CHAPTER 6 – ENDOCRINE SYSTEM
6.1 DRUGS USED IN DIABETES
ACE-I
o Cardioprotective
o Renal protective properties
HbA1C
o Shows control over past 2-3 months
o Ideal: 6.5-7.5%
Insulin needs
o Can increase in following:
Infection
Stress
Trauma
Puberty
o Can decrease in following:
Renal/hepatic impairment
Endocrine disorders
Coeliac disease
Gestational Diabetes (During pregnancy)
o 2nd and 3rd trimester usually need to increase insulin requirements
Blood Sugar Levels
o Most of time: 4-9mmol/L
o Before Meals: 4-7mmol/L
o After Meals: less 9mmol/L
6.1.1 Insulins
Short acting
o Soluble insulin
SC admin rapid onset of action 30-60 minutes, peaks at 2-4 hours and
duration for up to 8 hours
IV admin short T½ of 5 minutes and effects disappear after 30 minutes
o Insulin lispro and Insulin Aspart
Faster action and shorter duration of action than soluble insulin
Intermediate – isophane insulin and insulin zinc suspension
Long – insulin zinc suspension
o Intermediate and long acting insulins have an onset of action of 1-2 hours, maximum
effect at 4-12 hours and duration is 16-35 hours
Changing between insulins:
o Beef Human: Reduce insulin by 10%
, o Pork Human :Dose change not usually required
COUNSELLING POINT:
o WHEN DISPENSING INSULIN, SHOW PATIENT CONTAINER TO CONFIRM!!!
6.1.2 Antidiabetic Drugs
Sulphonylureas
o Augment insulin secretion
o Two types:
Long acting
Chlorpropamide, Glibenclamide (er side effects)
Short acting
Gliclazide , Tolbutamide
Acarbose
o Delays digestion and absorption of starch and sucrose
o SIDE EFFECT: FLATULENCE
o COUNSELLING: Tablets should be chewed with first mouthful of food or swallowed
with a little liquid immediately before food.
Biguanides (Metformin)
o gluconeogenesis and peripheral glucose use
o SIDE EFFECT: GI (Therefore take with or after food)
Thiazolidinediones (Pioglitazone, Rosiglitazone)
o peripheral insulin resistance
o CSM: CARE REQUIRED IN HEART FAILURE PATIENTS
Exanatide (Injection)
o Increases insulin secretion, suppresses glucagons secretion and slows gastric
emptying
o COUNSELLING: If miss dose continue with next one do not administer AFTER meal
Gliptins
o insulin secretion and s glucagons secretion
6.1.3 Diabetic Ketoacidosis
Symptoms:
o Increase blood glucose
o Dehydration
o Electrolye imbalance
o Production of ketones
Treatment
o Insulin
o Fluids
o Potassium
6.1 DRUGS USED IN DIABETES
ACE-I
o Cardioprotective
o Renal protective properties
HbA1C
o Shows control over past 2-3 months
o Ideal: 6.5-7.5%
Insulin needs
o Can increase in following:
Infection
Stress
Trauma
Puberty
o Can decrease in following:
Renal/hepatic impairment
Endocrine disorders
Coeliac disease
Gestational Diabetes (During pregnancy)
o 2nd and 3rd trimester usually need to increase insulin requirements
Blood Sugar Levels
o Most of time: 4-9mmol/L
o Before Meals: 4-7mmol/L
o After Meals: less 9mmol/L
6.1.1 Insulins
Short acting
o Soluble insulin
SC admin rapid onset of action 30-60 minutes, peaks at 2-4 hours and
duration for up to 8 hours
IV admin short T½ of 5 minutes and effects disappear after 30 minutes
o Insulin lispro and Insulin Aspart
Faster action and shorter duration of action than soluble insulin
Intermediate – isophane insulin and insulin zinc suspension
Long – insulin zinc suspension
o Intermediate and long acting insulins have an onset of action of 1-2 hours, maximum
effect at 4-12 hours and duration is 16-35 hours
Changing between insulins:
o Beef Human: Reduce insulin by 10%
, o Pork Human :Dose change not usually required
COUNSELLING POINT:
o WHEN DISPENSING INSULIN, SHOW PATIENT CONTAINER TO CONFIRM!!!
6.1.2 Antidiabetic Drugs
Sulphonylureas
o Augment insulin secretion
o Two types:
Long acting
Chlorpropamide, Glibenclamide (er side effects)
Short acting
Gliclazide , Tolbutamide
Acarbose
o Delays digestion and absorption of starch and sucrose
o SIDE EFFECT: FLATULENCE
o COUNSELLING: Tablets should be chewed with first mouthful of food or swallowed
with a little liquid immediately before food.
Biguanides (Metformin)
o gluconeogenesis and peripheral glucose use
o SIDE EFFECT: GI (Therefore take with or after food)
Thiazolidinediones (Pioglitazone, Rosiglitazone)
o peripheral insulin resistance
o CSM: CARE REQUIRED IN HEART FAILURE PATIENTS
Exanatide (Injection)
o Increases insulin secretion, suppresses glucagons secretion and slows gastric
emptying
o COUNSELLING: If miss dose continue with next one do not administer AFTER meal
Gliptins
o insulin secretion and s glucagons secretion
6.1.3 Diabetic Ketoacidosis
Symptoms:
o Increase blood glucose
o Dehydration
o Electrolye imbalance
o Production of ketones
Treatment
o Insulin
o Fluids
o Potassium
