Chapter 5 Drugs for Diabetes Mellitus

1. Chapter 5Drugs for Diabetes Mellitus

2. Diabetes Mellitus • Diabetes mellitus is a condition in which the body cannot effectively regulate blood glucose or “blood sugar.” • Hyperglycemia – high blood glucose • Hypoglycemia – low blood glucose

3. Glucose Metabolism • As we consume food, the digestive system predominately converts those foods into glucose. • Energy

4. Glucose Metabolism (cont.) • If glucose is not utilized for energy purposes at the time of digestion, it is stored. • Glycogen in the liver and muscles • Adipose

5. Glucose Utilization in the Body • Requires Insulin • Pancreas • Insulin binds with specific receptors on the cell membrane. • Once bound, the receptors signal protein messengers within the cell.

6. Glucose Utilization in the Body (cont.) • Proteins migrate to the cytoplasm of the cell membrane, bind with glucose, and allow passage into the cell by passive transport.

7. Glucose Utilization in the Body (cont.) • Without insulin in the body • Excess glucose accumulates in the blood, which goes unused • Excreted in the urine

8. Exceptions • The brain requires a constant supply of glucose. • The brain is freely permeable to glucose at all times. • During exercise, skeletal muscles can readily uptake glucose into the cells without the presence of insulin.

9. Exceptions (cont.) • The liver is also non-insulin dependent but insulin will enhance the metabolism of glucose throughout the body.

10. Box 5-2: Diagnostic Criteria for Diabetes

11. Types of Diabetes • Type 1 Diabetes • Formally known as “insulin Dependent Diabetes Mellitus” (IDDM) or “Juvenile-onset diabetes” • Diagnosed in children, teenagers, and young adults • Can result from an autoimmune destruction of the pancreatic -cells • Requires exogenous insulin to sustain life

12. Why Type 1 Diabetes • Auto-immune destruction of the pancreatic -cells. • Some will have rapid destruction and others will have slower rate of destruction. • Cell destruction can take place over weeks, months, or even years. • Virus, toxin, or some environmental condition is thought to stimulate the destruction of the -cells. • The exact destruction process is unclear.

13. Type 2 Diabetes • Formally known as “Non-Insulin Dependent Diabetes” (NIDDM) • Previously known as “Adult-onset diabetes” • Can occur at any age, including adolescence, but usually affects older individuals • May stem from insulin deficiency or resistance

14. Why Type 2 Diabetes • Age • Lack of exercise • Obesity • Hypertension, • Dyslipidemia – abnormal amount of lipids in the blood

15. Why Type 2 Diabetes (cont.) • Certain racial/ethnic groups • Women who were diagnosed with gestational diabetes • A strong genetic disposition plays a contributing role in developing type 2 diabetes, although the specific genetic link is not clearly known

16. Management of Diabetes • Glucose Monitoring • Blood glucose levels are measured using Self-Monitored Blood Glucose (SMBG) equipment • Blood tests 4 to 6 times per day

17. Blood Glucose Levels • Normal fasting plasma glucose (FPG) levels = 70 – 120 mg/dL • Fasting test is most appropriate to determine blood glucose levels (diabetes) • Two hours after a meal, glucose levels should be <140 mg/dL

18. Managing Diabetes • Diet • Exercise • Insulin Administration • Injection • Oral anti-diabetic agents

19. Diet • Timing of food intake • Type of foods eaten (carbohydrate, fat, protein) • Total caloric intake

20. Exercise • Recommended for: • Type 1 • Type 2

21. Insulin Administration • Exogenous insulin is required in: • Gestational diabetes • Type 1 • Sometimes Type 2

22. Insulin Injection Devices • Syringe/needle • Insulin pump/refillable • Prefilled insulin pens

23. Insulin Types • Rapid-acting • Humalog • Short-acting • Regular – slightly longer onset of action compared to rapid-acting • Intermediate-acting • Lente • Long-acting • Ultralente • Combination Products

24. Rapid-Acting Insulin • Humalog • FDA (1996) – first available rapid-acting insulin • Injected 15 minutes before meal • Onset = < 30 min • Peak = 30 min to 1 hour (longer depending on type) • Duration = 2 to 4 hours (+/–)

25. Short-Acting Insulin • Regular • Longer onset of action compared to rapid-acting • Onset = ½ – 1 hr. • Peak = 2 – 5 hrs. • Duration = 5 – 10 hrs.

26. Intermediate-Acting Insulin • Lente • Onset = 1 – 3 hrs. • Peak = 6 – 14 hrs. • Duration = 18 – 24 hrs. (+/–)

27. Long-Acting Insulin • Ultralente • Onset = 4 – 6 hrs. • Peak = 16 – 24 hrs. • Duration = 24 – 28 hrs. (+/–)

28. Table 5-4: Insulin Types and Actions*

29. Injections/Day • Two • One in the morning • One in the late afternoon • Mix of short and intermediate • Three to Four • Mainly used for more control of the diabetes

30. Figure 5-8: Onset and Duration of Action

31. Adverse Effects of Injections • Insulin shock – Hypoglycemia • Excess levels of insulin in the body • Weak, drowsy, confused, hungry, or dizzy • Loss of consciousness and possibly coma

32. Diabetic Concerns • Diabetic ketoacidosis • More common in Type 1 • Insulin deficiency results in use of fatty acids for energy • Ketones are released as a by-product of fat metabolism = high blood levels of ketones • Hyperglycemia, thirst, excess urination, fatigue, blurred vision, fruity breath, nausea, muscular stiffness, and difficulty breathing • Ketoacidosis can lead to coma and potentially death

33. Oral Antidiabetic Agents • Combination of oral antidiabetic medications plus a regimen of diet and exercise allows diabetics to better manage hyperglycemia • Variety or oral antidiabetic agents

34. Table 5-5: Oral Antidiabetic Agents: Types & Actions

35. Table 5-5: Oral Antidiabetic Agents: Types & Actions (cont.)

36. Box 5-1: Complications of Diabetes

37. The Athletic Trainer’s Responsibility • Monitor blood glucose levels – before and after exercise • Record food and insulin intakes for all types of activity • Monitor athlete/person for hypoglycemia • Make appropriate decisions regarding activity and blood glucose levels