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Drugs for Diabetes Treatment
July 1, 2009 | Leave a Comment
Diabetes ( nxkcirqv7h )
Diabetes mellitus is a deficiency caused by a lack of insulin, a specftffchormone secreted by the islet cells of the pancreas, or by a failure of the insulin-release mechanism. As a result of that insulin deficiency, carbohydrates and fats are not
fully metabolized. Glucose accumulates in the circulation and causes a diuresis,
so that polyuria and thirst are troublesome complications. Insulin-dependent
diabetes, which occurs mainly in children and young adults, can be controlled by
injections of insulin. Soluble insulin is used for rapid treatment and in
emergencies, but stabilized patients can be controlled by one of the longer-acting
forms of insulin such as insulin-zinc-suspension.. Insulin was once obtained from
pigs or cattle, but human types of insulin are now available and used to an
increasing extent. (See Table 12.)
In middle age, a non-insulin-dependent type of diabetes may develop. In such patients, the natural secretion of insulin still occurs, but the insulin is not released according to metabolic requirements. Release can, however, be induced by treatment with the orally active hypoglycaemic agents referred to as the
sulphonylureas, represented by chlorpropamide (see Table 13). The
sulphonylureas are most effective in mature patients who are already stabilized on low doses of insulin, or who do not respond to purely dietary control Patients receiving less than 20 units of insulin daily can usually be transferred directly to
an oral drug, but in other cases the transfer should be carried out over a few days.
For those patients who do not respond to the sulphonylureas, an alternative is
the biguanide metformin. The mode of action differs, as it functions mainly by
increasing the peripheral utilization of glucose. Guar gum has some antidiabetic 131
properties, possibly mediated by interfering with the absorption of carbohydrates,
and may be a useful supplementary treatment. Oral therapy with any antidiabetic
drug is not suitable for juvenile or unstable diabetics.
Diabetic
emergencies may hypoglycaemia which may also result in coma. The former requires
treatment with i.v. soluble insulin, preferably by an i.v. pump system, failing
which the insulin should be given by i.m. injection. Hypoglycaemic coma, which
may be due to an overdose of insulin, can be treated with the i.v. infusion of 50%
glucose solution, or by the injection of glucagon 1 m by any route. (Diazoxide is
used in the control of chronic hypoglycaemia which is due to the overproduction
of insulin. It has no place in the emergency treatment of diabetic coma.)
Insulin zinc (IZS) Human Ultratard
(crystalline) Humulin Zn
Protamine zinc Hypurin Protamine Zinc
Soluble insulin
Insulin zinc (IZS) (amorphous)
Isophane insulin (a complex
with protamine)
Biphasic insulin
Biphasic isophane insulin (a complex with protamine)
Insulin zinc (IZS) (amorphous)
Insulin zinc (IZS) (amorphous
+ crystalline)
Soluble
Human Actrapid Human Velosulin Humulin S Hypurin Neutral Velosulin
Insulin Lispro*
Semitard MC Hypurin Isophane Pork Insulatard Human Insulatard Humulin I Rapitard MC Pork Mixtard Human Mixtard Humulin M1-5 Semitard MC
beef 5-8 human-pyr human-emp human-prb beef
pork
humalog
pork 18-24 beef
pork
human-pyr human-prb beef & pork pork
human-pyr human-prb beef/pork
beef 24-36 beef/pork human-pyr human-prb
human-pyr 24-36 human-prb
beef
glibenclamide Daonil, Semi-Daonil, Euglucon
gliclizide Diamicron
glimepiride Amaryl
glipizide Glibenese, Minodiab
gliquidone Glurenorm
tolazamide Tolanase
tolbutamide Rastinon
biguanide
metformin Glucophage
acarbose Glucobay
guar gum Guarem
Iroglitazone* Romozin
Note: This new drug, an insulin enhancer, has recently been withdrawn pending investigations of reports of liver damage.
Table 13 Anti-diabetic drugs.