1. 1. ANTIDIABETIC DRUGS
2. 2. Diabetes Mellitus Metabolic disorder characterized by hyperglycemia, glycosuria Types: type I (IDDM) type II (NIDDM)
3. 3. Actions of insulin Inhibits glycogenolysis Inhibits gluconeogenesis Promotes glycogen synthesis Fat + glucose uptake + storage of TG Inhibits lipolysis Muscle + protein synthesis + glycogen synthesis - Protein breakdown
4. 4. 1. Rapid acting a. Lispro b. Aspart c. Glulisine 2. Short acting a. Regular insulin Insulin preparations
5. 5. 3. Intermediate acting a. Insulin zinc suspension (lente) b. Neutral Protamine Hagedorn (NPH) 4. Long acting a. Glargine b. Detemir
6. 6. Insulin administration All insulin preparations are administered subcutaneously Regular insulin can be administered i.v & i.m also
7. 7. 1. Hypoglycemia Treatment- oral glucose 50ml of 50% dextrose i.v 2. Local reactions lipodystrophy, swelling, erythema 3. Allergy and resistance Adverse effects of insulin
8. 8. Oral Antidiabetic Drugs
9. 9. Classification A. Stimulators of insulin release from pancreas i) Sulfonylureas Tolbutamide, chlorpropamide, glibenclamide, glipizide, gliclazide, glimepiride ii) Meglitinide analogue Repaglinide iii) D-phenylalanine derivative Nateglinide
10. 10. B. Inhibitors of hepatic neoglucogenesis Biguanides - Phenformin, metformin C. Drugs which reduces insulin resistance Thiazolidinediones - Rosiglitazone Pioglitazone D. - Glucosidase inhibitors Acarbose, Miglitol
11. 11. Adverse effects of sulfonylureas Hypoglycemia Nausea, vomiting, diarrhoea, headache, weight gain Hypersensitivity reactions Chlorpropamide - Cholestatic jaundice
12. 12. Repaglinide & Nateglinide Rapid and short acting Low risk of severe hypoglycemia
13. 13. Biguanides Adverse effects Nausea, metallic taste, abdominal pain, diarrhea Lactic acidosis Vitamin B12 deficiency
14. 14. Thiazolidinediones Adverse effects Nausea, vomiting, anemia, weight gain, fluid retention, hepatotoxicity (rare)
15. 15. Glucosidase inhibitors Adverse effects Flatulence, loose stools, abdominal pain
16. 16. Therapeutic uses Type II DM Alone or in combination with insulin Cannot be used for Type I DM