LEC#37 Anti Diabetic Drugs (Insulin)

ANTI DIABETIC DRUGS
BY
DR.SAMREEN ALI
Associate Professor (Pharmacology)
OVERVIEW:
 The pancreas is both an endocrine gland that produces
the peptide hormone insulin, glucagon, and somatostatin
and an exocrine gland that produces digestive enzymes.
 The peptide hormones are secreted from cells located in

the islets of Langerhans (β cells produce insulin, α cells
produce glucagon, and δ cells produce somatostatin).
 These hormones play an important role in regulating the

metabolic activities of the body, particularly the
homeostasis of blood glucose.
CONT….
Hyperinsulinemia can cause severe
hypoglycemia.
 A relative or absolute lack of insulin, such as in

diabetes mellitus, can cause serious
hyperglycemia.
If this condition is left untreated, retinopathy,

nephropathy, neuropathy, and cardiovascular
complications may result.
DIABETES MELLITUS
The incidence of diabetes is growing rapidly

worldwide.
Diabetes is not a single disease. Rather, it is a

heterogeneous group of syndromes characterized
by an elevation of blood glucose caused by a
absolute or relative deficiency of insulin.
CONT…
The American Diabetes Association (ADA)
recognizes four clinical classifications of diabetes:
 type 1 diabetes (formerly, insulin dependent
diabetes mellitus),
type 2 diabetes (formerly, non-insulin dependent
diabetes mellitus),
gestational diabetes, and
diabetes due to other causes (for example, due to
medications).
TYPE 1 DIABETES
 Type 1 diabetes most commonly afflicts individuals in puberty
or early Adulthood.
 The disease is characterized by an absolute deficiency of

insulin caused by massive Loss of β-cell function is usually
ascribed to autoimmune-mediated processes directed against
the β cell, and it may be triggered by an invasion of viruses or
the action of chemical toxins.
 As a result of the destruction of these cells, the pancreas fails

to respond to glucose, and the type 1 diabetic shows classic
symptoms of insulin deficiency (polydipsia, polyphagia,
polyuria, and weight loss).
TREATMENT:
 A person with type 1 diabetes must rely on exogenous
(injected) insulin to control hyperglycemia,to avoid to avoid
long term complications like diabetic ketoacidosis, and
maintain acceptable levels of glycosylated hemoglobin
(HbA1c).
 The rate of formation of HbA1c is proportional to the

average blood glucose concentration over the previous 3
months.
 Therefore, HbA1c provides a measure of how well

treatment has normalized blood glucose in diabetic patients.
TYPE 2 DIABETES
Most diabetic patients have type 2 disease. Type 2
diabetes is influenced by genetic factors, aging,
obesity, and peripheral insulin resistance.
The metabolic alterations observed are milder than

those described for type 1 .In contrast to patients
with type 1, those with type 2 diabetes are often
obese.
This resistance to insulin is considered to be a

major cause of this type of diabetes.
TREATMENT:
The goal in treating type 2 diabetes is to maintain
blood glucose concentrations within normal limits
and to prevent the development of long-term
complications of the disease.
 Weight reduction, exercise, and dietary

modification decrease insulin resistance and
correct the hyperglycemia of type 2 diabetes in
some patients.
Insulin
Classification Rapid acting
Insulin lispro
Insulin aspart
Insulin glulisin
Short acting
Regular
Intermediate acting
Neutral protamine hagadron
Long acting
Insulin glargine
Insulin detemir
INSULIN ADMINISTRATION:
 Because insulin is a polypeptide, it is degraded in the
gastrointestinal tract if taken orally. Therefore, it is generally
administered by subcutaneous injection.
 In a hyperglycemic emergency, regular insulin is injected

intravenously (IV).
 Continuous subcutaneous insulin infusion (insulin pump) has

become popular, because it does not require multiple daily
injections.
.
RAPID-ACTING INSULIN:
 Insulin lispro, insulin aspart, and insulin glulisine are rapid
actiing insulin Because of their rapid onset and short
duration of action.
 This results in more rapid absorption after subcutaneous

injection.
CONT…
They are administered to mimic the prandial
(mealtime) release of insulin, and they are
usually not used alone but with a longer-
acting insulin to ensure proper glucose
control.
SHORT-ACTING INSULIN
 Regular insulin is a short-acting.
Onset = within 30 min
Duration of action =6-8hours
It is usually given subcutaneously (or IV in

emergencies).
INTERMEDIATE-ACTING INSULIN
Onset 30 min-2 hrs
Duration 4-12 hrs
Neutral protamine Hagedorn (NPH) insulin .
Another name for this preparation is insulin
isophane.
It is useful in treating all forms of diabetes except
diabetic ketoacidosis and emergency hyperglycemia.
LONG-ACTING INSULIN
 1. Insulin glargine: It is slower in onset than NPH
insulin and has a flat, prolonged hypoglycemic effect
with no peak.
 Like the other insulins, it must be given
subcutaneously.
 2. Insulin detemir: Insulin detemir has a fatty-acid

sidechain. This addition enhances association to
albumin.
 Slow dissociation from albumin results in long-acting

properties similar to those of insulin glargine.
ADVERSE EFFECTS
OF INSULIN
Hypoglycemia
Lipodystrophy
hypersensitivity

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ANTI DIABETIC DRUGS

 The peptide hormones are secreted from cells located in

 These hormones play an important role in regulating the

 A relative or absolute lack of insulin, such as in

If this condition is left untreated, retinopathy,

The incidence of diabetes is growing rapidly

Diabetes is not a single disease. Rather, it is a

 The disease is characterized by an absolute deficiency of

 As a result of the destruction of these cells, the pancreas fails

 The rate of formation of HbA1c is proportional to the

 Therefore, HbA1c provides a measure of how well

The metabolic alterations observed are milder than

This resistance to insulin is considered to be a

 Weight reduction, exercise, and dietary

 In a hyperglycemic emergency, regular insulin is injected

 Continuous subcutaneous insulin infusion (insulin pump) has

 This results in more rapid absorption after subcutaneous

It is usually given subcutaneously (or IV in

 2. Insulin detemir: Insulin detemir has a fatty-acid

 Slow dissociation from albumin results in long-acting

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