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Pharmacological Management Of Type 2 Diabetes

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Pharmacological Management Of Type 2 Diabetes

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    1. Pharmacological Management Of Type 2 Diabetes

    2. OUTLINES Introduction to Type 2 DM Screening of asymptomatic individuals. Prevalence of Type 2 DM in KSA Carbohydrate Metabolism. Risk factors for Type 2 DM Diagnostic criteria for Type 2 DM Signs and symptoms of Type 2 DM Lifestyle modification.

    4. TYPE 2 DM - AN INTRODUCTION

    24. Diabetes can be made when one of the following criteria is present:Diabetes can be made when one of the following criteria is present:

    26. 6.1 ( 110 ) 6.9 ( 124 ) 7.8 ( 140 ) 11 ( 200 ) 6.1 ( 110 ) 6.9 ( 124 ) 7.8 ( 140 ) 11 ( 200 )

    27. GOALS OF GLYCEMIC CONTROL FOR PEOPLE WITH DIABETES Whole blood glucose (mg/dL) = plasma glucose (mg/dL) x 30.85Whole blood glucose (mg/dL) = plasma glucose (mg/dL) x 30.85

    37. INITIAL TREATMENT STRATEGY

    42. BIGUANIDES MECHANISM OF ACTION: Not stimulate insulin release. There is an evidence that Metformin can: ?FPG by ?the gluco-neo-genesis and by ?hepatic glucose production. It seems to improve peripheral sensitivity to insulin: ?enhanced glucose disposal and clearance. ?decreased plasma insulin concentration. ?TG ( 10 -20 %) by long term therapy. ? Total cholesterol ( 5-10 % ) ?HDL by small increments. Weight loss more likely to occur.

    43. PHARMACOKINETICS: ABSORPTION: From small intestine ( 50 – 60 %) ELIMINATION: Kidney as un-metabolized medication. PLASMA T ½: 6.2 Hrs. PLASMA PROTEIN BINDING: Not bound to plasma protein.

    56. SULFONYLUREAS FIRST GENERATION: Acetohexamide, chlorpropamide, tolazamide, and tolbutamide. SECOND GENERATION: Glipizide, Gliburide, Gliclazide, and Glimepiride. MECHANISM OF ACTION: (A) - Stimulate insulin release from pancreas beta cells specific receptors Increase beta cell sensitivity to glucose. (B) Extra-pancreatic effect ( Sulfonylureas can): NORMALIZE hepatic glucose production, REVERSE insulin resistance in peripheral tissues in type 2 DM. BUT failure of this effect in type 1 DM.

    60. Hypoglycemia. Weight gain. GIT symptoms ( Nausea, Fullness, bloating). Rare: Allergic dermatologic reactions, Hepatotoxicity,

    62. DRUG INTERACTIONS:

    64. THIAZOLIDINEDIONE MECHANISM OF ACTION: These drugs ? insulin resistance In MUSCLE and LIVER, which enhances glucose utilization and ? hepatic glucose output. Because this group enhance the effect of insulin, insulin must be present for them to exert their clinical effect. They bind to and activate a nuclear receptor (PPAR-? ) That is present in many insulin sensitive tissues to regulates the transcription of insulin responsive- genes that influence glucose and lipid metabolism.

    96. COMBINATION THERAPY OF INSULIN WITH ORAL AGENTS

    97. COMBINATION THERAPY OF INSULIN WITH ORAL AGENTS Introduction of insulin should not be delayed if metabolic control becomes suboptimal.Introduction of insulin should not be delayed if metabolic control becomes suboptimal.

    102. CHRONIC DIABETIC COMPLICATIONS

    108. SUMMARY

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