscus

esculentus okra is known to ha-e a positi-e efect on blood sugar

control among many other health bene+ts.

•

$ *hese tender pods are -ery low in calories pro-iding ;ust =>

calories per 1>> g and contain no saturated ats or cholesterol.

*hey are also rich in nutrients completely non&to3ic and ha-e no

ad-erse side efects.•


• K-idence o okra ha-ing anti&diabetic properties has increased in

recent years with multiple 7itro (laboratory) and 7i-o (animal)

studies con+rming okra as a potent blood glucose&lowering (or

anti&diabetic) ood.

• 5n one study published ,>11 in the 8ournal o 0harmacy

Bio!llied Sciences researchers in 5ndia ound that diabetic mice

ed dried and ground okra peels and seeds e3perienced a

reduction in their blood glucose le-els while others showed a

gradual decrease in blood glucose ollowing regular eeding o

okra e3tract or about ten days.

• @utside o scienti+c research many people with diabetes ha-e

reported decreasing blood sugar le-els ater soaking cut&up okra

pieces in water o-ernight and then drinking the ;uice in the

morning while in *urkey roasted okra seeds ha-e been used as a

traditional diabetes medicine or generations.

•

/$ O#ra

•

http://www.diabetes.co.uk/diabetes_care/Diabetes_and_blood_glucose.htmlhttp://www.diabetes.co.uk/diabetes-medication/index.htmlhttp://www.diabetes.co.uk/diabetes_care/Diabetes_and_blood_glucose.htmlhttp://www.diabetes.co.uk/diabetes_care/Diabetes_and_blood_glucose.htmlhttp://www.diabetes.co.uk/diabetes-medication/index.html


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$ Banaba is a Rowering plant that grows

in warm climate like the 0hilippines

5ndia and others. Banaba is widely used

in the 0hilippines and as herbal

medicine or diabetes. hile in 5ndia

Banaba is also used as !yur-edic

medicine or the treatment o diabetes.

*he Banaba lea-es and Rowers contain

3orrosolic Acid, a substance being studied or its insulin like efect

o lowering the glucose in the body. Banaba is also being studied

as a weight&loss supplement or its ability to delay or reduce the

absorption o carbohydrates. Banaba is also rich in -itamins and

minerals including #inc and magnesium. Banaba is also rich in

dietary +bers.

•

•

•

•

2ow to use Banaba 2erb or Diabetes

•

*he ollowing details the preparation and application o Banabaherbal medicine or diabetes.

1. Dry Banaba lea-es and ruits or about two weeks.,. Cut Banaba lea-es into pieces=. Boil the dried Banaba lea-es and ruits in water.6. @ne cup o dried banaba lea-es and ruits to one cup water. minutes. Strain the lea-es and ruits.. *ake the Banaba herbal tea or 6 to times daily.

•

E!idence ased-*ractice

'annabis co$pound legally sold in pill for$ for rst ti$e

could pro#ide health benets for people )ith diabetes*

.!eptember &4%)0

• TCannabis pillsT ha-e been legally sold in Kurope or the

+rst time. *he capsules which are a-ailable to buy online

could ofer health bene+ts to people with diabetes.

http://www.diabetes.co.uk/recreational-drugs/cannabis.htmlhttp://www.diabetes.co.uk/blog/2015/07/diabetes-pa-and-the-ten-best-diabetes-apps-available/http://www.diabetes.co.uk/recreational-drugs/cannabis.htmlhttp://www.diabetes.co.uk/blog/2015/07/diabetes-pa-and-the-ten-best-diabetes-apps-available/


17/17

• *here is substantial e-idence to suggest that 3annabidiol

.3B50, a compound ound in cannabis has bene+cial

efects on a number o health conditions including chronic

pain cancer an3iety diabetes epilepsy rheumatoid arthritis

0*SD sleep disorders and heart disease.

• :or people with diabetes research suggests

that CBD reduces the pain o neuropathy and lowers blood

glucose le-els. 5t can also bene+t some diabetic

complications including glaucoma.

• *he pills which are sold by ''8 0hyo*ech o !ustralia do

not pro-ide the ThighT o smoking cannabis which is caused

by tetrahydrocannabinol (*2C). *hey contain only CBD which

is the speci+c compound linked to health bene+ts.

• *he capsules are manuactured in Swit#erland and

registered in "ermany. *hey can be purchased in Kurope on

the companyGs website. ! 1>mg bo3 can be purchased or

UF?.>> (or V>mg bo3 costs U> (or V6,.,,).

%ources:

• httpEEwww.diabetes.co.uk

• httpEEaltmedicine.about.com

• 'edscape.com
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