Question

What is the difference between DM Type 1 and DM Type 2. Discuss the difference in pharmacologic treatment and why? Discuss the difference between the 4 different types of insulin (look at power point slides) and what each is used for. What is “insulin shock?” what are the signs and symptoms and how is it treated. Discuss how oral hyperglycemics such at Metformin work to reduce blood glucose level. What are the side effects, contraindications, and drug interactions of Metformin? Oral hyperglycemics are also prescribed for polycystic ovarian syndrome. How do these medications such as metformin work to reduce symptom of PCOS?

Answer 1

Difference between type 1 and type 2 DM :

Type 1 DM : people with type 1 DM don’t produce insulin. Cause: In people with type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin. Treatment : people with type 1 diabetes don’t produce insulin, so it must be regularly injected into body. Some people take injections into the soft tissue, such as the stomach, arms , or buttocks, several times per day. Other people use insulin pumps. Insulin pumps supply a steady amount of insulin into the body through a small tube.

Type 2 DM : people with type 2 diabetes don’t respond to insulin as well as they should and later in the disease often don’t make enough insulin. Cause: In people with type 2 diabetes have insulin resistance. The body still produces insulin, but its unable to use it effectively. Researchers aren’t sure why some people become insulin resistance and other don’t, but several lifestyle factors may contribute, including excess weight and inactivity. Other genetic and environmental factors may also contribute. Treatment: type 2 diabetes can be controlled and even reversed with diet and exercise alone, but many people need extra support. And doctor may prescribe medications.

4 types of insulin :

1. Rapid-acting Insulin : begins to work about 15 minutes after injection, peaks in about 1 hour, and continue to work for 2-4 hours.

2. Short-acting insulin : usually reaches the bloodstream within 30min after injection, peaks anyway from 2-3 hours after injection, and is effective for approximately 3-6 hours.

3. Intermediate-acting insulin : Generally reaches the bloodstream about 2-4 after injection, peaks 4-12 hours later and is effective for about 12-18 hours.

4.long-acting insulin : reaches the bloodstream several hours after injection and tends to lower glucose levels up to 24-hours or longer.

Insulin shock :

an Acute physiological conditions resulting from excess insulin in the blood, involving low blood sugar, weakness, convulsions, and potentially coma. Symptoms of insulin shock- dizziness, shaking, sweating, hunger, nervousness or anxiety, irritability, rapid pulse. treatment : administer an injection of glucagon

metformin :

metformin typically lowers fasting blood glucose concentration by approximately 20% , a response similar to that of sulfonylurea. Pharmacokinetics - Metformin should be taken with meals and should be started at a low dose to avoid intestinal side effects. The dose can be increased slowly as necessary to a maximum of 2550 mg / day (850mg TID). Side effects - The most common side effects of metformin are gastrointestinal, including a metallic taste in the mouth, mild anorexia, nausea, abdominal discomfort, and diarrhoea. A rare problem is lactic acidosis, which may be fatal in as many as one-half of cases. Drug interactions - A potential drug interaction exists between metformin and cimetidine (Tagamet) resulting in an increase in metformin blood levels. This interaction could increase the risk of hypoglycaemia in patient taking metformin plus a sulfonylurea or insulin, and could increase the risk of lactic acidosis in those with impaired renal function. These risks could increase now that cimetidine is available over-the-counter. Other H2-blockers are less likely to cause this problem. The manufacturer also recommended discontinuing metformin for 48 hours after any radiologic procedure involving the administration of iodinated contract material into the blood. Metformin in PCOS , the majority of women with pcos have high insulin levels which cause weight gain, cravings, and even dark patches on your skin. Over time, exposure to high insulin levels can make you insulin resistant or turn into type 2 diabetes. Metformin works to lower your insulin and reduce your risk for diabetes