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Diabetes mellitus
chronic disorder of carbohydrate, fat and protein metabolism due to deficient insulin secretion
primary diabetes mellitus
type 1 and type 2 and gestational diabetes
secondary diabetes mellitus
insulin
- humans need glucose fat for energy
- glucose is supplied to blood stream via GI tract and liver
- glucose requires transporter to move it from blood into cells
- known as glucose transport units (GLUTS)
- GLUTS move from inner cell to plasma membrane to pick-up glucose from the blood stream
- some GLUTS are insulin-responsive - only work in presence of insulin
major effects of insulin on body
liver
- stimulates glycogen synthesis
muscle
- stimulates glycogen synthesis
adipose tissue
- stimulates formation of glucose to fat to fatty acids to triglycerides
type 1 diabetes
- results from severe and absolute lack of insulin due to a reduction of pancreatic beta cells
- patients depend on insulin for survival
- autoimmune disease
- T cells directly kill the beta cells of the pancreas
type 2
- insulin resistance/relative deficiency
- often diagnosed in adults

Pharmacological management of DM
insulin pharmacology - treatment of type 1 DM
pharmacodynamics
- insulin is a protein
- exogenous insulin binds to insulin receptor on target cells
pharamacokinetics
sources of exogenous insulin
- bovine insulin
- human insulin
- synthetic insulin analogues
formulations of exogenous insulin
- insulin formulated in many ways to:
a) maximise blood glucose control
b) minimise fluctuation in blood glucose levels
examples of insulin preparations
- short acting
- long acting
- combination

absorption
exogenous insulin administration
- SC
- IV infusion or IM during emergency
- insulin supplied in vials, pre-packed cartridge pens, portable pumps
- short-acting insulin 30 mins before meals
- mixing insulin preparations
- storing insulin preparations
dosing through IV
- basal-bolous
- lasts 1 hour
- split-mixed
distributed around the body
metabolised in liver
if excess then excreted
pharmacological effects
- uptake, utilisation and storage of glucose, amino acids and fats after a meal
- decrease formation of glucose from other sources
- decrease blood glucose levels
adverse effects
- allergic reactions
- lipodystrophy
- overdose causes hypoglycaemia
drug interactions
- insulin requirements may be increased by meds with hyperglycaemic activity
e
...
g beta-blocker
drug abuse in diabetic patients
- alcohol
- CNS stimulants
- marijuana
- cigarettes
oral hypoglycaemic drugs
types
- biguanides e
...
g glipizide
- sitmulates insulin secretion
- inhibits the liver producing glucose
- improve body sensitivity to insulin
- thiazolindinediones
- improve sensitivity to insulin
- meglitinides
- stimulates insulin secretion

- not as popular as above

- glucosidase inhibitors

- decrease glucose absorption in the gut
hyperglycaemic agents
mild to moderate hypoglycaemia
- readily available sugar source followed by complex carbs
- glycogen can also be used and absorbs faster
other meds
- anti-hypertensive drugs
- lipid-lowering drugs
- aspirin

Consequences of diabetes
diagnosis
3 step screening and diagnosis is recommended for detecting undiagnosed type 2 diabetes
initial risk assessment using a risk assessment tool
…

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