Diabetes

Chapter 23: Co-existing Disease:  Diabetes

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Physiology

Overview

 

 

Alpha cell stimulation

"Inputs to alpha cells and effects of glucagon, including negative feedback, which increases plasma glucose levels"

courtesy of Robert H. Parsons, Ph.D., Rensselaer Polytechnic Institute, used with permission

"Inputs to beta cells and effects of insulin, including negative feedback on glucose and amino-acids levels. "

courtesy of Robert H. Parsons, Ph.D., Rensselaer Polytechnic Institute, used with permission

 

 

 

 

Properties of IDDM* and NIDDM**
Characteristic IDDM NIDDM

Genetic locus

Chromosome 6

unknown

Typical age of onset

Usually < 40 years of age

> 40 years of age

Plasma insulin

Low to absent

Normal to high

Plasma glucagon

High, suppressible

High, resistant

Acute complication

Ketoacidosis

Hyperosmolar coma

Insulin therapy

Responsive

Responsive to resistant

Response to sulfonylurea drugs

Unresponsive

Responsive

* Insulin-dependent diabetes mellitus

**Non-insulin dependent diabetes mellitus

Type II diabetes:

 

Insulin

Overview:

 

 

Insulin preparations: Overview

 

 

Table: Sulfonylureas

Tolbutamide (Orinase)

tolazamide (Tolinase)

acetohexamide

chlorpropamide (Diabinese)

glyburide (Micronase, DiaBeta)

glipizide (Glucotrol)

glimepiride (Amaryl)

 

Biguanides

Alpha-glucosidase Inhibitor

Thiazolidinedione Derivatives

 

Glucagon

Karam, J. H., Pancreatic Hormones and Antidiabetic Drugs, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 684-703
Foster, D. W., Diabetes Mellitus, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 2060-2080

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