3. INSULIN AND HYPOGLYCAEMIC AGENTS.ppt

7/17/2019 3. INSULIN AND HYPOGLYCAEMIC AGENTS.ppt

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ENDOCRINE SYSTEM: INSULIN AND

ORAL HYPOGLYCAEMIC AGENTS

Blood Glucose

• Normal blood glucose coce!ra!"o #$ %

&$$mg'dl(

• )$$mg'dl ad abo*e blood glucose

d"agosed as d"abe!"c or &)+mg'dl a,!era #-r ,as!(

&



ENDOCRINE SYSTEM: INSULIN AND ORAL

HYPOGLYCAEMIC AGENTS

• T-ere,ore "m.or!a! !o co!rol blood sugar

le*els(

% CNS ad red blood cells almos! e!"rel/

de.ede! o glucose as source o, eerg/(

Hypoglycaemia causes

% Isu,,"c"e! eerg/ % D"00"ess

% Dro1s"ess ad coma

)





Hyperglycaemia causes

% Osmo!"c loss o, cell 1a!er

% De-/dra!"o

% Ma/ bod/ !"ssue mal,uc!"o

% H/.erosmolar coma

2



3

ENDOCRINE SYSTEM: INSULIN

AND ORAL HYPOGLYCAEMIC AGENTS

DIABETES MEIT!S "DM#

• Is a c-ro"c metabolic disorder 4 resul!"g ,rom

Isul" de,"c"ec/(

• Is c-arac!er"sed b/5

% H/.ergl/caem"a

% Al!ered me!abol"sm o, carbo-/dra!es4

.ro!e"s4 ad l"."ds(

% Icreased r"s6 o, *ascular com.l"ca!"os



7



• T-e "sul" de,"c"ec/ ma/ be absolute or relative.

• T-e me!abol"c abormal"!"es " d"abe!es lead !oclass"c s/m.!oms5

% .ol/ur"a 8,re9ue! m"c!ur"!"o:

% .ol/d".s"a 8 e;cess"*e !-"rs!:

% .ol/.-ag"a 8 e;cess"*e -uger:

% ,a!"gue



+



• Log<!erm com.l"ca!"os "clude5

% Gagree

% Prol",era!"*e re!"o.a!-/ % M/ocard"al ",arc!"o

% Pol/euro.a!-/

% Uraem"a % Real ,a"lure



=



Pred"s.os"!"o !o DM "s -ered"!ar/(

• T-e !/.es o, DM(

(i) Insulin dependent 8T/.e I or >u*e"le ose!IDDM:

< Usuall/ occurs " non-obese persons be,oreage o, 2$ /ears(

< C"rcula!"g "sul" "s *"r!uall/ abse! ad be!a<cells ,a"l !o res.od !o s!"mul" !o release "sul"(

< I! "s an autoimmune disease o, !-e be!a<cells(



#



(ii) Non-insulin dependent 8T/.e II or ma!ur"!/

ose! NIDDM:(

% Usuall/ occurs a,!er !-e age o, 3$ /ears(

% Obes"!/ "s a ma>or ,ac!or(

% T-e be!a<cell mass "s modera!el/ reduced(



?



Gestational diabetes – re,ers !o !-e

ose! o, glucose "!olerace " 1ome

dur"g .regac/ 8e;clud"g 1ome 1-o

1ere d"abe!"c be,ore .regac/:(



&$



• All ,orms o, DM are due !o e"!-er5 % a decrease " c"rcula!"g ,ree "sul" 8"sul"

de,"c"ec/:4 or

% decrease " res.ose o, .er".-eral !"ssues !o"sul" 8"sul" res"s!ace: (

< o*erac!"*"!/ o, "sul" a!ago"s!"c -ormoesl"6e gro1!- -ormoe4 cor!"sol orca!ec-olam"es ma/ also be "*ol*ed(



&&



I$suli$ secre%io$

• Isul" "s s/!-es"sed " !-e edo.lasm"cre!"culum ad s!ored " @<cells *"a membrae

!ras.or!er Glu! )( I!s release "*ol*es acom.le; "!er.la/ be!1ee

% Bood .roduc!s

% Hormoes

% GIT -ormoes

% Neural s!"mul" ,rom ANS ad CNS(



&)



Factors affecting insulin release

S%imula%io$ o& release I$'i(i%io$ o& release

Glucose Ca!ec-olam"es

E;ogeous "sul"

Sul.-o/lureas S!ar*a!"o

c<AMP D"a0o;"de

Leuc"e P-e/!o"

ACTH ad cor!"cos!ero"ds Po!ass"um de,"c"ec/

Secre!" ad Pacro0/m" ago!om/

agal s!"mula!"o

Ace!/lc-ol"e Glucago



&2



• T-e mos! "m.or!a! ,ac!or co!roll"g "sul"secre!"o "s glucose( % Icrease " blood glucose le*el .romo!es bo!-

s/!-es"s ad secre!"o o, "sul" ,rom be!a cells(

% T-e be!a<cells -a*e a adenyl cyclase s/s!em1-"c- "s s!"mula!ed b/5

• glucose or beta-adrenergic stimulation and• inhibited by alpha-adrenergic stimulation





• T-ere,ore 1-e glucose coce!ra!"o

r"ses ATP .roduc!"o "creases4

c-aels close ad de.olar"0a!"o o, !-e

cells resul!s4 ad Ca c-aels o.e

lead"g !o "creased "sul" secre!"o ad

release(

&3



&7



• Ele*a!ed "sul" blood le*els 8e g obes"!/:

decrease umber o, "sul" rece.!ors o

cell membraes 8do1regula!"o:(

• F-"le a ,all " "sul" blood le*els 8e g(

d"abe!es: "creases !-e umber o, "sul"rece.!ors 8u.regula!"o:(





• Isul" "s released " ) .-ases5

1. Rapid phase % release o, s!ored "sul"(

2. elayed phase % co!"ued release o, s!ored

"sul" ad e1 s/!-es"s o, "sul"(

I! "s released as .re.ro"sul" ad co*er!ed

!o .re"sul" ad !-e "sul" (

&+



&=



!etabolism and "#cretion• Orall/ "sul" "s ra."dl/ .ro!eol/sed " !-e gu!(

• Has !o be g"*e .are!erall/4 usuall/ b/ SC">ec!"o(

• T-e ra!e o, absor.!"o ,rom s"!e de.eds o !/.e

o, "sul" used(

• Is ra."dl/ !a6e b/ !-e l"*er ad 6"de/ 1-ere "!"s ma"l/ degraded



&#



• I !-e l"*er !-e molecule "s bro6e do1 b/e0/me glutathione insulintranshydrogenase 8"sul"ase:(

• Ol/ me!abol"!es are e;cre!ed " ur"e ad,aeces(

• Hal,<l",e o, cr/s!all"e "sul" "s abou! 3$m"s(



&?



$ctions

I DM !-ere are d"s!urbaces " !-e me!abol"smo, carbohydrates% &at% protein% electrolytes

ad 'ater )(a) arbohydrates metabolism

Insulin deficiency produces twofundamental defects

8": reduced e!r/ o, glucose "!o cells

8"": "creased release o, glucose ,rom !-e

l"*er "!o c"rcula!"o(



)$



% Leads !o5

• -/.ergl/caem"a

• gl/cosur"a

I add"!"o "sul" de,"c"ec/ leads !o

glucoeogees"s 8.ro!e" !o glucose:(

Insulin administration stimulates

8": e!r/ o, glucose ad o!-er sugars "!o cell(



)&



8"": !-e .-os.-or/la!"o o, glucose adgl/coge s/!-es"s ad "!s s!orage " !-e

l"*er(

8""": co*ers"o o, glucose !o !r"gl/cer"des ad"!s s!orage " ad".ose !"ssue(

Bur!-er "sul" "-"b"!s glycogenolysis ad gluconeogenesis.

T-e abo*e ac!"os resul! " a ,all " !-e glucoseco!e! o, !-e blood ad !"ssues(



))



(b) *at !etabolism

• Isul" de,"c"ec/ leads !o a mob"l"0a!"o o, ,a! ,rom

ad".ose !"ssue "!o !-e blood s!ream 8l".aem"a:(

• T-e blood coce!ra!"o o, !r"gl/cer"des ad BBA r"se4

due !o "creased s/!-es"s " ad".ose !"ssue(

• T-e grea!er a*a"lab"l"!/ o, BBA !o !-e l"*er leads !o"creased .roduc!"o o, ace!oe ace!a!e ad be!a<

-/dro;/bu!/r"c ac"d 8ac"dos"s: ad ace!oe 8a 6e!oe:(



)2



• T-e 6e!oe bod"es e!er !-e blood ad

.roduce me!abol"c 6e!oac"dos"s(

• T-e blood c-oles!erol also r"ses(

Insulin administration stimulates5

% l".ogees"s ad ,ac"l"!a!es !-e de.os"!"o o,

!r"gl/cer"des " ad".ose !"ssue(



)3



(c) +rotein !etabolism

Isul" de,"c"ec/ ad a d"sordered glucose u!"l"sa!"oresul!s "5

< "m.a"red .ro!e" s/!-es"s(

< "creased .ro!e" brea6do1 !o am"o ac"ds (

< "creased glucose s/!-es"s ,rom am"o ac"ds

,he protein depletion together 'ith glucose richtissues and body &luids predispose the body toin&ection.



)7



Insulin replacement has anabolic e&&ect

< accelera!es !-e !ras,er o, am"o<ac"ds "!o cells(

< .romo!es am"o ac"d "cor.ora!"o"!o .ro!e"(

< .romo!es !-e ac!"o o, !-e gro1!--ormoe o .ro!e" s/!-es"s(



)+



(d) "lectrolytes

Isul" ,ac"l"!a!es e!r/ o, .o!ass"um "!o cells(

< .o!ass"um "s "m.or!a! " !-e regula!"o o,

!-e membrae .o!e!"al ad e0/me ac!"*"!/(

Isul" also .romo!es mages"um "!racellular

accumula!"o(

< mages"um "s res.os"ble ,or !-e

ac!"*a!"o o, ma/ cr"!"cal "!racellular

e0/mes(



)=



(e) ater

As a cose9uece o, gl/cosur"a4 !-ere "sa e;!ra loss o, 1a!er ,rom !-e bod/

8.ol/ur"a:(

T-e abo*e leads !o de-/dra!"o ad.ol/d".s"a 8abormal !-"rs!:(

Insulin replacement - due !o "!s o*eralle,,ec! o me!abol"sms re*erses e;cess"*e1a!er loss(



)#

Glucose*a%%y

Acids

Ami$o

Acids

*a%%yAcids

Triglycerides

$diposetissue

iver

Glycoge$ +ro%ei$

!uscle

S%imula%ed (y i$suli$

I$creased (y &eedi$g

I$'i(i%ed (y i$suli$

I$creased (y &as%i$g a$d i$ dia(e%es

O,er,ie- o& i$suli$ ac%io$



)?



!ode o& $ction

• T-e ac!"os o, Isul" are ""!"a!ed b/5

% !-e a!!ac-me! o, !-e "sul" molecule !o a

s.ec","c "sul" rece.!or o !-e cell sur,ace(

% !-e "sul"<rece.!or com.le; "!erac!"o "s

re*ers"ble(

% !-e "sul" molecule "s o! c-em"call/ al!ered(



2$



% !-e -ormoe<rece.!or com.le; "s !-e

"!eral"0ed b/ a edoc/!o!"c mec-a"sm(

% !-e "sul" molecule "s !-e me!abol"sed ad!-e "sul" rece.!or "s rec/cled !o !-e

membrae ,or reuse(

Oce "s"de !-e cell4 Isul" lo1ers !-e c<AMP

co!e! " some !"ssues b/5



2&



% I-"b"!"g !-e ade/l c/clase s/s!em

• "s more mar6ed 1-e c<AMP s/!-es"s "s

s!"mula!ed b/ -ormoes l"6e glucago ad

ca!ec-olam"es4 bu! basal le*els o, c<AMP are o!

muc- a,,ec!ed(

% S!"mula!"g c/cl"c ucleo!"de

.-os.-od"es!erase 8e0/me 1-"c- des!ro/sc<AMP: ac!"*"!/4 !-us lo1er"g c<AMP o, cells(



2)



ecause o, lo1er c<AMP " cells5

< less gl/coge brea6do1 8gl/cogeol/s"s:

occurs(



22



*actors !odi&ying Insulin $ction

T-e ,ollo1"g ,ac!ors subs!a!"all/ al!er !-e"sul" eed " d"abe!"c .a!"e!s5

( i) !uscular e#ercise A,!er e;erc"se !-e .lasma co!a"s a subs!acel"bera!ed b/ !-e s6ele!al muscle 1-"c- .romo!eso;"da!"o o, glucose 8ca lead !o -/.ogl/caem"a4

less "sul" eeded:(

(ii) *actors a&&ecting insulin secretion 8asd"scussed alread/:



23



(iii) Insulin antibodies

• O re.ea!ed ">ec!"os o, "sul" s.ec","c "sul"a!"bod"es de*elo. " !-e .lasma(

• T-ese a!"bod"es b"d "sul" ad "! loses "!s.-/s"olog"cal ac!"*"!/(

• Isul" res"s!ace "s de,"ed as a s!a!e 1-eda"l/ "sul" re9u"reme! o, a "d"*"duale;ceeds )$$ u"!s(



27



( iv) Insulin antagonists

Suc- as5

< gro1!- -ormoe4

< glucocor!"co"ds4< glucago4 ad

< o!-er u"de!","ed ma!er"als(

(v) iet

T-e d"e! -as !o be s.ec"all/ ada.!ed !o mee! !-eme!abol"c eeds4 !o a*o"d -/.er or

-/.ogl/caem"a(



2+



INS!IN prepara%io$s

• Isul" ca be s/!-es"sed bu! "s ma"l/ob!a"ed ,rom ca!!le or ."g .acreas(

• T-e/ -a*e a b"olog"cal ac!"*"!/ o, )7u"!s'mg(

• T-e pig insulin closel/ resembles -uma"sul" 8" !erms o, .ol/<.e.!"de c-a"s:4

as a resul! -as lo1 a!"ge"c"!/(



2=



• Isul" "s soluble " 1a!er4 bu! udergoesmolecular aggrega!"o a! .H 2() % &$8"creased b/ .resece o, 4 1-"c-causes "sul" cr/s!all"sa!"o:

• Ca be comb"ed 1"!- .ro!e"s l"6e globinad protamine !o .rolog "!s ac!"o(





• Huma Isul" -as bee success,ull/.roduced5

% !-roug- E. coli recomb"a! DNA!ec-"9ue or

% b/ c-em"cal mod","ca!"o o, ."g "sul" !ore.lace loe am"o ac"d d",,ere! ,rom-uma "sul"(

2#





• Commerc"al "sul" "s a m";!ure o, !-e-ormoe e;!rac!ed ,rom !-e .acreas o,ca!!le 8bo*"e: ad ."g 8.orc"e:(

• T-e .o!ec/ o, "sul" "s assa/ed b/5

% com.ar"g !-e e1 sam.le 1"!- a"!era!"oal s!adard ,or "!s -/.ogl/caem"ce,,ec!4

2?



3$



• Is measured " grou.s o, m"ce4

• !-e ed .o"! be"g -/.ogl/caem"c coma(

% T-e .o!ec/ "s measured " u"!s(

% Pre.ara!"os are ad>us!ed !o co!a" 3$4 #$4&$$ or 7$$ u"!s'ml(



3&



• T-e *ar"ous "sul" .re.ara!"os d",,er ma"l/

" !-e ra!e o, absor.!"o ,rom s"!e o, SC

">ec!"o(

• Regular "sul" 8Cr/s!all"e Isul": "s mod","ed!o ,orm sus.es"os b/ !1o .rocedures5

8": as"c .ro!am"e "s added !o ac"d"c "sul" !o ra"se

"!s .H ad ,orm a less soluble com.le;(

8"": H"g- coce!ra!"os o, 0"c ad ace!a!e bu,,er

ma6e ", .oss"ble !o .re.are sus.es"os -a*"g

*ar/"g .ar!"cle s"0e(



3)



T-e abo*e ,ac!ors de!erm"e !-e !"me o, onset

ad duration o, ac!"o o, !-e .re.ara!"o(

T-ere,ore "sul"s are class","ed accord"g !othe time o& onset ad duration o& action.





1. *ast $cting

+reparation /nset o& uration o&

action(hrs) action (hrs)

8": Regular & 7Cr/s!all"e

"sul"

8"": Prom.! Isul" & &)<&+

"c Sus.es"o

8SEMILENTE:

32



33



2. Intermediate $cting

(i) Iso.-ae Isul" ) &#<)3

Sus.es"o

8NPH Isul":

(ii) Isul" "c )<3 &#<)3

Sus.es"o

8LENTE:

8""": Glob" "c &<) &)<&#

Isul"

8Glob" Isul":



37



0. ong $cting

(i) Pro!am"e "c 3<+ )3<2+

Isul" Sus.es"o

8PI:

8"": E;!eded "c 3<+ )3<2+

Isul" Sus.es"o8ULTRALENTE:



3+



Ne'er Insulins

&( Ac!ra."d 8Nusol: % recr/s!all"sed .orc"e

"sul"4 ac!s ,as!er !-a regular "sul"(

)( Ra."!ard 8".-as"c Isul": % ac!ra."d 8&.ar!:ad "soluble cr/s!als o, bo*"e "sul" 82 .ar!s:4

same ac!"o as le!e "sul" bu! 9u"c6er ose!(

2( Moo!ard % "s a moocom.oe! "sul" 0"c

sus.es"o o, -"g-l/ .ur","ed .orc"e "sul" ad

"s de*o"d o, a!"ge"c .ro.er!/(



3=



3( Huma Isul"s % -"g-l/ .ur","ed "sul"s.re.ared b/5 % recomb"a! DNA !ec-"9ue " E( col"4 or

% sem"s/!-e!"call/ us"g .orc"e "sul"s s!ar!"g

ma!er"al ad mod",/"g some am"o ac"ds e g lispro % Has more ra."d absor.!"o ad ac!"o a,!er SC ">ec!"o

!-a regular "sul"(

% S-ould be adm""s!ered &7m"s be,ore meals(

% Ac-"e*es .ea6 a! 2$ <&)$ m"s com.ared !o +$ <&)$m"s regular "sul"(

% Has s-or!er dura!"o o, ac!"o !-ere,ore usuall/ used1"!- loger ac!"g regular "sul"(



3#



Insulin administration

(i) Insulin syringe –a s/r"ge gradua!ed "!ou"!s o, "sul"( I>ec!ed !-roug- !-e SC rou!e(

(ii) /pen loop system- uses a m"cro com.u!er!o regula!e !-e ,lo1 o, "sul" ,rom !-e s/r"ge !o!-e eedle "ser!ed subcu!aeousl/ " d"abe!"c

.a!"e!(





(iii) losed loop system % au!oma!"call/

reads blood glucose le*els ad ad>us!s !-e

ra!e o, "sul" del"*er/4 subcu!aeousl/(

3?



7$



$dverse Reactions and +recautions

1. ypoglycaemia

Ma/ occur due !o5< "sul" o*erdosage

< ,a"lure !o ea!

< uaccus!omed .-/s"cal e;erc"se

< "ges!"o o, alco-ol 8"m.a"rs -e.a!"c

glucoeogees"s:(



7&



2. Insulin allergy

Occurs ",re9ue!l/(

Is ma",es!ed b/ local "!c-"g ad

l/m.-adeo.a!-/(

Isul"s co!a""g .ro!e"s are more l"6el/

!o cause allerg/ !-a le!e(



7)



0. Insulin lipoatrophy

A!ro.-/ o, subcu!aeous ,a! occurs a! s"!eso, ,re9ue! "sul" ">ec!"os(

T-e absor.!"o o, "sul" ,rom suc- s"!esbecomes erra!"c(

Ca be a*o"ded b/ ,re9ue! c-age o, s"!eo, ">ec!"o(

OC S S



72



. Insulin presbyopia

8D",,"cul!/ or loss o, e/e accommoda!"o:

Occurs 1-e a d"abe!"c "s ra."dl/

co!rolled 1"!- "sul"(

T-e cod"!"o graduall/ se!!les do1(

ENDOCRINE SYSTEM



73



3. Insulin neuropathy

Ra."d co!rol o, d"abe!es 1"!- "sul" ma/.rec"."!a!e or 1orse .re<e;"s!"g euro.a!-/(

4. Insulin resistance• O .rologed "sul" adm""s!ra!"o !-e da"l/

re9u"reme! graduall/ r"ses due !o ,orma!"o o,"sul" a!"bod"es(

• Isul" res"s!ace ca be maaged b/adm""s!er"g glucocor!"co"ds 8.red"soloe: orc-age o*er ,rom bo*"e !o .orc"e "sul"(

ENDOCRINE SYSTEM



77



5. /besity

Isul" !-era./ 1"!-ou! d"e!ar/ res!r"c!"o

ca lead !o obes"!/(

ENDOCRINE SYSTEM



7+



,herapeutic uses

1. In diabetes mellitus

2.In schi6ophrenia• Isul" s-oc6 !-era./4 "s a use,ul !-era.eu!"cmeasure(

• T-e coma "s allo1ed !o las! )$<2$ m"u!es4 !-e!erm"a!ed b/ adm""s!ra!"o o, glucose b/ I ors!omac- !ube4 glucago ca also be used !o!erm"a!e coma(

ENDOCRINE SYSTEM



7=



0. !yocardial in&arction

Isul"4 glucose ad .o!ass"um -a*e bee used1"!- bee,"!(

. $nore#ia nervosa

Isul" "m.ro*es a..e!"!e ad !-ere "ss"mul!aeous ga" " bod/ 1e"g-!(

3. 7urns

Isul" 1"!- glucose adm""s!ra!"o reduces !-e"!roge ad .o!ass"um losses " se*erel/ bur!.a!"e!s.

ENDOCRINE SYSTEM



7#



I$dica%io$s &or I$suli$ T'erapy i$ DM

• All d"abe!"cs do o! re9u"re "sul"(

• Some .a!"e!s o, !-e ma!ur"!/<ose! !/.e ca beco!rolled o diet ad e#ercise aloe(

• T-e ,ollo1"g ca!egor"es ecessar"l/ re9u"re"sul" adm""s!ra!"o(

8": u*e"le d"abe!"cs4 es.ec"all/ o, more !-a )

/ears dura!"o(

ENDOCRINE SYSTEM



7?



8"": Older d"abe!"cs 1"!- ma!ur"!/<ose!d"abe!es(

8""": All d"abe!"cs 1"!- com.l"ca!"os(

8"*: D"abe!"c coma ad .recoma8*: Pr"mar/ ad secodar/ ,a"lure o,

sul.-o/lurea !-era./(

8*": Dur"g .regac/ !o a*o"d !-e.oss"ble embr/o.a!-"c ac!"*"!/ o, oral-/.ogl/caem"c age!s(

8*"": D"abe!"cs udergo"g surger/(

ENDOCRINE SYSTEM



+$



G!CAGON

• Is s/!-es"sed4 s!ored ad secre!ed b/ al.-acells o, Islets of Langerhans.

• Glucose "s ma>or regula!or o, glucago secre!"o(

• H/.ergl/caem"a "-"b"!s4 1-"le -/.ogl/caem"a

s!"mula!es release o, glucago( % T-us glucose "s a ma>or glucago "-"b"!or (

ENDOCRINE SYSTEM



+&



• Secre!"o o, glucago "s also regula!ed b/

!-e ANS "er*a!"o o, !-e .acrea!"c Isle!(

% S!"mula!"o o, s/m.a!-e!"c er*es or

adm""s!ra!"o o, s/m.a!-om"me!"c am"es

"creases glucago secre!"o(

ENDOCRINE SYSTEM S



+)



!ode o& action

• Glucago .romo!es glucose .roduc!"o

8gl/cogeol/s"s: ,rom l"*er gl/coge *"a5

% s!"mula!"o o, !-e adenyl cyclase cell 1all s/s!em4

% ,orma!"o o, c<AMP 81-"c- med"a!es e,,ec! o,

glucago o l"*er:4 ad

% ac!"*a!"o o, hepatic phosphorylase 8a ra!e l"m"!"g

e0/me " gl/cogeol/s"s:

ENDOCRINE SYSTEM INSULIN



+2



• Glucago also5 % "creases -e.a!"c glucoeogees"s ad

6e!ogees"s

% s!"mula!es .ro!e" ca!abol"sm(

% s!"mula!es release o, ca!ec-olam"es ,rom !-eadreal medulla(

% Icreases co!rac!"l"!/ o, !-e m/ocard"um4caus"g a r"se " blood .ressure(




+3



,herapeutic 8ses

&( Isul" -/.ogl/caem"a4 !o ra"se le*els o,glucose(

)( Used 1"!- de;!rose !o cu! s-or! "sul""duced -/.ogl/caem"a coma(

2( I d"agos"s o, Isul"omas 8glucagoele*a!es glucose blood sugar:(

3( I d"agos"s o, !-e -e.a!"c ,orm o,glycogen storage disease 8glucago

,a"ls !o ele*a!e blood glucose le*els:(




+7



7( Ma/ be used " !rea!me! o, be!a<bloc6er

8.ro.raolol: .o"so"g 8"!s e,,ec! o

m/ocard"um:4 "creases c<AMP .roduc!"o(

$dverse reactions5 ausea a,!er large doses

ad -/.erses"!"*"!/ reac!"os ma/ occur(

ose Glucago -/droc-lor"de & mg IM4 I(




++



ORA HY+OGYGYCAEMIC AGENTS

Oral -/.ogl/caem"c age!s are d"*"ded "!o !1o

classes5

8": Sul.-o/lureas

8"": "gua"des




+=



Drug ad Class Dura!"o Table! Dose

o, ac!"o s!reg!- rage 8g:

8-ours: 8mg: 8da"l/:

Sulp'o$ylureas

Tolbu!am"de +<&) )7$4 7$$ $(7<2($ Ace!ao-e;am"de &)<&3 )7$4 7$$ $()7<&(7

Tola0am"de&$<&3 &$$4 )7$ $(&<&($

C-lor.ro.am"de 3#<+$ &$$4 )7$4

7$$ $(&<$(7

Gl"beclam"de &$<&7 7 7<3$

Gl"."0"de )3 74 &$ 7<3$

ENDOCRINE SYSTEM INSULIN AND ORAL



+#



Drug ad Class Dura!"o Table! Dose

o, ac!"o s!reg!- rage 8g:

8-ours: 8mg: 8da"l/:

Gl/bur"de )3 &()74 )(74 )(7<)$

7

Bigua$ides

P-e,orm" 3<+ )7 7$<)$$

P-e,orm" <T"med #<&3 7$ 7$<)$$

Me!,orm" 7<+ 7$$ &<&(7




+?



Sulp'o$ylureas

T-e/ are c-em"call/ rela!ed !o !-e

sul.-oam"des bu! -a*e o a!"bac!er"al ac!"*"!/(

+harmacological $ctions

• Are read"l/ absorbed ,rom GIT4 .ar!"all/ .ro!e"

boud ad me!abol"sed " !-e l"*er(• T-e/ lo1er blood glucose le*el " non-diabetic

ad ,ype II diabetes.




=$



• S"mul!aeousl/ !-e/ lo1er !-e .lasma ,ree,a!!/ ac"d le*els(

• T-e/ are ol/ e,,ec!"*e " !-e .resece o,a ,uc!"o"g .acreas(

• T-e/ ormal"se !-e me!abol"c s!a!us o, !-ed"abe!"c(

• L"6e Isul" .a!"e!s !ed !o ga" 1e"g-!(




=&



!ode o& $ction

8&:T-e sul.-o/lureas s!"mula!e !-e be!a<cell "sle!!"ssue !o secre!e "sul" 8"sle! betacytotropic ac!"*"!/:(

T-e/ bloc6 !-e ATP de.ede! c-aels!-ereb/ de.olar"s"g !-e membrae ad caus"grelease o, "sul"4 !-us

% !-e/ cause degraula!"o o, !-e be!a<cells(

8):T-e/ also "-"b"! -e.a!"c gl/cogeol/s"s(






82: T-e/ "crease b"d"g o, Isul" !o!arge! !"ssues ad rece.!ors(

• T-e/ are "e,,ec!"*e " T/.e I d"abe!esbecause !-e .acreas loses "!sca.ac"!/ !o s/!-es"0e ad secre!e"sul"

=)




=2



,o#icity

To;"c"!/ "s remar6abl/ lo1 " .ro.erl/ maaged

.a!"e!s4 bu! !-e ,ollo1"g reac!"os -a*e bee

obser*ed(

8i) Hypoglycaemia

- Due !o o*erdose4 m"ssed meals4 *om"!"g orassoc"a!ed l"*er ad 6"de/ damage(

< Alco-ol ma/ "duce se*ere -/.ogl/caem"a(




=3



8"": Allerg"c s6" reac!"os

8""": oe marro1 de.ress"o 8leuco.e"a4

!-romboc/!o.e"a ad agrauloc/!os"s ma/occur:(

8"*: C-lor.ro.am"de "s re.or!ed !o "duce >aud"ce(




=7



8*: T-ere "s l"6el"-ood !o "duce

embr"/o.a!-/(

8*": T-e/ are go"!roge"c as !-e/ "-"b"! !-e

"od"de u.!a6e b/ !-e !-/ro"d glad(

8*"": C-lor.ro.am"de ma/ "duce se*ere

intolerance !o alco-ol(




=+



,herapeutic 8ses

(i) !aturity-onset diabetes mellitus4 " .a!"e!s

1-o cao! be co!rolled o d"e! aloe(

Cr"!er"a ,or selec!"o "s58a: Obese sub>ec!s4 aged 3$ or more(

8b: D"abe!"cs o, less !-a &$ /earsdura!"o4 1"!-ou! s"g","ca! 6e!our"a or

o!-er acu!e com.l"ca!"o(




==



8c: Bas!"g blood glucose le*el less !-a2$$mg'dl(

8d: Regular "sul" re9u"reme! less !-a 3$u"!s .er da/(

8e: Absece o, acu!e real d"sease(




=#



% =$J o, .a!"e!s res.od4 !-e res! ,a"l !ores.od4 K primary &ailures.)

% Ou! o, !-e =$J 1-o res.od earl"er4 o.rologed !-era./4 !-e res.ose graduall/

d"m""s-es due !o .rogress"*e de!er"ora!"o o,

.acrea!"c ,uc!"o Ksecondary &ailures9




=?



(ii) Insulin-resistant diabetes mellitus

8iii# hlorpropamide has been used in

some cases o& diabetes insipidus

($ de&icient condition)8*aso.ress"

.o!e!"a!"o:(




#$



Bigua$ides• D",,er ,rom !-e sul.-o/lureas " !-e"r ac!"o(

• Do o! lo1er blood glucose le*els " o<

d"abe!"c .ersos(

• Lo1er blood glucose " d"abe!"cs ad " abseceo, a ,uc!"o"g .acreas(




#&



• T-us lo1er blood glucose " bo!- !/.es o,

d"abe!es mell"!us(

• T-e/ .o!e!"a!e !-e -/.ogl/caem"c ac!"o

o, "sul" ad sul.-o/lureas(

• T-e/ also reduce -/.erl"."daem"a 8LDL

ad LDL: ad HDL r"ses(




#)



!ode o& $ction

• T-e"r ac!"os are e#trapancreatic.

• Do o! de.ed o !-e .resece o,

e;ogeous or edogeous "sul" " !-e

bod/(

8": T-e/ s!"mula!e !-e .er".-eral u!"l"sa!"o

o, glucose4 suc- as " muscles(




#2



8"": T-e/ decrease -e.a!"c glucose ou!.u!4

b/ "-"b"!"g glucoeogees"s(

8""": T-e/ also reduce !-e "!es!"al

absor.!"o o, glucose(




#3



,herapeutic 8sesMe%&ormi$

8": Me!,orm" "s used ,or !rea!me! o, ma!ur"!/<ose!d"abe!es mell"!us accord"g !o !-e cr"!er"a ,or

sul.-o/lureas(

% Is 1ell absorbed orall/ ad o! boud !o serum.ro!e"s(

% Is o! me!abol"sed ad "s e;cre!ed *"a ur"e(




#7



8"": Me!,orm" ma/ be comb"ed 1"!-sul.-o/lureas " case o, .r"mar/ or

secodar/ ,a"lure(

8""": Me!,orm" ma/ be comb"ed 1"!-

"sul" " !-e maageme! o, >u*e"le

d"abe!es !o "duce smoo!- -/.ogl/caem"aad !-e dose o, "sul" "s reduced




#+



,o#icity

Metformin

• Iduces me!all"c !as!e4 ausea4 aore;"a4

ad d"arr-oea(

• Causes le!-arg/4 muscle 1ea6ess4 ad

1e"g-! loss(

• Ma/ cause 6e!our"a ad lac!"c ac"dos"s(




#=



Ne-er Oral Hypoglycaemic Age$%s

/)T'ia0olidi$edio$e Deri,a%i,es

• Is a e1 class o, oral a!"d"abe!"cs4 "!

"cludes ,roglita6one% iglita6one%"nglita6one% +oiglita6one.

• T-e/ 1or6 b/ 58": e-ac"g !-e !arge! !"ssue ses"!"*"!/ !o

"sul"(




##



8"": T-e/ .o!e!"a!e !-e ac!"o o, "sul" b/"creas"g glucose u.!a6e ad glucose

o;"da!"o bo!- " !-e muscle ad ad".ose

!"ssue(

8""": T-e/ also reduce -e.a!"c glucose ou!.u! ad

l"."d s/!-es"s " muscle ad ad".ose !"ssue(

• T-e e,,ec!s occur 1"!-ou! a/ "crease " "sul"

release(




#?



• Trogl"!a0oe "s a*a"lable as )$$ ad3$$mg !able!s(

• Dosage "s s!adard"sed accord"g !o !-e

.a!"e!(




?$



1( alp'a2Glucosidase I$'i(i%or

Acar(ose

• Is a orall/ ac!"*e drug ,or NIDDM(

• I! "s a .oss"ble ad>uc! !o Isul" " IDDM

.a!"e!s(

• For6s b/ "-"b"!"g alpha-glucosidase en6yme" !-e "!es!"al brus- border ad !-us

decreases !-e absor.!"o o, s!arc- ad

d"sacc-ar"des(




?&



• Cose9ue!l/ !-e r"se o, blood sugar "s blu!ed(

• Does o! s!"mula!e "sul" release ,rom

.acreas or "crease "sul" ac!"o " !-e

!"ssues(

• T-us Acarbose does o! cause -/.ogl/caem"a(

• Ca be used aloe or " comb"a!"o 1"!- o!-er

oral -/.ogl/caem"c age!s(






• I! "s .oorl/ absorbed(

• Ma>or s"de e,,ec!s are5 ,la!ulece4

d"arr-oea4 ad abdom"al cram.s(

• Dose5 I"!"all/ 7$mg OD dur"g ,"rs! 1ee64

7$mg b"d secod 1ee64 7$mg !"d !-"rd1ee64 ,ur!-er "creme!s made a,!er 3<#1ee6s !o )$$mg ma;(

3. INSULIN AND HYPOGLYCAEMIC AGENTS.ppt

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