JUNAINAH BINTI ANUAR

DPM 1/12 A
DIPLOMA IN PHARMACY

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NO. CONTENT SLIDE
1 DEFINITION 3
2 ROLE OF PANCREAS 4-5
3 PANCREAS HORMONES AND ITS FUNCTION 6
4 TYPES OF DIABETES 7-8
5 CAUSES OF DIABETES 9-11
6 DIAGNOSIS 12-14
7 SYMPTOMS 15
8 COMPLICATON 16
9 PHARMACOLOGICAL TREATMENT 17-25
10 NON PHARMACOLOGICAL TREATMENT 26
11 REFERENCES 27

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DIABETES MELLITUS is a condition in which the
pancreas no longer produces enough insulin or cells stop
responding to the insulin that is produced, so that glucose
in the blood cannot be absorbed into the cells of the
body.

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The pancreas is a gland organ that is located in the
abdomen.

It is part of the digestive system and produces important

enzymes and hormones that help break down foods.

Pancreas carries out two important role:

An exocrine function- helps in digestion

An endocrine function- that regulates blood sugar level.

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Two of the main pancreatic hormones are insulin and
glucagon.
Hormone Functions
Insulin Insulin is produced by the beta cells of the pancreas.
This hormone lowers blood glucose levels after a meal by
stimulating the absorption of glucose by liver, muscle, and
adipose tissues.

Glucagon Glucagon is produced by the alpha cells of the pancreas.

Glucagon raises blood glucose levels by stimulating the
liver to metabolize glycogen into glucose molecules and to
release glucose into the blood.

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Type I Diabetes

Type I diabetes mostly afflicts individuals in adulthood but

some forms can occur later in life.
Type I diabetes is also known as Insulin Dependent
Diabetes.
Type I diabetic is the chronic (lifelong) disease that occurs
when the pancreas does not produce enough insulin to
control blood sugar levels properly.
Daily injection of insulin is needed.

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Type II Diabetes

Type II diabetes is influenced by genetic factors , aging,

obesity and peripheral insulin resistance.
Type II diabetes is also known as Non-insulin Dependent
Diabetes.
Type II diabetes results from insulin resistance, a condition
in which cells fail to use insulin properly, sometimes also
with an absolute insulin deficiency.

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Type I Diabetes
Bodys own immune system attacks and destroys beta cell in
the pancreas which is responsible for creating the hormone
insulin.

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Type II Diabetes

The pancreas retains some beta cell function , but insulin

secretion is insufficient to maintain glucose homeostasis.
Its occur when the pancreas doesnt make enough insulin or
he cells of body become resistant to insulin.

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Following tests can be done for diabetes type I and
type II:
1. Glycated hamoeglobin (A1C) test
This blood test indicates your average blood sugar level for
the past two to three months.
It measures the percentage of blood sugar attached to
hemoglobin.
The higher your blood sugar levels, the more hemoglobin
you will have with sugar attached. An A1C level of 6.5 percent
or higher on two separate tests indicates that you have
diabetes. Below 5.7 is considered normal.

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2. Random Blood Sugar Test
A blood sample will be taken at the random time.
Regardless of when you last ate, a random blood sugar
level of 200 milligrams per deciliter (mg/dL) 11.1
millimoles per liter (mmol/L) or higher suggests diabetes.
3. Fasting Blood Sugar Test
A blood sample will be taken after an overnight fast.
A fasting blood sugar level less than 100 mg/dL (5.6
mmol/L) is normal.
If it's 126 mg/dL (7 mmol/L) or higher on two separate
tests, you have diabetes.
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4.Oral Glucose Tolerence Test

For this test, you fast overnight, and the fasting blood
sugar level is measured.
Then you drink a sugary liquid, and blood sugar levels are
tested periodically for the next two hours.
A blood sugar level less than 140 mg/dL (7.8 mmol/L) is
normal.
A reading of more than 200 mg/dL (11.1 mmol/L) after
two hours indicates diabetes.

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 COMPLICATION
Nephropathy Retinopathy
Coronary Artery
Disease
Neuropathy
High levels
of blood
High blood glucose Diabetes can cause glucose can
and blood pressure High blood damage to the cause the
can damage to small pressure, high nerves throughout blood vessel
blood vessels in the cholesterol, high the body when formation in
kidneys leading to blood glucose blood glucose and the retina of
the kidneys becoming can contribute to blood pressure are the eyes.
less efficient or to fail cardiovascular too high. Leads to
altogether. disease. Mostly nerve reduced
Which can leads damages in foot and vision and
to heart attack its called Diabetic blindness.
and stroke. foot ulcer. Leading
to serious infections
and require 16
amputation.
1. Insulin
Drug Names Dosage
Insulin aspart 0.2-0.6 unit/kg/day divided doses
Insulin detemir Once or twice daily subcutaneous administration
Insulin glargine Once daily subcutaneous administration
Insulin lisipro Usually 0.5-1 unit/kg/day divided doses
Regular insulin 0.5-1 unit/kg/day sc divided doses
NPH insulin suspension 0.5-1 unit/kg/day divided doses

Side effects: Redness, headache, back pain, diarrhea ,

hypersensitivity and allergic reaction, hypoglycemia,
itching, hunger.
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Mechanism of action : Insulin
Covert the glucose to glycogen in liver and muscle.
Decreases the production of glucose from glycogen.
Decreases formation of glucose from non-
carbonhydrate.
Decreases lipolysis and ketogenesis.

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2.Oral Agents
Drug Names Dosage
Acarbose 50mg 200mg bd- tds
Glipizide 2.5mg 50mg daily
Glimepiride 1mg daily
Metformin 500 mg up to 2g bd
Miglitol 25mg PO
Nateglinide 60mg 180mg daily
Pioglitazone 15mg- 45mg daily
Rosiglitazone 4mg PO
Repaglinide 500mcg- 16mg daily
Sitagliptin 11mg once daily
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Tolbutamide 1 to 2g orally daily
Oral Agents

Side Effects :
Dizzy
Drowsy
Heartburn
Stomach pain
Constipation

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Mechanism of action : Oral agents

Stimulate the release of insulin from pancreatic B-cells.

Decreases hepatic glucose output and increases insulin
sensitivity (muscle, liver).
Increase insulin sensitivity (muscle and liver) and decrease
glucose production.

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3. Amylin Analog

Drug Names Dosage

Pramlintide 60 mcg subcutaneously

Side Effects: Nausea, vomiting, headache, abdominal pain,

weight loss and fatigue.

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Mechanism of action : Amylin Analog

Pramlintide is an analog of human amylin. Amylin is

colocated with insulin in secretory granules and
cosecreted with insulin by pancreatic beta cells in
response to food intake.
4. Incretin Mimetic
Drug Names Dosage
Exenatide 5mcg subcutaneously
Liraglutide 0.6 mg daily

Side effects: Diarrhea, constipation ,upper respiratory

tract infection, and headache.

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Mechanism of action : Incretin Mimetic

GLP-1 increases the secretion of insulin from the pancreas,

slows absorption of glucose from the gut, and reduces the
action of glucagon.

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EXERCISE
Physical activity promotes weight reduction and improves
insulin sensitivity, thus lowering blood glucose levels.
DIETS
Dietary treatment should aim at:
Ensuring weight control.
Providing nutritional requirements.
Allowing good glycemic control with blood glucose level
as close to normal as possible.

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Lippincotts Illustated Review Pharmacology 5th
Edition.
Clinical pharmacy and therapeutics 4th edition
MIMs
www.rxlist.com
www.medscape.com

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