Our goals for today. Define diabetes and subtypes Distinguish between the etiology of the prevalent forms of diabetes Discuss basic features of gestational diabetes Understand the pharmacological management of diabetes. Strange but true……….
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Things to remember:
Secretes other half gradually during day and night (basal secretion). To replace this: need long acting insulin
Insulin to cover meals: short or rapidly acting insulin.
NOVOLOG (insulin aspartate)
For later meal: intermediate acting insulin
NPH (neutral protamine of Hagedorn)
For basal insulin: long acting insulin
INSULIN GLARGINE (Lantus)
Figure 41-2 from Katzung, 8th edition, 2001
HYPOGLYCEMIA is the most prominent adverse effect of insulin.
Evolutionary Pathway ?
Oral medications initiated when 2-3 months of lifestyle
modifications cannot maintain optimal plasma glucose
First generation: tolbutamide
Second generation: glyburide, glipizide
Metformin used as monotherapy
Definition: “any degree of glucose intolerance with onset or first recognized during pregnancy”. IncludesPatients that may previously have undiagnosed diabetes, or may develop diabetes coincidentally with diabetes.Occurs in 5-10% of all pregnancies
Non-pharmacological: Cornerstone treatment
Take Away Messages……….
Diabetes is a progressive disease: high rates of morbidity and mortality.
Most diabetics die of cardiovascular complications.
Treatment of diabetes is a partnership: patient, physician, home support, nutritionist….others.
Insulin types and use (type 1 and type 2 diabetes).
Oral hypoglycemics (type 2 diabetes).
Gestational diabetes—risks for baby and also for mother.