Insulin and Anti-Diabetic Drugs
1. Diabetes Mellitus
- Definition: Elevated blood glucose due to absolute or relative insulin deficiency.
- Complications: Retinopathy, nephropathy, neuropathy, cardiovascular disease.
- Types:
- Type 1 (T1DM): Absolute insulin deficiency (autoimmune β-cell destruction).
- Type 2 (T2DM): Insulin resistance + β-cell dysfunction.
- Gestational diabetes.
- Other causes: medications, pancreatitis, pancreatectomy.
Type 1 Diabetes Mellitus (T1DM)- beta cell necrosis
- Usually develops in puberty/early adulthood due to autoimmune process of beta cells/ invasion of
viruses
- Absolute insulin deficiency → hyperglycaemia, ketoacidosis risk.
- Symptoms: Polydipsia (excessive thirsty), polyphagia (excessive hunger), polyuria (excessive
urine), weight loss (unable to utilize glucose)
- Management:
- Exogenous insulin therapy (basal + prandial)
- Amylin is hormone that co-secreted with insulin from pancreatic beta cells following food intake.
- slows gastric emptying & promotes satiety (full)
- Pramlintide (synthetic amylin analogue) adjunct therapy, SE: N/V
- Goal: Maintain near-normal glucose, prevent complications (HbA1c monitoring); – Rate of HbA1c
formation is proportional to the average blood glucose concentration over the previous 3 months
Type 2 Diabetes Mellitus (T2DM)
- Causes: genetics, ageing, obesity, insulin resistance.
- Partial β-cell function; insulin secretion insufficient for glucose control.
- Often associated with obesity
- lack of sensitivity of target organs to either endogenous or exogenous insulin
- Management:
- Lifestyle modification (diet, exercise, weight reduction), maintain blood glucose concentration
- Oral hypoglycaemic agents.
- Insulin therapy as β-cell function declines.
, Gestational Diabetes
- Placental hormones → insulin resistance (most pronounced in third trimester).
- Risks: fetal macrosomia (abnormally large), shoulder dystocia, neonatal hypoglycaemia.
- Management: diet, exercise, ± insulin; glyburide or metformin possible alternatives.
2. Insulin
- Structure: Small protein (MW 5808 Da), synthesized as proinsulin → cleaved to insulin + C-peptide
connected by disulfide bonds
- Secretion: Triggered by ↑ intracellular ATP → K⁺ channel closure → Ca²⁺ influx → insulin release
- Sources: Recombinant DNA (E. coli or yeast), modified analogues for different PK profiles.
1. Diabetes Mellitus
- Definition: Elevated blood glucose due to absolute or relative insulin deficiency.
- Complications: Retinopathy, nephropathy, neuropathy, cardiovascular disease.
- Types:
- Type 1 (T1DM): Absolute insulin deficiency (autoimmune β-cell destruction).
- Type 2 (T2DM): Insulin resistance + β-cell dysfunction.
- Gestational diabetes.
- Other causes: medications, pancreatitis, pancreatectomy.
Type 1 Diabetes Mellitus (T1DM)- beta cell necrosis
- Usually develops in puberty/early adulthood due to autoimmune process of beta cells/ invasion of
viruses
- Absolute insulin deficiency → hyperglycaemia, ketoacidosis risk.
- Symptoms: Polydipsia (excessive thirsty), polyphagia (excessive hunger), polyuria (excessive
urine), weight loss (unable to utilize glucose)
- Management:
- Exogenous insulin therapy (basal + prandial)
- Amylin is hormone that co-secreted with insulin from pancreatic beta cells following food intake.
- slows gastric emptying & promotes satiety (full)
- Pramlintide (synthetic amylin analogue) adjunct therapy, SE: N/V
- Goal: Maintain near-normal glucose, prevent complications (HbA1c monitoring); – Rate of HbA1c
formation is proportional to the average blood glucose concentration over the previous 3 months
Type 2 Diabetes Mellitus (T2DM)
- Causes: genetics, ageing, obesity, insulin resistance.
- Partial β-cell function; insulin secretion insufficient for glucose control.
- Often associated with obesity
- lack of sensitivity of target organs to either endogenous or exogenous insulin
- Management:
- Lifestyle modification (diet, exercise, weight reduction), maintain blood glucose concentration
- Oral hypoglycaemic agents.
- Insulin therapy as β-cell function declines.
, Gestational Diabetes
- Placental hormones → insulin resistance (most pronounced in third trimester).
- Risks: fetal macrosomia (abnormally large), shoulder dystocia, neonatal hypoglycaemia.
- Management: diet, exercise, ± insulin; glyburide or metformin possible alternatives.
2. Insulin
- Structure: Small protein (MW 5808 Da), synthesized as proinsulin → cleaved to insulin + C-peptide
connected by disulfide bonds
- Secretion: Triggered by ↑ intracellular ATP → K⁺ channel closure → Ca²⁺ influx → insulin release
- Sources: Recombinant DNA (E. coli or yeast), modified analogues for different PK profiles.
