About Diabetes mallitus & it’s treatment

Hello,everyone
We know that diabetes mellitus is a common disease now a days in the world. I wish to writing about this problem.

Diabetes mellitus ia a Group of metabolic disorders characterized by hyperglycemia due to defects in insulin secretion.

Diagnostic criteria for diabetes according to WHO :

1. Fasting plasma glucose >126mg/dl
2. Random plasma glucose >200 mg/dl
3. A glycated haemoglobin level > 6.5%

Classification :

1. Type 1 diabetes : It occurs due to beta cell destruction of pancrease. Onset most often occurs in childhood, but the disease can also develop in adults in their late 30s and early 40s.The immune form is the most common form of type 1 diabetes. Type 1 diabetes is found in all ethnic groups, but the highest incidence is in people from northern Europe and from sardinia.

Type 2 diabetes :
It is characterized by tissue resistance to the action of insulin. A given individual may have more resistance or more beta cell deficiency, and the abnormalities may be mild or severe. Although insulin is produced by the beta cells in these patients, it is inadequate to overcome the resistance, and the blood glucose rises.The impaired insulin action also affects fat metabolism, resulting in increased free fatty acid flux and triglyceride levels and reciprocally low levels of high density lipoprotein.

Individuals with type 2 diabetes may not require insulin to survive, but 30% or more will benefit from insulin therapy to control blood glucose.

Insulin:
It is a small protein with a molecular weight in human of 5808.It contains 51 amino acids arranged in two chains linked by disulfide bridges. Insulin is released from pancreatic beta cells at a low basal rate and at a much higher stimulated rate in response to a variety of stimuli,especially glucose. The liver and kidney are the two main organs that remove insulin from the circulation.

Structure of human insulin.
Promote exercise and regular balanced diet is essential for control diabetes.

Treatment with insulin:
Four principal types of injected insulins are available -

1. Rapid acting, 2. Short acting, 3. Intermediate acting, 4. Long acting insulin.

Intensive insulin regimens are prescribed for almost everyone with type 1 diabetes.

Oral anti-diabetic agents:

Sulfonylureas drugs: Drugs that primarily stimulate insulin release.

1. Tolbutamide, 2. Tolazamide, 3. Glyburide, 4. Glipizide.

Drugs that primarily lower glucose levels bi their actions on the liver, muscle, and adipose tissues.

1. Metformin
2. Thiszolidinedions
3. Rosiglitaxone

Drugs that affect absorption of glucose :

1. Alpha glucosidase inhibitors
2. Acarbose
3. Miglitol

Drigs that mimic incretin effect or prolong incretin action :

1. DPP-4 inhibitors
2. Sitagliptin
3. Saxagliptin
4. Linagliptin
5. Alogliptin

Insulin shock and hyperglycemia :

As already emphasized,the central nervous system normally derives essentially all its energy from glucose metabolism, and insulin is not necessary for this use of glucose to fall to low levels.
Proper treatment for a patient who has hypoglycemic shock or coma is immediate intravenous administration of large quantities of glucose. Also, the administration of glucagon can cause glycogenolysis in the liver and thereby increase the blood glucose level.