Type 2 Diabetes Mellitus Aetiology, Pathogenesis, History, and Treatment.

Slides:



Advertisements
Similar presentations
NEW ORAL AGENTS IN DIABETES MANAGEMENT
Advertisements

Oral Hypoglycemic Drugs And Classifications
Insulin, Glucagon & Diabetes mellitus ENDOCRINE HORMONE.
Antidiabetic Drugs Until 1994, FDA-approved antidiabetics Insulin and Sulfonylurea Last few years, the list was expanding Insulin (different preparations.
Islets of Langerhan. Prof. K. Sivapalan Islets of Langerhan2 Histology. A cells 20 % [glucogon] B cells 50% [Insulin] D cells 8% [somatostatin]
Diabetes Mellitus.
Control of Blood Sugar Diabetes Mellitus. Maintaining Glucose Homeostasis Goal is to maintain blood sugar levels between ~ 70 and 110 mg/dL Two hormones.
Diabetes and Aging MCB 135K Laura Epstein 4/14/06.
Glycogen Metabolism Storage and Mobilization of Glucose NUTR 543 – Advanced Nutritional Biochemistry David L. Gee, PhD Professor of Food Science and Nutrition.
Oral Medications to Treat Type 2 Diabetes
PANCREAS AND DIABETES Valerija Vrhovnik Mentor: A. Žmegač Horvat.
Diabetes: An Overview Christine Rubie MS, RD, LD.
LONG TERM BENEFITS OF ORAL AGENTS
What you do this lesson Copy all notes that appear in blue or green Red / White notes are for information and similar notes will be found in your monograph.
Control of Energy The Original Biofuels. Importance of Glucose Regulation Too little – Brain problems Too much –Osmotic water loss (cellular and systemic)
Diabetes mellitus.
Adult Medical-Surgical Nursing
Diabetes Mellitus Diabetes Mellitus is a group of metabolic diseases characterized by elevated levels of glucose in blood (hyperglycemia) Diabetes Mellitus.
Treatment of diabetes:  Life style modification  Insulin  Oral hypoglycemic agents.
DIABETES AND HYPOGLYCEMIA. What is Diabetes Mellitus? “STARVATION IN A SEA OF PLENTY”
Diabetes Mellitus (Lecture 2). Type 2 DM 90% of diabetics (in USA) Develops gradually may be without obvious symptoms may be detected by routine screening.
Diabetes Mellitus For high school and college students By Emily Freedman A disease that disrupts normal metabolism, interfering with cells’ ability to.
oral hypoglycemic agents
Oral Hypoglycemic Drugs
Diabetes Mellitus By: Jenna Pressler Sara Seidman Emily Freedman A disease that disrupts normal metabolism, interfering with cells’ ability to take in.
Explain the control of blood glucose concentration, including the roles of glucagon, insulin, and a and B in the pancreatic islets Pancreas: exocrine.
Regulating Blood Sugar Islets of Langerhans groups of cells in the pancreas beta cells produce insulin alpha cells produce glucagon.
Regulation of insulin levels Starter: what do each of the following cells produce and are they part of the endocrine or exocrine system; –α cells –β cells.
Oral hypoglycemic drugs Prof. Mohammad Alhumayyd.
Oral hypoglycemic drugs Prof. Mohammad Alhumayyd.
Diabetes mellitus (DM), also known simply as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period.
Pancreas – Disorders Biology Pancreas The pancreas is between the kidneys and the duodenum and provides digestive juices and endocrine functions.
Pancreas Pancreas is a glandular organ located beneath the stomach in the abdominal cavity. Connected to the small intestine at the duodenum. Functions.
Oral hypoglycemic drugs
Diabetes Mellitus Overview and Treatments
Endocrine Physiology The Endocrine Pancreas Dr. Khalid Al-Regaiey.
Course: Medical Biotechnology.  Metabolic and Multifactorial disease develops mostly due to deficiency of insulin. As a result high blood sugar will.
Control of Blood Glucose. Changes in glucose concentration What makes blood glucose concentration increase? What makes blood glucose concentration increase?
Pancreatic Hormones & Antidiabetic Drugs By S. Bohlooli, PhD Pharmacology Department School of Medicine, Ardabil University of Medical Sciences.
INSULIN & ORAL HYPOGLYCEMIC AGENTS.
Oral hypoglycemic drugs
Diabetes Mellitus Ch 13 ~ Endocrine System Med Term.
"We can be very successful at controlling diabetes."
HOMEOSTASIS AND NEGATIVE FEEDBACK BLOOD GLUCOSE, INSULIN AND GLUCAGON.
Diabetes mellitus.
Dr. Mansour Alzahrani. متى اكتشف داء السكري؟ داء السكري في الحضارة الهندية والصينية القديمة اسهامات علماء المسلمين في داء السكري.
POWERPOINT PRESENTATION Group Members- Labiba Sharmin Hossain ( ) Marvia Nabi Ratree ( )
 Insulin is a peptide hormone released by beta cells when glucose concentrations exceed normal levels (70–110 mg/dL).  The effects of insulin on its.
Oral hypoGLYCEMICS.
Diabetes Mellitus Part 1 Kathy Martin DNP, RN, CNE.
What is Diabetes? Definition: A disorder of metabolism where the pancreas produces little or no insulin or the cells do not respond to the insulin produced.
Dr. Sasan Zaeri (PharmD, PhD) Department of Pharmacology, BPUMS.
Diabetes in the Pediatric Population
Blood Glucose, insulin and glucagon
Type 2 diabetes.
Lecture on Anti Diabetic Drugs
Diabetes Mellitus Nursing Management.
Oral hypoglycemic drugs
Regulating Blood Sugar
Diabetic Disorders 4th Leading cause of deaths in the US
Drugs for Diabetes Mellitus
Diabetes Jessica Tagerman PharmD
Presented By: Sumia Khan
המשותף לכל סוגי הסוכרת היפרגליקמיה כרונית.
Diabetic Disorders 4th Leading cause of deaths in the US
Oral Hypoglycemic Drugs
oral hypoglycemic agents
Anatomy & Physiology II
Presentation transcript:

Type 2 Diabetes Mellitus Aetiology, Pathogenesis, History, and Treatment

The Diabetes Mellitus epidemic Estimated 180 million people in the world have DM. That’s roughly 6% of the world population. These numbers are estimated to double by Healthcare costs approaching 92 billion a year for the U.S.

What is Diabetes Mellitus? A metabolic disorder that results when the body is unable to maintain adequate insulin secretion to prevent hyperglycemia. Disease classification: Type 1 or Type 2 90% of DM cases are Type 2

Type 2 DM Inception of disease begins with development of key metabolic abnormality, insulin resistance. Integral to understanding of type 2 DM is the role of insulin/glucose in the metabolic system.

Insulin A polypeptide hormone secreted by the islet of Langerhans in β-cells of the pancreas. First isolated in 1921 by Canadian researchers Banting & Best Essential in homeostatic regulation of blood glucose

Insulin’s function Standard metaphor (Lock & Key) Insulin (the key) must be bound to target cell (the lock) in order for glucose to enter the target cell from the bloodstream. Homeostatic function Signals muscle/adipose tissues and liver to absorb glucose and utilize it. When energy requirements are met, insulin in the bloodstream triggers the liver to absorb glucose and convert it into energy saving form glycogen.

Insulin Resistance Metabolic abnormality that triggers the onset of type 2 DM Normal amount of insulin becomes inadequate for proper absorption of blood glucose The body’s energy absorption system becomes inept Hypothesized triggers of IR 1 in 10 people have genetic code for IR. Obesity, Aging, Genetics, Diet high in sucrose/HFCS

Ensuing Hyperglycemia Complications Vascular problems (neuropathy, nephropathy, retinopathy) Cardiovascular disease Wound infection Symptoms Frequent urination (polyuria) Frequent thirst (polydipsia) Excessive hunger (polyphagia)

Type 2 DM Diagnosis Fasting blood glucose level - diabetes is diagnosed if higher than 126 mg/dL on two occasions. Random (non-fasting) blood glucose level - diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. Oral glucose tolerance test - diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours.

Treatment of type 2 DM First goal is to eliminate symptoms and stabilize blood glucose levels. If diet/exercise fail, then oral medications are used Treatments include agents which increase the amount of insulin secreted by the pancreas agents which increase the sensitivity of target organs to insulin agents which decrease the rate at which glucose is absorbed from the gastrointestinal tract.

Oral Medications Overview Sulfonylureas Meglitinides Biguanides Thiazolidinediones α-Glucosidase inhibitors Dipeptidyl peptidase- 4 inhibitors

Sulfonylureas Stimulates insulin secretion by β cells. Binds and closes K + channels on β cells causing influx of Ca 2+ which triggers the release of insulin. Not glucose dependent. Cause insulin release regardless of glucose level 1 st generation Acetohexamide Chlorpropamide Tolbutamide Tolazamide 2 nd generation Glipizide Gliclazide Glyburide Glimepiride

Meglitinides Also stimulates insulin secretion by β cells Similar mechanism of action to Sulfonylureas. Attaches to K + channel at a different binding site Insulin efflux is glucose dependent. High glucose levels are needed for optimal action. Repaglinide Nateglinide

Biguanides Improves insulin’s ability to move glucose into cells (particulary in muscle tissue) Exact mechanism of action is not fully elucidated First-line medication used for treatment of type 2 DM Metformin

Thiazolidinediones Improves insulin sensitivity (adipose tissue) Bind to steroid hormone nuclear receptor family- peroxisome proliferator activated receptors [PPARs]- specifically PPARγ isoform. Activated PPARγ causes the transcription of specific genes that are intimately involved in cellular metabolism. Activated genes regulate glucose/fat metabolism and result in increased insulin sensitivity. rosiglitazone (Avandia) pioglitazone (Actos)

α-Glucosidase inhibitors Prevents digestion of carbohydrates Thus, they reduce their impact on blood glucose Competitively inhibits enzymes needed for carbohydrate digestion Acarbose Miglitol

Dipeptidyl peptidase 4 inhibitors Causes increased Incretin levels Vildagliptin Sitagliptin

Drug cocktails Combination therapy is sometimes used. Two drugs combined into one tablet. Examples include: Sulfonylurea + Metformin = Glucovance + Metformin + Thiazolidinedione = Metaglip

Future of type 2 DM Complications can be prevented through proper diet and exercise Goal of future drug research is normalizing blood glucose and decreasing insulin resistance Proper education is necessary. Majority of complications are caused by negligence.