Presentation By: PRATIKSHA V. DOKE M.PHARM 1 st year Oriental college of pharmacy Guided by: IMTIAZ ANSARI SIR 1
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Presentation By: PRATIKSHA V. DOKEM.PHARM 1st year Oriental college of pharmacy Guided by: IMTIAZ ANSARI SIR
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Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:• Type 1 DM results from the pancreas's failure to produce enough insulin. This
form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.
• Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop.This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.
• GESTATIONAL DIABETES is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood-sugar levels.
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SIGN & SYMPTOMS
• The classic symptoms of untreated diabetes are:1. weight loss,2. polyuria (increased urination), 3. polydipsia (increased thirst), and 4. polyphagia (increased hunger)
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Management
• SURGICAL
• DIETARY
• EXERCISE
• SELF MONITORING OF BLOOD GLUCOSE [SMBG]
• FOOT CARE
• HERBAL DRUG
• PHARMACOLOGICAL
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Surgical management
1. Pancreas Transplant ( Not Usually Done)
2. Islet Cell Transplants
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Dietary managementGoals • Maintain near-normal blood glucose levels • Achieve optimal serum lipid levels • Provide adequate calories for reasonable weight • Prevent & treat acute complications of insulin treated diabetes • Improve overall health through optimal nutrition
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Diet Composition • Carbohydrates: 60 – 70% of daily diet • Protein: 15 – 20% of daily diet • Fats: No more than 10% of total calories from saturated fats • Fibre: 20 to 35 grams/day; promotes intestinal motility and gives feeling of
fullness • Sodium: recommended intake 1000 mg per 1000 kcal • Sweeteners approved by FDA instead of refined sugars • Limited use of alcohol: potential hypoglycaemic effect of insulin and oral
hypoglycaemic
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Alcohol and Diabetes
Increase risk of… • Hypoglycemia • Affects the liver • Don’t take on empty stomach • Esp. if on insulin or oral hypoglycemic meds
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Exercise
• Decreases blood glucose levels • Increases the uptake of glucose by body muscle • Potentiates action of insulin • Decreases insulin requirement• Effect lasts 24 hours• Increases circulation
•Improve serum lipid levels •Improves cardiovascular status •Assist with wt control •Decreases stress
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Monitoring Glucose• SMBG • Glucometers • Urine testing for glucose (2-4 times a day )• Continuous glucose monitoring system
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SELF MONITORING OF BLOOD GLUCOSE (SMBG)
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Foot care
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HERBAL DRUGS
DRUGS SOURCE MOA
KARELA Fruit of Momardica charantia Family:Gutturbitaceae
Increase the insulin secreation
FENUGREEK Seeds of Trigonella foenum graecumFamily:Fabaceae
Reduced the glucose absorption in blood
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PHARMACOLOGICAL
Insulin Sensitizers• Biguanides• Thiazolidinediones Secretagogues• Sulfonylureas • Nonsulfonylurea secretagogues
Alpha-glucosidase inhibitors Peptide analogs
• Injectable Incretin mimetics
• Injectable Amylin analogues Glycosurics
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INSULIN
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DRUG MOA ADR MKD FORMULATION
METFORMIN -decreases hepatic glucose production by suppressing hepatic gluconeogenesis-decreases intestinal absorption of glucose-improving insulin sensitivity by increasing peripheral glucose uptake and utilization
vomiting, diarrhea, abdominal pain, tachycardia, drowsiness, and, rarely, hypoglycemia or hyperglycemia
Actoplus MetJanumet M1
PHENFORMIN BANNED DUE TO HIGHER RISK OF LACTIC ACIDOSIS
Sensitizers: Insulin sensitizers address the core problem in Type II diabetes—insulin
resistance.
BISGUINIDES
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THIAZOLIDINEDIONES
DRUG MOA ADR MKD FORMULATION
Rosiglitazone PPARɣ in fat tissue Plasma VolumeExpansion, Edema, Weight Gain, Headache,Myalgia And Mild Anaemia
Avandia(GlaxoSmithKline)
Pioglitazone PPARɣ as well as PPARα Increase the chance of pregnancy in individuals taking oral contraception.
Glizone (Zydus Cadila)Pioz
This novel class of oral antidiabetic drugs are selective agonists for the nuclear peroxisome prolierator-activated receptors which enhances the transcription of several insulin responsive genes.
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Secretagogues Secretagogues are drugs that increase insulin output from the pancreas.
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DRUG MOA ADR MKD FORMULATIONTOLBUTAMIDE(1st GEN)
Inhibit the ATP-potassium channels (ie SULPHONYLUREA RECEPTOR SUR-1 RECEPTOR) on the beta cell membraneof Pancreas.
Decreases the efflux of potassium
Depolarization of the cell
Causing ca2+ influx
Ca2+ -calmodulin complex formation
Exocytosis of insulin vesicles leading to insulin release
Nausea, vomiting, flatulence, diarrhoea or constipation, headache, paresthesias and weight gain.
The second generation sulfonylureas are more potent, can be administered in lower doses, and can be given on a once daily basis
Rastinone
ACETOHEXAMIDE(1st GEN)
Dymelor
Glipizide (2nd GEN)
Glipizide XL Glipizide ER
Glimepiride (2nd GEN)
Amaryl
Gliclazide (2nd GEN)
DiamicronGliclazide
SULFONYLUREAS
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DRUG MOA ADR MKD FORMULATION
MEGLITINIDES
Same as Sulfonylureas But have less affinity for
SUR-1 Receptor
weight gain and hypoglycemia
REPAGLINIDE Gluconorm 0.5mg
NATEGLINIDE Nateglinide
NON-SULFONYLUREAS
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ALPHA-GLUCOSIDASE INHIBITORS
DRUG MOA ADR MKD FORMULATION
Miglitol Reversible inhibition of membrane-bound intestinal α-glucoside hydrolase enzymes which hydrolyzes oligosaccharides, trisaccharides, and disaccharides to glucose.
Less glucose is absorbed because the carbohydrates are not broken down into glucose molecules
Nausea, vomiting, flatulence, diarrhoea or constipation, headache, weight gain.
Glyset
Acarbose Glucobay
Voglibose Voglibose Vobose
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PEPTIDE ANALOGS
Injectable Incretin mimetics
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DRUG MOA ADR MKD FORMULATION
GLUCAGON-LIKE PEPTIDE-1 AGONIST(GLP-1 agonist)
Exenatide
Enhance glucose-dependent insulin secretion
Suppresses pancreatic release of glucagon which stop the liver from overproducing sugar when it is unneeded.
BydureonByetta
Dipeptidyl Peptidase-4 Inhibitors (DPP-4 inhibitors) VILDAGLIPTIN
SITAGLIPTIN
Inhibits the inactivation of GLP-1and GIP by DPP-4,
Allowing GLP-1 and GIP to potentiate the secretion of insulin in the beta cells
Suppress glucagon release by the pancreas.
Nausea, Hypoglycemia, Tremor, Headache, Dizziness
Jalra-M
Januvia
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DRUG MOA ADR MKD FORMULATION
PRAMLINTIDE Modulation of the rate of gastric emptying,
Prevention of post-prandial rise in glucagon levels,
By increasing sensations of satiety,
Weight loss Symlinpen
INJECTABLE AMYLIN ANALOGUES
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GLYCOSURICS
DRUG MOA ADR MKD FORMULATION
DAPAGLIFLOZIN
EMPAGLIFLOZIN
CANAGLIFLOZIN
SODIUM/GLUCOSE COTRANSPORTER 2 (SGLT2) is a member of the sodium glucose cotransporter family which are sodium-dependent glucose transport proteins
SGLT2 inhibitors lead to a reduction in blood glucose levels.
Weight loss Farxiga
Jardiance
How Do Insulin Pumps Work?Insulin pumps deliver insulin by continuous infusion through a single subcutaneous site which is replaced, on average, every three days. Only rapid-acting insulin is used, and the analogue insulin’s have gained popularity over regular insulin for this purpose . A pump delivers programmable insulin dose around the clock which is tailored to the patient’s 24-h glucose profile. The insulin requirements may be affected by the individual’s physiology, the type and duration of daily activity, work schedule, exercise, illness, concomitant medications, etc.
INSULIN PUMPS
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• Insulin pens provide a compact and portable advantage for people with type 1 diabetes on multiple daily injections. Although they are easy to use, health care providers unfamiliar with the pens may be hesitant to teach patients about them. But once a patient has used a pen, he or she will not want to return to using the traditional bottles and syringe . Pens provide increased ease of use, accuracy, convenience, and less pain and fear of injections. Disadvantages are storage issues and increased cost over the conventional method
INSULIN PENS
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INHALABLE INSULIN
After conducting further studies, Mannkind submitted a new application, and in June, 2014, the FDA approved Afrezza for both Type I and Type II adult diabetics, with a label restriction for patients having asthma, active lung cancer or COPD. In 2014 Mannkind and Sanofi agreed that Sanofi would take over manufacturing and marketing of AfrezzaInhalable insulin is a powdered form of insulin, delivered with a nebulizer into the lungs where it is absorbed
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REFERENCE
Walker, Donald (November 2007). "Similarity Determination and Case Retrieval in an Intelligent Decision Support System for Diabetes Management" (PDF). Retrieved 2 October 2009.
Alexander, G Caleb; Sehgal NL; Moloney RM; Stafford RS (27 October 2008). "National trends in treatment of type 2 diabetes mellitus, 1994-2007". Archives of Internal Medicine. 168 (19): 2088–2094.
American Diabetes Association, Standards of medical care in diabetes—2014, Diabetes Care, 2014; 37(1): S14-S80.
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