1. Dr. Mansour Alzahrani

2. متى اكتشف داء السكري؟ داء السكري في الحضارة الهندية والصينية القديمة اسهامات علماء المسلمين في داء السكري

3. 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

4. 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)

7. 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

16. Life style modification ( Diet, weight and physical exercise) Oral hypoglycemic drugs Insulin

17. 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.

18. 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

19. Short acting Insulins 1.Regular Iletin II, Humulin R, Novolin R 2.May be given sub Q or IV 3.May be given as a continuous IV drip 4.The only insulin that may be given IV 5.Onset is ½-1 hour, peak is 2-3 hours and duration is 5-7 hours

20. 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

21. Insulin glargine (Lantus)-once daily at bedtime. Onset is 1.1 hours, peak is none, duration is 24 hours

22. Insulin Mixtures NPH 70/30 (Humulin or Novolin 70/30) Durations of actions same as individual components

23. 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

24. First generation are essentially obsolete Use 2 nd 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.

25. Acarbose (Precose) and miglitol (Glyset) inhibit alpha- glucosidase 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

26. 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.

27. 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.

28. 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.

29. 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

30. 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.