Drug induced diabetes mellitus ppt.

A cukorbetegség kezelése

Intenzív konzervatív inzulin terápia napi többszöri inzulin injekció: a főétkezések előtt gyorshatású, éjszaka és esetleg reggel is elhúzódó hatású inzulin adása 2. Folyamatos inzulinadás pumpa segítségével 3. Kivárás a sc. A betegség természete, szövődményei, az optimális beállítás előnyei.

Soronkívüli étkezés társasági vacsora, fogadás, stb. De: tökéletes bázisinzulin kell!

drug induced diabetes mellitus ppt

McKeage K et al. Kramer W. Exp Clin Endocrinol Diabetes. New approaches to the treatment of diabetes. Bridgewater, NJ: Aventis Pharmaceuticals; Insulin glargine: a review of its therapeutic use as a long-acting agent for the management of type 1 and type 2 diabetes mellitus. Pharmacokinetics and dynamics of s.

Cardiovascularis kockázatcsökkentés a diabetológus szemével

Abstract Less hypoglycaemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care. Insulin glargine: a review of its therapeutic use as a long-lasting agent for the management of type 1 and type 2 diabetes mellitus. Treatment to target study: insulin glargine vs NPH insulin added to oral therapy of type 2 diabetes. Successful control with less nocturnal hypoglycemia. Abstract P. Insulin glargine. The second profile shows, a more desirable profile with less fluctuations around the overall mean level References Russell-Jones D et al.

Accepted for publication, Clinical Therapeutics 20 15 10 5 Russell-Jones D et al. References Russell-Jones D et al. Clinical Therapeutics 29 Pancreas és Langerhans-sziget transzplantáció Kérdés: a DM vagy az immunszuppresszív drug induced diabetes mellitus ppt veszélyei a nagyobbak? Így a dominánsan inzulinrezisztens, túlsúlyos betegeknél az inzulinsensitizerek biguanidok és glitazonok alkalmazása javasolt elsődlegesen — testre szabott kezelés.

Referenciák 1. Henry Drug induced diabetes mellitus ppt. Jones TA et al. Diabet Obes Metab ; 5: — Viberti GC. Int J Clin Pract ; — Insulin-sensitizer should be preferred Insulin secretagog is preferred? Non-secretagog készítmények I. Alpha-glucosidase-hydroxylase gátlók Acarbose, Miglitol B. Insulin secretagog készítmények I. Sulfanylureák II. Meglitinid származékok pl.

D-Phenylalanin származékok pl. DPP-4 dipeptidyl-peptidase-4 gátlók un. Rosiglitazon és pioglitazon nem [alig] hepatotoxikus testsúly növekedés, folyadék retenció! Rosiglitazon mellett EKG sz. Hosszútávú hatékonyság főleg kombinációban jó Kombinálhatók: sulfanylurea készítményekkel és az újabb secretagog gyógyszerekkel is kombinálhatók elvben metforminnal is, de: GI mellékhatások hasonlóak! Glibenclamide kifejezetten elnyújtott hatás hypoglyk. Six young healthy subjects were given a 25, 50, or g oral glucose load or isoglycaemic drug induced diabetes mellitus ppt glucose infusions.

The g data is shown above. C-peptide may be a better measure of insulin secretion than plasma insulin, because C-peptide levels are not affected by hepatic insulin extraction. This difference in C-peptide levels in response to oral vs intravenous glucose suggests that other factors incretinsand not merely the direct actions of plasma glucose, affect the insulin secretory response.

Incretin Effect 5. Nauck MA, et al. Incretin effects of increasing glucose loads in man calculated from venous insulin and C-peptide responses.

J Clin Endocrinol Metab. It demonstrated that after a meal, Glucose began to rise. Baseline level was 83 ± 1. Glucose returned to baseline levels by minutes. Insulin followed a similar pattern.

Glucagon, however, dropped to a low by 90 minutes, then increased to a level above that of the baseline level. Adapted from Woerle HJ et al. Am J Physiol Endocrinol Metab.

Reference: 1.

drug induced diabetes mellitus ppt

Pathways for glucose disposal after meal ingestion in humans. These abnormalities contribute markedly to hyperglycemia both at the level of body tissues where insulin is not sufficient to drive glucose uptake and at the level of the liver where increased glucagon and decreased insulin cause the liver to inappropriately release glucose into the blood, thereby causing fasting hyperglycemia or increasing postprandial hyperglycemia.

A cukorbetegség kezelése

Adapted from Müller WA et al. N Engl J Med. References: 1. Abnormal alpha-cell function in diabetes. Response to carbohydrate and protein ingestion. Del Prato S. Loss of early insulin secretion leads to postprandial hyperglycemia. J Clin Invest. Adapted from Lebovitz HE et al. Their blood glucose levels were monitored throughout the infusion period.

drug induced diabetes mellitus ppt

However, GLP-1 infusion induced a significant reduction of both overnight from 7. Islets were maintained in culture for five days in the presence or absence of GLP At day 1, islets maintained their physiologic spherical shape panel A.

By day 3, many islets showed a progressive loss of structure, losing the acellular membrane that surrounds them panel C. At day 5, the three-dimensional structure of many cell aggregates had deteriorated to a two-dimensional structure typical of a cell monolayer panel E.

In contrast, islets treated with GLP-1 retained their three-dimensional organization for a longer period of time panels B, D, and F. Reference 1. Glucagon-like peptide inhibits cell apoptosis and improves glucose responsiveness of freshly isolated human islets. Endocrinology ;— Beta-cell mass and pancreatic functions were assessed on Day 7 and at 2 months.

Results from the GLP-1 injection are shown here. The Diabétesz kezelésében éhség rat is a genetic model of type 2 diabetes in which basal hyperglycaemia is first detectable three weeks after birth. The histological sections of rat pancreas were immunostained for insulin using a peroxidase indirect labeling technique.

Vilsbøll T et al. The terminal half-life of exenatide ranges from ~ hours. Exenatide shares some of the glucoregulatory effects with endogenous GLP Regulatory Peptides.

GLP -amide was injected at four different doses: 0. GLP-1 half-life values ranged from 4.

Exendin-4 half-life values ranged from 90 ± 3 min to ± 13 min. Its longer plasma half-life may render exendin-4 an attractive prospect for the treatment of diabetes. Adapted from Parkes D, et al. Drug Dev Res. Diabetesben a DPP-4 enzimek működése fokozott így lecsökken az aktivált inkretinek mennyisége, és felborul a CH-háztartás egyensúlya.

Az inkretinek a pancreas alfa és béta sejtjeire egyaránt hatnak. A korábban alkalmazott OAD-ok csak a béta sejt funkciót drug induced diabetes mellitus ppt inzulin termelés, vagy inzulin iránti érzékenység fokozódás.

A Galvus és az Eucreas azonban hat az alfa sejtekre is, csökkentve a glikagon termelést. Ezen kettős, fiziológiás hatás vezet a CH egyensúly létrejöttéhez. Abstract OR. Adapted from Deacon CF, drug induced diabetes mellitus ppt al. Eligible patients were either not on antihyperglycemic therapy HbA1c 6.

Mean baseline HbA1c levels ranged from 7.

Paper Presentation - SELF MANAGEMENT OF TYPE 1 DIABETES MELLITUS IN A TERITIARY CARE HOSPITAL

Modified intent-to-treat, last-observation-carried-forward LOCF analysis of results for placebo-subtracted changes from baseline at week Adapted from Herman GA et al. Poster P. The slide shows this pattern in the group on sitagliptin mg QD according to the per-protocol analysis of completers without data carried forward non-LOCF. A greater reduction 0.

drug induced diabetes mellitus ppt

The greatest reduction 1. The investigators enrolled 28 patients with type 2 diabetes and inadequate glycemic control mean baseline HbA1c 7. Patients were randomized to receive 4 weeks of therapy with either placebo plus the prior dose of metformin, or sitagliptin 50 mg BID plus the prior dose of metformin period 1.

A cukorbetegség kezelése. dr. Hosszúfalusi Nóra Semmelweis Egyetem III. sz. Belgyógyászati Klinika

At the end of period 1, patients underwent hour blood sampling drug induced diabetes mellitus ppt then were crossed over to the alternate regimen for 4 weeks period 2. The primary efficacy endpoint was hour weighted mean glucose WMG ; secondary endpoints included mean daily glucose and FPG.

Safety was also assessed in the trial. Among patients who received sitagliptin during period 1, a substantial carryover effect was seen during placebo treatment in period 2.

Because the results from period 1 were not confounded by the carryover effect, these data are presented on the slide. Importantly, glucose levels were reduced throughout the day during both the postprandial and fasting periods. Adapted from Brazg RL et al. Effect of adding MK to on-going metformin therapy in type 2 diabetic patients who have inadequate glycemic control on metformin. Protocol MF mg b.

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