Diabetes Mellitus : Therapeutic Overview

Type I is a quick onset, as opposed to Type II, which comes on in later life. Type I diabetes is treated by insulin (primary tx), diet and exercise. Type II diabetes is treated by oral hypoglycemic agents – sulfonylureas (the gold std, because of cost effectiveness), metformin (Glucophage) (very effective, able to alter insulin receptor and alter the glucose transporter), acarbose, insulin, diet, weight reduction, and exercise. Combining metformin with another drug such as sulfonylureas is effective.


Troglitazone (Rezulin) HAS BEEN WITHDRAWN due to toxicity.



As determined by the glucose tolerance test, in type 1 diabetics the plasma glucose is greatly elevated at all time and the plasma insulin concentration is essentially nondetectable. In type 2 diabetics plasma glucose concentration is elevated at all time points and the plasma insulin response to an oral glucose tolerance test is delayed by prolonged. Total insulin response is normal or increased. In early type 2 diabetes (glucose intolerance) the plasma insulin concentration is elevated and secretion is exaggerated.


It is recommended to schedule a diabetic pt in the morning, because if they have just eaten breakfast they will have enough glucose in their blood. However, the most important thing is that the pt is taking his/her meds and that they are controlled.


The most serious condition we’ll encounter with these drugs is hypoglycemia. If the dose isn’t properly adjusted or if the pt doesn’t have a meal to maintain appropriate blood levels, hypoglycemic shock is always the fear. It may manifest as nervousness, sweatiness, dizziness and agitation, and you might want to blame it on other things when what is happening is that the pts blood sugar levels are dropping. If there’s other drugs like beta-blockers (propanolol, et al.) on board that block those responses, they mask the symptoms of the emerging hypoglycemia.



Insulin action is on carbohydrate and lipid metabolism. With respect to carbohydrate metabolism, insulin increases glucose transport, increases glycogen synthesis, increases pentose shunt activity, increases glucose oxidation and decreases gluconeogenesis.

With respect to lipid metabolism, it increases fatty acid transport and triglyceride synthesis, while decreasing lipolysis. So hyperlipidemia is also a concern with diabetic pts, they will commonly be taking anti-cholesterol medications (lipid lowering drugs) as well.



The nomenclature for insulin is all over the place. There are many insulins and analogs. They are divided into short acting (if in a zinc suspension, it adds a little bit to the duration of action), intermediate acting (may still need to be used more than once a day) and long acting versions (about 36 hours, slow onset of action).



Lantus is the first and only insulin analog that provides 24-hour basal glucose-lowering activity with just one shot. This is a new medication. Although there are no high peaks of insulin, but a constant blood level.

Category: Pharmacology Notes