Complications

 Blindness
 Heart Attack
 Kidney Failure
 Amputation

Microvascular Complications
Retinopathy: annual screening for prevention
Neuropathy: nerves

Macrovascular Complications
 CVA: stroke, affects large blood vessels of the brain
 CAD
 PAD: lower legs, DVT

Diabetes Depression

Prevalence
1 in 4 people or 25% people in the Philippines have diabetes

Diabetes Dietary
Rich in fiber:
Insoluble – non-absorbable
Soluble – absorbable
Red meat – lamb
White meats – chicken, fish: good fatty acid

Meat
Lean meat
Non-lean
Fatty

Fat
Good: Unsaturated
Unsaturated
Mono-saturated
Poly-saturated
Bad: Saturated, Transfat

CHO
1 gram = 40 kcal

Lifestyle Modification (DESS)

 Dietary
 Exercise
 Smoking Cessation
 Stress Management

Management:
 Medical Nutrition Therapy, diet therapy
 OAD (oral anti-diabetics); OHA (oral hyperglycemic
 Insulin therapy
1. monotherapy: one medicine either oral diabetic, or insulin/non-insulin
injectable
2. Dual therapy: ORAL diabetic and insulin
3. Polypharmacy: more than 3 diabetic
 Non-insulin injectables

Insulin pump or Continuous subcutaneous insulin infusion (CSII)

OADs
Insulin Enhancers: enhance insulin secretions
Sulfonylureas: Glibenclamide, Gliclazide
Meglitinides: Insulin Secretagogoues – increases the secretions of
Incretin: gastrointestinal tract, insulin-secreting gastrin, increase insulin = decreasing
blood glucose level

Dipeptidyl-peptidase 4 (DPP4
Glucagon-like peptide

Insulin Enhancers
 Sulfonylureas: Glibenclamide, Gliclazide
 Meglitinides:
 Incretin
 DPP-4 inhibitor
 GLP-I analogue
Alpha Glucosidase Inhibitor
 Acarbose, Voglibose - Flatulence
Insulin Sensitizers
 Biguanides: Metformin
 Thiazolidinediones (TZD): Pioglitazone
Sodium-glucose Cotransporter-2 inhibitor (SGLT 2): decreases satiety

Insulin Therapy
Exogenous insulin – injectable, human insulin
Endogenous insulin – made by pancreas

Aims of pharmacological treatment

 Reduce symptoms of hyperglycemia
 Limit adverse effects of treatment
 Maintain quality of life
 Prevent or delay vascular complications
Basal insulin or base; levels are sustained throughout the day
Bolus insulin or meal insulin

Insulin Action
A: Onset of action
B: Peak of action
C: Duration

Insulin Preparation Onset of action Peak action Duration of action

Short-Acting Insulin = bolus insulin
Regular 30 – 60 minutes 2 – 3 hours 5 – 8 hours
Intermediate Acting Insulin = basal insulin
NPH 2 - 4 hours 4 – 10 hours 10 – 16 hours
Long-Acting Insulin = basal insulin
Insulin Glargine 2 - 4 hours Peakless 20 - 24 hours
Insulin Detemir 2 - 4 hours 6 – 14 hours 16 – 20 hours
Rapid Acting Insulin Analog = bolus insulin
Insulin Lispro 5 – 15 minutes 30 – 90 minutes 3 – 5 hours
Insulin Aspart 5 – 15 minutes 30 – 90 minutes 3 – 5 hours
Insulin Glulisine 5 – 15 minutes 30 – 90 minutes 3 – 5 hours
Insulin Mixtures
70/30 human 30 – 60 minutes Dual 10 – 16 hours
50/50 human 30 – 60 minutes Dual 10 – 16 hours
75/25 Lispro analog 5 – 15 minutes Dual 12 - 20 hours
75/25 Lispro analog 5 – 15 minutes Dual 12 - 20 hours
50/50 Lispro analog 5 – 15 minutes Dual 12 - 20 hours

Side Effects:
Lipodystrophy – changes in morphology; causes: repetitive rotation, reusing needles
Edema
Allergic Reactions

Somogyi effect – decreasing blood glucose level in evening, increase in morning