drugs used in diabetes- mr. panneh

DRUGS USED IN DIABETES.

MR. ABDOU MARAM PANNEH

(RM ,FWACN,NT, RN)

INTRODUCTIONDiabetes is a group of metabolic disorders of carbohydrate

metabolism in which there is a defect in insulin secretion, insulin action, or a combination of both factors resulting in a high blood glucose level. (hyperglycemia)

The situation is that; there is either no insulin, or little insulin secretion, or the insulin secreted have no or little effect on the carbohydrates, or there is a combination of both.

Insulin is a hormone produced by the pancreas and being secreted by the beta cells of the islet of Langerhans. It controls the level of glucose in the blood by regulating its production, absorption and storage. It allows the glucose to enter the cells for energy, suppress excess glucose production in the liver and muscles, and excess breakdown of fat for energy.

Two major types of Diabetes are identified:-Type I:- characterized by destruction of pancreatic beta cells.Type II:- characterized by insulin resistance by the tissues

and impaired insulin secretion.

COMMON ANTIDIABETES DRUGS USED:-

1.ANTIGLYCEMICS:They prevent hyperglycemia by decreasing insulin resistance

and decreasing glucose production in the liver.They are mainly used as monotherapy in the treatment of Type

2diabetes but can also be used in combination therapy with insulin in type 1 diabetes.

TYPES OF ANTIGLYCEMICS:-a). The Biguanides:- They facilitate insulin action on the

receptor sites and reduces hepatic production of glucose.This means they are effective with a functional pancreas.

ADR:- abdominal discomfort, diarrhea, metallic taste, sweating, headache, lactic acidosis.

DRUGS USED:-- Metformin (Glucophage) 500mg. 1000mg.given daily, twice or

three times based on the level of glucose.


TYPES OF ANTIGLYCEMICS Cont’d:-b) Alpha-Glucosidase Inhibitors:- they delay the absorption of

glucose in the intestinal system resulting in a lowering of blood glucose level.

ADR:- Flatulence, bloating, diarrhea, reduction of hematocrit level.DRUGS USED:-- Acarbose (Precose) 50mg, 100mg- Miglitol (Glyset)c) Thiazolidinediones:- they enhance insulin action at the cell

receptor and post-cell receptor site and decrease insulin resistance. They can be used with dietary control

ADR:- weight gain, peripheral edema, GIT discomfort, increase in plasma level.

DRUGS USED:-- Pioglitazone (Actos) 15mg, 30mg, 45mg tabs- Rosiglitazone (Avandia) 2mg, 4mg, 8mg.


2. HYPERGLYCEMIC HORMONES These are produced in the alpha cells of the

pancreas. Serum blood glucose level is raised by breaking down stored glycogen in the liver and muscles and synthesis of glucose.

These hormones are secreted normally in response to hypoglycemia for the concurrent release of insulin and catecholamine.

ADR:- Hypoglycemia, weight gain.

TYPES OF HYPERGLYCEMIC HORMONES

a) INSULIN THERAPY:-

Helps to facilitate the uptake and utilization of glucose by muscles, fat and liver cells.

DRUGS USED:-1.Rapid-acting:- Works in 10-20mins after administration.

Peaks in 45-90mins. Should be given 1hr before food. Therapeutic duration is 3-5hrs.

EXAMPLES:-Insulin Lispro Humalog)InsulinAspart (Novolog)Glulisine (Aspidra)

ii.Short-acting:- Works in 30-60mins after administration. Peaks in 2-4hrs. Therapeutic duration is 10-16hrs.

EXAMPLES:-Insulin Soluble Regular®


TYPES OF INSULIN Cont’d..iii. Intermediate-acting:- Works 1-4 hours after administration.

Peaks in 8-12hrs. Therapeutic duration is 10-16hrs.EXAMPLES:- NPH (N) , Lente (L)iv. Long-acting:- works in 4-6hrs. Peaks in 18-20hrs. Therapeutic

duration is 24-36hrs.EXAMPLES:-

Ultralente (Lantus,UL)Detemir (Levemir)

v. Very long-acting:- Starts work in 1hour.Lowers glucose for 24hrs and therapeutic duration is 12hrs.

EXAMPLES:- insulin Gargine (Lantus)Insulin Isophane.

vi. Premix:- starts work in 30mins,peaks in 8-12 hrs and therapeutic duration is 16-24hrs.


B) SULFONYLUREAS:They directly stimulate the pancreas to secret insulin.

Therefore, they require a functioning pancreas. They are divided into two:- First Generation and Second Generation.

ADR:- Hypoglycemia, weight gain, skin rash, GIT disturbances.

EXAMPLES:i) First generation Sulfonylureas:- rarely used now.

Tolbutamide (Orinase) 250mg, 500mg.Acetahexamide (Dymelor) 250mg, 500mgTolazamide (Tolinase)100mg, 250mg, 500mgChlorpamide (Daibinese)

COMMON ANTIDIABETES DRUGS USED:-ii) Second Generation Sulfonylureas:- commonly used.

Glipizide (Glucotrol 5MG, 10MGGlyburide (DiaBeta, Glynase, PresTab, Micronase)1.25mg,

2.5mg, 5mg, 6mgGlimipiride (Amaryl) 1mg, 2mg, 4mgGlibenclamide (Daonil) 5mg, 10mg

C. MEGLITINIDES These agents stimulate insulin release form the pancreatic

beta cells.ADR:- Hypoglycemia, weight gain, headache, upper respiratory

infections.EXAMPLES:-

Meglitinide (Repaglinide) 0.5mg, 1mg, 2mg.Neteglinide (Starix) 60mg, 120mg

REFERENCES

Basic and Clinical Pharmacology. Bertram G. Katzung.Pharmacology. H. P Rang, M. M. Dale, J. M. Ritter, P. K. Moore.Pharmacology. 2005. Lippincott Willians and Wilkins.Basic Clinical Pharmacokinetics. Fourth Edition. Lippincott

Willians and Wilkins.British National Formulary 2009, London WC1H 9JP, UKGoodman and Gilman`s. The pharmacological basis

therapeutics.Morton J.R(BSN,PH.d.), Dorothy W.S.- Pharmacology and drug

therapy in nursing. J.B Lippicott company. Toronto, USA.Hall.J.W.: Drug therapy in infectious diseases. Am.J. Nursing,

61:56. 1961The Gambia Standard Drug Treatment Manual, MOHSW,

Banjul. July 2005,British National Formularly. BMA, Tavistock Square, London

WC1H 9JP, UK, 2008 series.

QUESTIONS, CONTRIBUTIONS, CLARIFICATIONS & CONSTRUCTIVE CRITICISMS?????

drugs used in diabetes- mr. panneh

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