Diabetes Mellitus

JUNAINAH BINTI ANUAR

DPM 1/12 A
DIPLOMA IN PHARMACY

CONTENT
NO.

CONTENT

SLIDE

DEFINITION

ROLE OF PANCREAS

PANCREAS HORMONES AND ITS

FUNCTION

TYPES OF DIABETES

CAUSES OF DIABETES

DIAGNOSIS

12-14

SYMPTOMS

15

COMPLICATON

16

PHARMACOLOGICAL TREATMENT

4-5
6
7-8
9-11

17-25

10

NON PHARMACOLOGICAL
TREATMENT

26

11

REFERENCES

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DEFINITION
DIABETES MELLITUSisaconditioninwhichthe
pancreasnolongerproducesenoughinsulinorcellsstop
respondingtotheinsulinthatisproduced,sothatglucose
inthebloodcannotbeabsorbedintothecellsofthe
body.

ROLE OF PANCREAS
Thepancreasisaglandorganthatislocatedinthe
abdomen.
Itispartofthedigestivesystemandproducesimportant
enzymesandhormonesthathelpbreakdownfoods.
Pancreascarriesouttwoimportantrole:
Anexocrinefunction-helpsindigestion
Anendocrinefunction-thatregulatesbloodsugarlevel.

PANCREAS
HORMONES AND
ITS FUNCTION
Twoofthemainpancreatichormonesareinsulinand
glucagon.
Hormone

Functions

Insulin

Insulinisproducedbythebetacellsofthepancreas.
Thishormonelowersbloodglucoselevelsafteramealby
stimulatingtheabsorptionofglucosebyliver,muscle,and
adiposetissues.

Glucagon

Glucagonisproducedbythealphacellsofthepancreas.
Glucagonraisesbloodglucoselevelsbystimulatingthe
livertometabolizeglycogenintoglucosemoleculesandto
releaseglucoseintotheblood.
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TYPES OF DIABETES
TypeIDiabetes
TypeIdiabetesmostlyafflictsindividualsinadulthoodbut
someformscanoccurlaterinlife.
TypeIdiabetesisalsoknownasInsulinDependent
Diabetes.
TypeIdiabeticisthechronic(lifelong)diseasethatoccurs
whenthepancreasdoesnotproduceenoughinsulinto
controlbloodsugarlevelsproperly.
Dailyinjectionofinsulinisneeded.

TYPES OF DIABETES
TypeIIDiabetes
TypeIIdiabetesisinfluencedbygeneticfactors,aging,
obesityandperipheralinsulinresistance.
TypeIIdiabetesisalsoknownasNon-insulinDependent
Diabetes.
TypeIIdiabetesresultsfrominsulinresistance,acondition
inwhichcellsfailtouseinsulinproperly,sometimesalso
withanabsoluteinsulindeficiency.

CAUSES OF DIABETES
TypeIDiabetes
Bodysownimmunesystemattacksanddestroysbetacellin
thepancreaswhichisresponsibleforcreatingthehormone
insulin.

CAUSES OF DIABETES
TypeIIDiabetes
Thepancreasretainssomebetacellfunction,butinsulin
secretionisinsufficienttomaintainglucosehomeostasis.
Itsoccurwhenthepancreasdoesntmakeenoughinsulinor
hecellsofbodybecomeresistanttoinsulin.

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11

DIAGNOSIS
FollowingtestscanbedonefordiabetestypeIand
typeII:
1. Glycatedhamoeglobin(A1C)test
.Thisbloodtestindicatesyouraveragebloodsugarlevelfor
thepasttwotothreemonths.
.Itmeasuresthepercentageofbloodsugarattachedto
hemoglobin.
.Thehigheryourbloodsugarlevels,themorehemoglobin
youwillhavewithsugarattached.AnA1Clevelof6.5
percentorhigherontwoseparatetestsindicatesthatyouhave
diabetes.Below5.7isconsiderednormal.
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Diagnos
2.RandomBloodSugarTest
is

Abloodsamplewillbetakenattherandomtime.

Regardlessofwhenyoulastate,arandombloodsugar
levelof200milligramsperdeciliter(mg/dL)11.1
millimolesperliter(mmol/L)orhighersuggestsdiabetes.

3.FastingBloodSugarTest
Abloodsamplewillbetakenafteranovernightfast.
Afastingbloodsugarlevellessthan100mg/dL(5.6
mmol/L)isnormal.
Ifit's126mg/dL(7mmol/L)orhigherontwoseparate
tests,youhavediabetes.
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DIAGNOSIS
4.OralGlucoseTolerenceTest
Forthistest,youfastovernight,andthefastingblood
sugarlevelismeasured.
Thenyoudrinkasugaryliquid,andbloodsugarlevelsare
testedperiodicallyforthenexttwohours.
Abloodsugarlevellessthan140mg/dL(7.8mmol/L)is
normal.
Areadingofmorethan200mg/dL(11.1mmol/L)after
twohoursindicatesdiabetes.

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SYMPTOMS

15

COMPLICATION
Nephropathy
CoronaryArtery
Disease

Highbloodglucose
andbloodpressure
candamagetosmall
bloodvesselsinthe
kidneysleadingto
thekidneys
becomingless
efficientortofail
altogether.

Highblood
pressure,high
cholesterol,high
bloodglucose
cancontributeto
cardiovascular
disease.
Whichcanleads
toheartattack
andstroke.

Retinopathy
Neuropathy

Diabetescancause
damagetothe
nervesthroughout
thebodywhen
bloodglucoseand
bloodpressureare
toohigh.
Mostlynerve
damagesinfootand
itscalledDiabetic
footulcer.Leading
toseriousinfections
andrequire
amputation.

Highlevels
ofblood
glucosecan
causethe
bloodvessel
formationin
theretinaof
theeyes.
Leadsto
reduced
visionand
blindness.
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PHARMACOLOGICAL
TREATMENT
1. Insulin

Drug Names

Dosage

Insulin aspart

0.2-0.6 unit/kg/day divided doses

Insulin detemir

Once or twice daily subcutaneous

administration

Insulin glargine

Once daily subcutaneous administration

Insulin lisipro

Usually 0.5-1 unit/kg/day divided doses

Regular insulin

0.5-1 unit/kg/day sc divided doses

NPH insulin
suspension

0.5-1 unit/kg/day divided doses

Sideeffects:Redness,headache,backpain,diarrhea,
hypersensitivityandallergicreaction,hypoglycemia,
itching,hunger.
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PHARMACOLOGICA
L TREATMENT
Mechanismofaction:Insulin
Coverttheglucosetoglycogeninliverandmuscle.
Decreasestheproductionofglucosefromglycogen.
Decreasesformationofglucosefromnoncarbonhydrate.
Decreaseslipolysisandketogenesis.

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PHARMACOLOGICAL
TREATMENT

2.OralAgents

Drug Names

Dosage

Acarbose

50mg 200mg bd- tds

Glipizide

2.5mg 50mg daily

Glimepiride

1mg daily

Metformin

500 mg up to 2g bd

Miglitol

25mg PO

Nateglinide

60mg 180mg daily

Pioglitazone

15mg- 45mg daily

Rosiglitazone

4mg PO

Repaglinide

500mcg- 16mg daily

Sitagliptin

11mg once daily

Tolbutamide

1 to 2g orally daily

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PHARMACOLOGICA
L TREATMENT
OralAgents
SideEffects:
Dizzy
Drowsy
Heartburn
Stomachpain
Constipation
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PHARMACOLOGICAL
TREATMENT
Mechanismofaction:Oralagents
StimulatethereleaseofinsulinfrompancreaticB-cells.
Decreaseshepaticglucoseoutputandincreasesinsulin
sensitivity(muscle,liver).
Increaseinsulinsensitivity(muscleandliver)anddecrease
glucoseproduction.

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PHARMACOLOGICA
L
TREATMENT
3.AmylinAnalog
Drug Names
Pramlintide

Dosage
60 mcg subcutaneously

SideEffects:Nausea,vomiting,headache,abdominalpain,
weightlossandfatigue.

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PHARMACOLOGICA
L
TREATMENT
Mechanismofaction:AmylinAnalog
Pramlintideisananalogofhumanamylin.Amylinis
colocatedwithinsulininsecretorygranulesand
cosecretedwithinsulinbypancreaticbetacellsin
responsetofoodintake.

PHARMACOLOGICA
L TREATMENT
4.IncretinMimetic
Drug Names

Dosage

Exenatide

5mcg subcutaneously

Liraglutide

0.6 mg daily

Sideeffects:Diarrhea,constipation,upperrespiratory
tractinfection,andheadache.

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PHARMACOLOGICAL
TREATMENT
Mechanismofaction:IncretinMimetic
GLP-1increasesthesecretionofinsulinfromthe
pancreas,slowsabsorptionofglucosefromthegut,and
reducestheactionofglucagon.

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NON
PHARMACOLOGICA
EXERCISE
L TREATMENT

Physicalactivitypromotesweightreductionandimproves
insulinsensitivity,thusloweringbloodglucoselevels.
DIETS
Dietarytreatmentshouldaimat:
Ensuringweightcontrol.
Providingnutritionalrequirements.
Allowinggoodglycemiccontrolwithbloodglucoselevel
asclosetonormalaspossible.

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REFERENCES
LippincottsIllustatedReviewPharmacology5th
Edition.
Clinicalpharmacyandtherapeutics4thedition
MIMs
www.rxlist.com
www.medscape.com

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