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Blood Sugar; Diabetes Mellitus; Non-Insulin Dependent Diabetes Mellitus; Type II Diabetes |
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If glucose levels still continue to increase despite the use of these medications the addition of a sulfonylurea or glitinide may be necessary Acarbose Precose
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and individuals who therefore have more severe defects in insulin secretion The short acting agents are useful in patients with erratic mealtimes and or who have renal dysfunction Slide Alpha Glucosidase Inhibitors Acarbose Miglitol And finally the alpha glucosidase inhibitors delay the absorption of carbohydrate from the gastrointestinal tract and primarily reduce
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Richard S Beaser MD What are the current available treatment tools Martin J Abrahamson MD Slide Oral Medications to Treat Type 2 Diabetes There are a variety of oral agents that address the pathophysiologic abnormalities that lead to diabetes drugs that reduce insulin resistance
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Slide The Evolution of Diabetes Therapy Addressing Multiple Defects Richard S Beaser MD What are the current available treatment tools
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drugs that reduce insulin resistance those that stimulate endogenous insulin secretion or insulin itself and those that delay the absorption of carbohydrate from the gastrointestinal tract Slide Sites of Action of Oral Medications Currently in Use to Treat Type 2 Diabetes This next graphic summarizes the major metabolic defects that are present in the patient with type 2
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very rarely liver enzyme elevations if the concentrations of the doses or the doses of the drugs are exceeded These agents are useful for individuals who have postprandial hyperglycemia Slide Pharmacotherapy of Type 2 Diabetes General Principles Now it should be said that one drug will lower HbA1c levels by no more than 1 5 to 2 0 and fasting glucose concentrations by
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only occur if you use the drug when it s contraindicated And these contraindications include abnormal renal or liver function congestive heart failure metabolic acidosis and alcohol abuse Slide Medications That Reduce Insulin Resistance Thiazolidinediones Rosiglitazone and Pioglitazone The next group of sensitizers are the thiazolidinediones rosiglitazone and pioglitazone
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on lowering hepatic glucose production And finally the alpha glucosidase inhibitors are used to slow the digestion of starches and the absorption of glucose from the gastrointestinal tract Slide Medications That Reduce Insulin Resistance Biguanide Metformin So if you look at these drugs in a little more detail the biguanide metformin will lower hepatic glucose production
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the obese patient who is insulin resistant with or without the presence of dyslipidemia A note should be made that thiazolidinediones can also be used in patients with renal insufficiency Slide Insulin Secretagogues Sulfonylureas Meglitinides Phenylalanine Derivatives If we look at the insulin secretagogues that we have available to us these will increase basal or
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PROLIFERATIVE DIABETIC RETINOPATHY ON OPTIC DIS
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on major systems of the body which are characterized by myriad manifestations of ths disease in each of these systems Major impact of diabetes is borne by cardiovascular and renal System followed by nervous and extremities A CVD
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on by the patient and the care providers and that the goals and treatment plan are reasonable Following algorithm depicts the step wise approach the management of type 2 diabetes The drugs used to treat diabetes can be classified as follows with their respective mechanism of action 1 Sulfonylureas they increase endogenous insulin secretion by
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with the presence of proliferative diabetic retinopathy PDR Lowering blood pressure as demonstrated by the UKPDS has been shown to decrease the progression of retinopathy Patients with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes Patients
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to 82 2 kg over the course of the study There was a slight increase in body weight for those receiving glyburide from an initial average of 82 8 kg to 83 0 kg after six months In addition patients in the acarbose arm also had a small decrease in heart rate from an average of 79 5 beats minute at initial measurement to 75 9 beats minute at the end
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additive effect as shown here combination of metformin and pioglitazone shown on the left of the graphic and combination of metformin and rosiglitazone shown on the right of the graphic Slide Metformin and Acarbose Combination Therapy Effect on HbA1c And finally metformin and alpha glucosidase inhibitors have been used in combination with some degree of success
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2 Båvenholm PN et al Postprandial hyperglycaemia and vascular damage the benefits of acarbose Diabetes Vasc Dis Res 2006 3 72 9 Foto SPL IBL Den viktigaste skillnaden mellan paleolitisk kost och medelhavskost är att den paleolitiska inte innehåller spannmål Bilden Homo erectus som levde för ca 1 8 till 0
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suggested to reduce the incidence of diabetic nephropathy are tight glycemic control blood pressure control renin angiotensin aldosterone system blockade and protein restriction Treatment In the treatment of both micro and macroalbuminuria either ACE inhibitors or ARBs should be used except during pregnancy While there are no adequate head to head comparisons
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