Dr. Mansour Alzahrani
‫• متى اكتشف داء السكري؟‬
‫• داء السكري في الحضارة الهندية والصينية القديمة‬
‫• اسهامات علماء المسلمين في داء السكري‬
• Up to 382 million diabetics over the world, 34 million in middle
east, 3.6 million in K.S.A.
• Prevalence of DM in K.S.A. 23%
• 150,000 case/year
• 31% of diabetics have retinopathy; 4000/year have some sort
of diabetes visual impairments and related blindness
•
51% of patients in end-stage renal failure who are on
dialysis are diabetic
· 36 diabetic foots are diagnosed daily
· 26 diabetic limbs are amputated
• Total cost direct and indirect is 35 billion SR 2007
• Type 1 diabetes
– β-cell destruction
• Type 2 diabetes
– Progressive insulin secretory defect
• Other specific types of diabetes
– Genetic defects in β-cell function, insulin action
– Diseases of the exocrine pancreas
– Drug- or chemical-induced
• Gestational diabetes mellitus (GDM)
• A complete medical evaluation should be performed to
– Classify the diabetes
– Detect presence of diabetes complications
– Review previous treatment, risk factor control in patients
with established diabetes
– Assist in formulating a management plan
– Provide a basis for continuing care
• Perform laboratory tests necessary to evaluate each
patient’s medical condition
• Life style modification ( Diet,
• Oral hypoglycemic drugs
• Insulin
weight and physical exercise)
• Human insulin is chemically identical to endogenous insulin but it
is not derived from the human pancreas
• Cannot be given orally
• Insulins differ in onset and duration of action. Ultra-short, short,
intermediate and long acting.
• Insulin lispro (Humalog) or insulin aspart (Novolog) are very
shorting acting insulins
• More effective in decreasing post-prandial hyperglycemia
• Less likely to cause hypoglycemia before the next meal
• Onset is 15’, peaks in 1-3 hours, duration is 3-5 hours
•
1.
2.
3.
4.
5.
Short acting Insulins
Regular Iletin II, Humulin R, Novolin R
May be given sub Q or IV
May be given as a continuous IV drip
The only insulin that may be given IV
Onset is ½-1 hour, peak is 2-3 hours and duration is 5-7
hours
• Isophane insulin suspension (NPH, NPH Iletin II, Humulin N,
Novolin N)
• Onset is 1-1.5 hours, peaks in 8-12 hours and duration is 18-24
• Insulin glargine (Lantus)-once daily at bedtime. Onset is 1.1
hours, peak is none, duration is 24 hours
Insulin Mixtures
• NPH 70/30 (Humulin or Novolin 70/30)
• Durations of actions same as individual components
• Five types used to treat Type 2 DM
• Sulfonylureas—oldest. Increase release of insulin. Also decrease
production of glucose in the liver, increase the number of insulin
receptors and increase peripheral use of glucose. Effective only
if have functioning beta cells.
• Primary side effect is hypoglycemia
• First generation are essentially obsolete
• Use 2nd generation agents
• Are glipizide, glyburide and glimepiride Can be used with
metformin, glitazones, insulin or acarboes
• Caution w/renal or hepatic impairment. Not used in pregnancy.
• Acarbose (Precose) and miglitol (Glyset) inhibit alphaglucosidase enzymes (maltase, amylase, sucrase) in GI
tract. Delays absorption of complex CHO and simple
sugars
• Can be combined therapy w/insulin or w/sulfonylurea
• Contraindicated in cirrhosis, malabsorption, severe renal
impairment
• Take at beginning of each meal
• Can cause bloating and diarrhea
• Metformin (Glucophage) increases the use of glucose by
muscle and fat cells, decreases hepatic glucose production,
and decreases intestinal absorption of glucose
• Does not cause hypoglycemia
• May be used alone or in combination
• Contraindicated in liver or renal impairment. Can result in
lactic acidosis.
Must check renal function before beginning this medication •
Caution with parenteral radiographic contrast media containing •
iodine. May cause renal failure and has been associated with
lactic acidosis.
• Pioglitazone (Actos) and rosiglitazone (Avandia) are also called
thiazolidinediones or TZDs
• Are insulin sensitizers
• Decrease insulin resistance. Stimulate receptors on muscle, fat,
and liver cells. Results in increased uptake of glucose in
periphery and decreased production by the liver.
• Contraindicated in patients with liver disease or who have ALT
levels > 2.5 of normal
• May be used as monotherapy or in combination with insulin,
metformin (Glucophage) or a sulfonylurea
• Caution in patients with heart failure
• Ensure baseline LFTs are performed
• Nateglinide and repaglinide are nonsulfonylureas that
lower blood sugar by stimulating pancreatic secretion of
insulin
• Monotherapy or in combination with metformin
• Should be taken before or up to 30 minutes before a
meal. Dosage and frequency is flexible depending on
food intake.