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First Speaker
Definition
Diabetes mellitus is a disorder in which the level of blood glucose is
persistently raised above the normal range. Diabetes mellitus is a
syndrome with disordered metabolism and inappropriate hyperglycemia
due to either a deficiency of insulin secretion or to a combination of
insulin resistance and inadequate insulin secretion to compensate.
There are several different types of diabetes mellitus, they may differ in
cause, clinical course, and treatment. The major classifications of diabetes
are:
B. Second Speaker
C. Third Speaker
DIABETES MANAGEMENT
The main goal of diabetes treatment is to normalize insulin activity and
blood glucose levels to reduce the development of vascular and
neuropathic complications.
a. Drugs for Treating Hyperglycemia
The drugs for treating type 2 diabetes fall into several categories:
1) Drugs that primarily stimulate insulin secretion by binding to the
sulfonylurea receptor. Sulfonylureas remain the most widely
prescribed drugs for treating hyperglycemia. The meglitinide
analog repaglinide and the D-phenylalanine derivative nateglinide
also bind the sulfonylurea receptor and stimulate insulin secretion.
2) Drugs that alter insulin action: Metformin works in the liver. The
thiazolidinediones appear to have their main effect on skeletal
muscle and adipose tissue.
3) Drugs that principally affect absorption of glucose: The
glucosidase inhibitors acarbose and miglitol are such currently
available drugs.
4) Drugs that mimic incretin effect or prolong incretin action:
Exenatide and DPP 1V inhibitors fall into this category.
5) Other: Pramlintide lowers glucose by suppressing glucagon and
slowing gastric emptying.
Insulin
Insulin is indicated for type 1 diabetes as well as for type 2 diabetic
patients with insulinopenia whose hyperglycemia does not respond to diet
therapy either alone or combined with other hypoglycemic drugs.
Therefore, the therapeutic goal for diabetes management is to achieve
normal blood glucose levels (euglycemia) without hypoglycemia and
without seriously disrupting the patients usual lifestyle and activity.