November 29, 2022

Diabetes Lecture, metformin, DPP4, Sulphonylureas, insulin, MDI, T2DM, USMLE, medical, Roze Pharm

Diabetes diabetes occur when the blood sugar is too high diabetes should be handled because if not it will lead to risks such as navigating your opacity the damage of the nerves net profancy the kidney disease retinopathy the damage of eyes which cause vision impairment there are type 1 and type 2 diabetes and the diagnosis is symptoms plus random blood glucose

In vein is over 11.1 millimole per liter so most people 9 are type 2. let’s compare between this type 1 and type 2 diabetes type 1 diabetes composed of 10 of total diabetes population it acts on younger people like teenagers or younger adults it is symptomatic so the patients pee a lot is thirsty tired weightless and there’s possible ketosis so as you can see

In this picture from wikipedia the autoimmune attack our own cell in type 1 diabetes so this autoimmune destruction of beta cell in longer hands isolate in pancreas so there’s a absolute insulin deficiency in our body it is me attacking myself in contrast type 2 diabetes composes 90 of total diabetes population the person is usually obese so lifestyle matters

Uh the person is mainly 40 years older asymptomatic yep so the cause is i keep eating too much chocolate or sugar and the insulin keeps being released and so the sense is becoming loud let’s talk about the hormones that that matters so there are insulin glucagon that is working reciprocally to control the blood sugar they are doing like kind of negative feedback

Among themselves we have an insulin uh insulin is secreted by better cell of ireland over along their hands so when blood glucose level is too high the insulin comes and work insulin removes glucose from blood and then you take it to into muscle or fat cell and store the nutrients it’s called cellular uptake so it is storing the carbohydrate whereas glucagon is

Secreted by alpha cell in pancreas so when blood glucose level is low glucagon comes acts on liver and makes gluconeogenesis and gluconeolysis which is making the blood sugar level up it is antagonizer of insulin also exercise stress high protein meal also in stimulate glucogen release you have other hormone food in creatine it is also known as glp1 and gip so

It is secreted from small intestine when there is food it acts on the pancreas better cells and increase insulin level in plays important role in balance glucose level after eating so when you eat there’s food in our stomach and our small intestine so when increasing detects food insulin is being released and the battle cell in palm grass the number rises and

It suppresses glucogen secretion and increases gastric empty time also there’s terms called hypoglycemia and hyperglycemia hypoglycemia means there’s too low sugar in blood the blood glucose level is less than four millimole per liter the symptoms include tremor sweating hunger and dizziness when managing hypoglycemia patient with treatment we check the blood

Glucose level in 50 minutes it is important and there’s term called hyperglycemia this is in contrast so there’s too much sugar in blood the symptoms include the breast order shortness of breath dry mouth weakness and abdominal pain let’s check out the drug treatment for diabetes too so there are many drugs and then each drug acts differently on weight so for

Example the medicine that causes weight loss is sglt2 inhibitor ng lp1 receptor antagonist weight neutral or loss is metformin weight neutral is dpp4 inhibitor the weight gain is sulfonylureas and insulin so we can see the first line is metformin and second line the cell phone uranus dpp4 inhibitor or sglg2 inhibitor firstly metformin is the first line which

Acts on liver and it prevents glucose synthesis so glucose output decreases coming outside of liver when using metformin please monitor hemoglobin a1c in three months and adjust it if it is not effective for example a hiring the dose or changing or adding the other medicine into metformin second line still following urease glycoside glycopyride glipizide and

Gleben clarmite the sulfonylureas is the second line uh sulfonylureans increase the insulin secretion drops down hp1ac or the four but the disadvantage is weight gain also um note that especially glycoside has neutral effect on weight so it is considered best among the best better than other sulfonylurea drugs such as climate pride glipizide or glyphon clamite so

The others are causing the weight gain but glycoside is special so it is doing the neutral effect on weight we have dpp4 inhibitor for the second line it is succely yeah saxoglyptine cetagoleptine availagliptin allogliptin and linogliptin so dpp4 enzymes rhapsody deactivates glp-1 and gip which is insulin but in creatine but related insulin but dpp-4 inhibitor

Plugs gpp-4 so negative negative is positive so increasing hormone rises uh so the glucagon secretion decreases let’s talk about sg lt2 inhibitor uh is a second line two double glyphosin and ampullyflosing the sglt2 transporter is located in this proximal tubule and it is responsible for ninety percent of glucagon resolution so when this transporter is inhibited

90 percent of glucagon glucose is excreted out of urine yeah the advantage is the weight loss by 3 kilogram disadvantage is urinary tract infection so or vaginal stretch the people who have vaginal trash or the infection it is recommended not to use sglt2 inhibitor use our drug instead let’s talk about the third line so the third line includes glp-1 receptor

Antagonist insulin tzd and all carbons so tcd diazole genome is ppar gamma receptor it excellent yeast and agavos um it slows food digestion and helps keeping blood sugar level moderate after the meals so let’s talk about the third line insulin regimen we have mdi which is multiple day injection we have mixed insulin we have basal insulin so some acts on type

1 diabetes some acts on type 2 diabetes and it is like not actually the third line but it is kind of mixed mgi multiple daily injection for type 1 diabetes it uses both rapid acting and long acting as you can see it is combination and the picture reference is from leahey 2012. it mimics pancreas daily insulin release advantage is flexible mdi initially adjusts

Quite fast to the meal and the patient can skip meals its advantage is four to five injections a day and also include several blood glucose level testing so it may increase the confusion premixed is a cloudy and it is mixed used for type 2 diabetes and diabetes smell juice in pregnancy advantage is just one or two times a day breakfast and dinner you can just

Use it once is also fine disadvantage is less flexibility than to eat the food basal insulin is a long acting and single dose for type 2 diabetes advantage is only one disadvantage is it is often suboptimal glucose control so there’s risk of hypoglycemia basal insulin

Transcribed from video
Diabetes Lecture, metformin, DPP4, Sulphonylureas, insulin, MDI, T2DM, USMLE, medical, Roze Pharm By ROZE PHARM