1. Glucoregulatory Drugs Ways To Control Blood Glucose In Diabetic Patients

2. Classification Of Diabetic Patients n Type I Diabetic Patient l Insulin-Dependent Diabetes Mellitus Mellitus l Juvenile Onset Diabetes

3. Type I Diabetes Mellitus u Problem : l Loss Of Insulin Production l Development Of Hypoinsulinemia l Development Of Diabetes

4.  Type II Diabetic Patient l Adult-Onset Diabetes Mellitus l Non-Insulin Dependent Diabetes Mellitus

5. n Problem : l No Functional Loss Of The Beta Cell Population l Blood Insulin Levels May Be Below Normal, Normal, or Higher Than Normal

6. l Exhibit Peripheral Tissue Resistance To Insulin l Obesity

7. Drug Choices For The Diabetic Patient u Oral Hypoglycemic Agents l The Sulfonylureas l The Biguanides l Alpha-Glucosidase Inhibitors l Others

8. u Insulin l Porcine Insulin l Bovine Insulin l Humulin

9. The Sulfonylureas l Increase The Availability Of Insulin In Type II Diabetics

10. Sulfonylureas  First Generation Drugs l Tolbutamide (Orinase) l Chlorpropamide (Diabinese) l Tolazamide (Tolinase) l Acetohexamide (Dymelor)

11.  Second Generation Drugs l Glipizide (Glucotrol) l Glyburide (Micronase, Diabeta) l Glimepiride (Amaryl)

12. Sulfonylureas Mechanism Of Action l Stimulate Release Of Insulin From Pancreatic Islet Cells In Type II NIDDM Patients l Blunt The Release Of Glucagon

13. l Increase The Sensitivity of Peripheral Tissues To Insulin l Up-Regulation Of Insulin Receptors l Improve The Binding Of Insulin To Its Recptor

14. Medical Uses Of The Sulfonylureas u Used Only In Type II Diabetics l Functional Only In A Patient With A Pancreas That Is Still Making Insulin

15. Sulfonylureas u Used To Blunt Glucagon Release l Keeps Insulin To Glucagon Ratio Higher l Higher Insulin:Glucagon Ratio Favors Glucose Uptake Into Cells

16. The Overall Effect : The Overall Effect : Blood Glucose Regulation Blood Glucose RegulationEuglycemia

17. Adverse Side Effects For The Sulfonylureas l Hypoglycemia l Skin Rashes l Nausea l Vomiting

18. The Biguanides l Metformin (Glucophage) l Buformin

19. Biguanides Mechanism Of Action l Create An Environment Conducive to Keeping Blood Sugar Low

20. l Suppress Gluconeogenesis In The Liver l Inhibit The Absorption Of Glucose In The Intestine

21. l Stimulate Glycolysis l Probably Up-Regulates Insulin Receptors For Improved Clearance of Glucose

22. Medical Uses Of The Biguanides u Used Only In Conjunction With Sulfonylureas l Inhibit The Liver From Making New Glucose & Stimulates The Burning Of Endogenous Glucose

23. l Help To Deplete Blood Levels Of Glucose By Reducing Uptake Of Dietary Glucose

24. The Overall Effect : The Overall Effect : Blood Glucose Regulation Blood Glucose RegulationEuglycemia

25. Adverse Reactions For The Biguanides l Nausea l Vomiting l Anorexia l Diarrhea l Metallic Taste

26. Alpha-Glucosidase Inhibitors l Miglitol ( Glyset) l Acarbose (Precose)

27. Mechanism Of Action For AGI’s l Delay The Digestion Of Ingested Carbohydrates l Results In A Lower Postprandial Blood Glucose

28. l The Alpha-Glucosidase Inhibitors do not increase insulin receptor sensitivity and do not increase blood insulin levels in Type II diabetics.

29. Medical Uses Of AGI’s n The Alpha-Glucosidase Inhibitors are used alone or in combination with Sulfonylureas to improve blood glucose control. The net effect is euglycemia.

30. Adverse Side Effects Of AGI’s l Skin rashes l Flatulence l Diarrhea l Abdominal pain

31. Others Repaglinide (Prandin) Repaglinide (Prandin) n Troglitazone (Rezulin)

32. Repaglinide Mechanism of Action n Stimulates release of insulin n Regulates calcium channel function in the beta cell

33. Adverse Reactions l Hypoglycemia l Diarrhea l Nausea l Vomiting l Arthralgia Chest pain Chest pain

34. Medical Uses l Used to regulate blood glucose levels l Can be used in combination with Metformin (Glucophage)

35. Troglitazone l Troglitazone is a thiazolidinedione antidiabetic agent.

36. Mechanism Of Action l Improves target cell responsiveness to insulin without increasing insulin secretion - reduces peripheral resistance.

37. l Decreases liver glucose output l Helps to increase skeletal muscle, liver and adipose tissue uptake of glucose

38. Adverse Side Effects l Headache & Pain l Dizziness l Hepatotoxicity l Nausea & Vomiting l Rhinitis l Diarrhea

39. Medical Uses l Used to regulate blood glucose levels - euglycemia

40. The Insulins l To Encourage Glucose Transport Into The Cell l To Reduce The Possibility Of Hyperglycemia

41. Porcine, Bovine, Humulin l Short Acting : 2-4 Hrs l Regular, Semilente, Regular Iletin

42. l Intermediate Acting : 12-20 Hrs l NPH, Lente, Lente Iletin I l Long Acting : 24-36 Hrs l Ultralente Iletin I, Ultralente

43. Mechanism Of Action uBinding Of Insulin To Cell Receptors Causes : l Glucose Transporters To Be Made In Greater Numbers - Up Regulation l Glucose Transporters Migrate To The Cell Membrane And Bring Glucose Into The Cell

44. Medical Uses n Essential For Type I Diabetics l Must Have To Control Blood Sugar n May Be Used In Type II Diabetics l If Sulfonylureas and Biguanides Do Not Keep Blood Sugar In Control

45. Adverse Reactions Hypoglycemia l Sweating l Dizziness l Palpitations l Tremor l Hunger l Tingling In Extremities l Lightheadedness

46. l Headaches l Anxiety l Drowsiness l Slurred Speech l Irritability l Unsteady Movement l Seizures

47. l Lipodystrophy l Allergic Reactions l Shortness of Breath l Skin Rashes At Site of Injection l Whole Body Rashes l Sweating l Tachycardia l Wheezing

48. Clinical Considerations l Be Familiar With The Signs Of Hypoglycemia l Make Sure The Patient Has Not Skipped Meals l Know The Patient's Medications

49. l Make Sure The Patient Is Hydrated l Advise The Patient To Wear Medical ID Tags l Teach The Patient To Monitor Their Blood Sugar - Glucometer

50. Exercise Considerations n Type I Diabetic l Mode : Aerobic l Frequency : 7 days/week l Duration : 20-30 min/session l Intensity : 45%-85% MHR 10 - 14 RPE (Borg) 10 - 14 RPE (Borg)

51. l Type II Diabetic l Mode : Aerobic l Frequency : 5 days/week l Duration : 30-60 min/session l Intensity : 45%-70% MHR 10 - 14 RPE (Borg) 10 - 14 RPE (Borg)

52. l Blood Glucose l < 6 mmol/L ( <108 mg/dl) = Eat CHO l 6-16 mmol/L (108-288 mg/dl) = Ex. l > 16 mmol/L (>288 mg/dl) = See MD

53. Exercise Considerations l Avoid Exercising During The Peak Insulin Activity l To Avoid Hypoglycemia (Type I) l Eat a meal 1-2 hrs. before exercise

54. l Eat extra CHO during exercise if longer than 30 minutes l Measure blood glucose before, during and after exercise

55. l Inject Insulin Into Skinfold of Non- Exercising Muscle (Abdominal Wall) l Drop Insulin Levels 1-2 Units Before Exercise l Exercise With A Partner

56. l Carry Money While Exercising l Wear Good Foot Wear l Practice Scrupulous Foot Care l Inspect Calluses l Look For Red Pressure Areas l Look For Blisters & Ulcerations