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Glucoregulatory Drugs
Ways To Control Blood
Glucose In Diabetic Patients
Classification Of Diabetic Patients

Type I Diabetic Patient
 Insulin-Dependent Diabetes
Mellitus
 Juvenile Onset Diabetes
Type I Diabetes Mellitus
Problem
:
 Loss Of Insulin Production
 Development Of Hypoinsulinemia
 Development Of Diabetes
Type
II Diabetic Patient
 Adult-Onset Diabetes Mellitus
 Non-Insulin Dependent
Diabetes Mellitus

Problem :
 No Functional Loss Of The
Beta Cell Population
 Blood Insulin Levels May Be
Below Normal, Normal, or
Higher Than Normal
Exhibit Peripheral Tissue
Resistance To Insulin
 Obesity

Drug Choices For
The Diabetic Patient

Oral Hypoglycemic Agents
The Sulfonylureas
 The Biguanides
 Alpha-Glucosidase Inhibitors
 Others


Insulin
 Porcine Insulin
 Bovine Insulin
 Humulin
The Sulfonylureas

Increase The Availability Of
Insulin In Type II Diabetics
Sulfonylureas

First Generation Drugs
 Tolbutamide (Orinase)
 Chlorpropamide (Diabinese)
 Tolazamide (Tolinase)
 Acetohexamide (Dymelor)

Second Generation Drugs
 Glipizide (Glucotrol)
 Glyburide (Micronase, Diabeta)
 Glimepiride (Amaryl)
Sulfonylureas
Mechanism Of Action
Stimulate Release Of Insulin From
Pancreatic Islet Cells In Type II
NIDDM Patients
 Blunt The Release Of Glucagon


Increase The Sensitivity of
Peripheral Tissues To Insulin
Up-Regulation Of Insulin
Receptors
 Improve The Binding Of Insulin
To Its Recptor

Medical Uses Of The
Sulfonylureas

Used Only In Type II Diabetics
 Functional Only In A Patient
With A Pancreas That Is Still
Making Insulin
Sulfonylureas

Used To Blunt Glucagon Release
 Keeps Insulin To Glucagon
Ratio Higher
 Higher Insulin:Glucagon Ratio
Favors Glucose Uptake Into
Cells
 The
Overall Effect :
Blood Glucose Regulation
Euglycemia
Adverse Side Effects
For The Sulfonylureas




Hypoglycemia
Skin Rashes
Nausea
Vomiting
The Biguanides


Metformin (Glucophage)
Buformin
Biguanides
Mechanism Of Action

Create An Environment
Conducive to Keeping Blood
Sugar Low
Suppress Gluconeogenesis In
The Liver
 Inhibit The Absorption Of
Glucose In The Intestine

Stimulate Glycolysis
 Probably Up-Regulates Insulin
Receptors For Improved
Clearance of Glucose

Medical Uses Of The Biguanides

Used Only In Conjunction With
Sulfonylureas
 Inhibit The Liver From
Making New Glucose &
Stimulates The Burning Of
Endogenous Glucose

Help To Deplete Blood Levels
Of Glucose By Reducing
Uptake Of Dietary Glucose
 The
Overall Effect :
Blood Glucose Regulation
Euglycemia
Adverse Reactions
For The Biguanides





Nausea
Vomiting
Anorexia
Diarrhea
Metallic Taste
Alpha-Glucosidase Inhibitors


Miglitol ( Glyset)
Acarbose (Precose)
Mechanism Of
Action For AGI’s
 Delay
The Digestion Of Ingested
Carbohydrates
 Results In A Lower Postprandial
Blood Glucose
 The Alpha-Glucosidase
Inhibitors do not increase insulin
receptor sensitivity and do not
increase blood insulin levels in
Type II diabetics.
Medical Uses Of AGI’s
 The Alpha-Glucosidase
Inhibitors
are used alone or in combination
with Sulfonylureas to improve
blood glucose control. The net
effect is euglycemia.
Adverse Side Effects Of AGI’s




Skin rashes
Flatulence
Diarrhea
Abdominal pain
Others
 Repaglinide
(Prandin)
 Troglitazone (Rezulin)
Repaglinide
Mechanism of Action
 Stimulates
release of insulin
 Regulates calcium channel
function in the beta cell
Adverse Reactions
 Hypoglycemia
 Diarrhea
 Nausea
 Vomiting
 Arthralgia
 Chest
pain
Medical Uses
 Used
to regulate blood glucose
levels
 Can be used in combination with
Metformin (Glucophage)
Troglitazone
 Troglitazone
is a thiazolidinedione
antidiabetic agent.
Mechanism Of Action
 Improves
target cell
responsiveness to insulin without
increasing insulin secretion reduces peripheral resistance.
 Decreases
liver glucose output
 Helps to increase skeletal muscle,
liver and adipose tissue uptake of
glucose
Adverse Side Effects






Headache & Pain
Dizziness
Hepatotoxicity
Nausea & Vomiting
Rhinitis
Diarrhea
Medical Uses
 Used
to regulate blood glucose
levels - euglycemia
The Insulins
To Encourage Glucose
Transport Into The Cell
 To Reduce The Possibility Of
Hyperglycemia

Porcine, Bovine, Humulin

Short Acting : 2-4 Hrs
Regular, Semilente, Regular
Iletin


Intermediate Acting : 12-20 Hrs
NPH, Lente, Lente Iletin I
Long Acting : 24-36 Hrs
Ultralente Iletin I, Ultralente



Mechanism Of Action
Binding Of Insulin To Cell
Receptors Causes :
 Glucose Transporters To Be Made
In Greater Numbers - Up
Regulation
 Glucose Transporters Migrate To
The Cell Membrane And Bring
Glucose Into The Cell
Medical Uses


Essential For Type I Diabetics
 Must Have To Control Blood
Sugar
May Be Used In Type II Diabetics
 If Sulfonylureas and Biguanides
Do Not Keep Blood Sugar In
Control
Adverse Reactions
Hypoglycemia
Sweating
 Dizziness
 Palpitations
 Tremor
 Hunger
 Tingling In Extremities
 Lightheadedness

Headaches
 Anxiety
 Drowsiness
 Slurred Speech
 Irritability
 Unsteady Movement
 Seizures



Lipodystrophy
Allergic Reactions
 Shortness of Breath
 Skin Rashes At Site of Injection
 Whole Body Rashes
 Sweating
 Tachycardia
 Wheezing
Clinical Considerations



Be Familiar With The Signs Of
Hypoglycemia
Make Sure The Patient Has Not
Skipped Meals
Know The Patient's Medications



Make Sure The Patient Is Hydrated
Advise The Patient To Wear Medical
ID Tags
Teach The Patient To Monitor Their
Blood Sugar - Glucometer
Exercise Considerations

Type I Diabetic
 Mode
: Aerobic
 Frequency :
7 days/week
 Duration
: 20-30 min/session
 Intensity
: 45%-85% MHR
10 - 14 RPE (Borg)

Type II Diabetic
 Mode
: Aerobic
 Frequency :
5 days/week
 Duration
: 30-60 min/session
 Intensity
: 45%-70% MHR
10 - 14 RPE (Borg)

Blood Glucose
 < 6 mmol/L ( <108 mg/dl) = Eat CHO
 6-16 mmol/L (108-288 mg/dl) = Ex.
 > 16 mmol/L (>288 mg/dl) = See MD
Exercise Considerations


Avoid Exercising During The Peak
Insulin Activity
To Avoid Hypoglycemia (Type I)
 Eat a meal 1-2 hrs. before
exercise
Eat extra CHO during
exercise if longer than 30
minutes
 Measure blood glucose
before, during and after
exercise




Inject Insulin Into Skinfold of NonExercising Muscle (Abdominal Wall)
Drop Insulin Levels 1-2 Units Before
Exercise
Exercise With A Partner



Carry Money While Exercising
Wear Good Foot Wear
Practice Scrupulous Foot Care
 Inspect Calluses
 Look For Red Pressure Areas
 Look For Blisters & Ulcerations