Chapter 26 Treatment of Diabetes Mellitus

Diabetes mellitus

Chronic condition in which the body is unable to use glucose properly for energy.

Diabetic neuropathy

Damage to peripheral nerves caused by diabetes, leading to numbness in lower limbs.

Fasting blood glucose

Blood glucose level measured after fasting for 8 to 12 hours.

Gestational diabetes

Diabetes occurring during pregnancy, caused by hormones or insulin shortage.

Hemoglobin A1c

Blood test measuring average blood glucose level over 2 to 3 months.

Hyperglycemia

Elevated blood glucose levels.

Hypoglycemia

Low blood glucose levels.

Insulin resistance

Condition where the body does not respond to insulin, contributing to type 2 diabetes.

Postprandial

After a meal.

Prediabetes

Condition of consistently elevated glucose levels that are not yet diabetic.

Type 1 diabetes

Autoimmune disease destroying pancreatic β-cells, leading to insulin deficiency.

Type 2 diabetes

Condition characterized by high blood glucose levels and insulin resistance.

Common ending for meglitinides

-glinide

Common ending for thiazolidinediones

-glitazone

Common ending for DPP-4 inhibitors

-gliptin

Common ending for sodium-glucose cotransporter-2 (SGLT2) inhibitors

-gliflozin

Common ending for GLP-1 receptor agonists

-tide

Acarbose: Dosing Administration

Take with the first bite of a meal.

Meglitinides (Nateglinide, Repaglinide): Missed Meal Instruction

Take immediately before meals; skip dose if the meal is missed.

Rybelsus (Semaglutide tablet): Administration Instruction

Take 30 minutes before the first meal of the day; swallow whole.

Invokana (Canagliflozin): Dosing Administration

Take 1 hour before the first meal of the day.

Pancreatic cells releasing insulin

β-cells in the islets of Langerhans, in response to rising glucose, amino acids, and gut hormones.

Pancreatic cells secreting glucagon

α-cells in the islets of Langerhans, when glucose levels drop.

Prediabetes clinical manifestations

Impaired fasting glucose and impaired glucose tolerance.

Type 1 diabetes pathophysiology

Autoimmune destruction of insulin-producing β-cells in the pancreas.

Type 2 diabetes prevalence

Most common form, accounting for 90% to 95% of all diabetes cases.

Visual check for clear insulin solutions

Discard if they appear cloudy (applies to aspart, glulisine, lispro, regular, detemir, glargine).

Why sulfonylureas only work in Type 2 diabetes

They require functioning pancreatic β-cells to stimulate insulin release.

Metformin mechanism of action

Decreases hepatic gluconeogenesis, decreases intestinal glucose absorption, and improves insulin sensitivity.

Colesevelam indication in diabetes

Cholesterol-lowering agent approved for treating type 2 diabetes alongside diet and exercise.

Nutritional supplements for diabetes

α-Lipoic acid, magnesium, omega-3 fatty acids, and garlic show some evidence of effectiveness.