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Zuhir pbl-iii (diabetes)
• The following is a collection of medical
• It is to be used for educational purposes only
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and the authors claims no rights over them.
1. Rapid acting2. Regular3. NPH (N)-slower and longer acting 4. Lente (L)- slower and longer acting 5. Ultralente- slowest and longest acting 6. Long acting basal-slowest and longest acting
• The discovery of a new polymer that may allow
development of an effective insulin pill was
reported at a recent meeting of the American
• When the polymer is used as a pill coating, it
allows insulin to get into the bloodstream
without being destroyed by the digestive system.
So far it has only been tested in animals.
• Some experts question whether insulin in pill
form will prove useful, since dosing is so critical
• Although daily injections of insulin would still be
needed, inhaled insulin is currently in clinical
trials and may be headed for a fast track approval
by the Food and Drug Administration (FDA).
• These inhalers are about the size of a flashlight
• The sprayed insulin is inhaled into the mouth and
coats the mouth, throat and tongue. The insulin
passes quickly into the bloodstream.
• In the past year, three new formulations of
insulin have become available which have
been designed to offer the advantages of
simpler regimens and better glucose control
for people whose diabetes must be treated
• All are human insulin analogs derived from
(from Aventis Co.) is a basal insulin,
offering a more continuous activity with much
less of a peak than NPH insulin. It can be used
with a very-rapid-acting insulin such as lispro
or aspart, and should provide a flatter basal
(from Novo Nordisk) is a very-rapid-acting
insulin that can be injected 15 minutes prior to
eating. Its fast action also allows more freedom in
the timing of meals and the amount of food
is a 75/25 lispro mixture is the first of
the analog mixtures available (from Eli Lilly); it
contains Lilly's very-rapid-acting lispro and a
novel human insulin analog called NPL. It is
designed for those who need better control after
meals and want to use an insulin pen.
Advances in Management
• DPP-4 inhibitors
include the oral drugs Januvia,
Onglyza, and Tradjenta. These protect a natural
compound in the body -- GLP-1 -- from breaking down.
• Incretin mimetics or GLP analogs
include the injected
drugs Byetta and Victoza. They use the body's own
signaling system to boost insulin after meals.
• Other drugs
includeSymilin, an injectable synthetic
hormone. It helps lower blood sugar after meals in
• Combination drugs
have made a huge difference.
• They join different medications in one pill -- often
metformin and a sulfonylurea, a meglitinide, a DPP4
inhibitor, a thiazolidinedione, or a thiazolidinedione in
• This cuts down the number of pills a person has to
• Combination drugs include Actoplus MET, Avandamet,
Duetact, Glucovance, Metaglip, and PrandiMet.
• There can be drawbacks. They tend to cost more than
generic drugs. They can also make it harder to fine-
• New types of insulin
allow some people to take
just one injection of a long-acting insulin each
day. That can be much easier than multiple
injections of standard insulin, says Cypess.
• Future medications.
Other classes of medication
are in development. One type doesn't affect
insulin, unlike most diabetes drugs. It blocks the
body from reabsorbing glucose from urine, says
Kalyani. While the FDA has not approved any
drug from this class, it could in the future.
Vaccine against Diabetes
• Researchers have produced a drug (essentially
a peptide) that targets auto-immune diabetes.
• It interferes with the function of immune cells
that attack the β-cells of the pancreas without
affect the rest of the immune system.
• It thereby offers the possibility of preventing
type 1 diabetes in people at high risk and of
halting its progress in people newly diagnosed
• Results published in a recent issue of The Lancet
showed that three injections of the compound
given within six months of diagnosis of type 1
diabetes successfully arrested the progression of
the disease in newly diagnosed patients.
• After treatment, these patients produced insulin
and required fewer insulin injections. They did
not experience any harmful or major side effects.
• Studies are still underway to determine their
Islet cell transplant
• A new islet cell transplant technique has shown
• Called the 'Edmonton' technique, the transplants
have resulted in seven patients becoming insulin
free for up to 14 months after treatment.
• Clinical trials are now underway at 10 national
diabetes centers to see if the insulin reversal can
• The Edmonton technique uses islet cells (cells
from the pancreas) from two or more donor
• Patients are required to take immuno-
suppressive drugs for the rest of their life.
Differences between DM-I/II
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