Chapter 36 Insulin and oral hypoglycemic agents - 山.ppt

Chapter 37Insulin and oral hypoglycemic agents diabetes mellitus Metabolic disorder of multiple etiology characterized by hyperglycemia with carbohydrates, fat, and protein metabolic alterations that result from a decrease in the circulating concentration of insulin (insulin deficiency) and a decrease in the response of peripheral tissues to insulin (insulin resistance). Characteristics of DM hyperglycemia disturbance in metabolism of lipids, carbohydrates and proteins Symptoms of diabetes Polyuria (urinating frequently) Polydipsia (very thirsty) Continuous hunger Weight loss Other diabetes symptoms Fatigue Dry skin Frequent infections Feet ulceration Loss of sensibility in inferior extremities (legs) Classification of DM type Ⅰ DM (insulin-dependent diabetes mellitus, IDDM) type Ⅱ DM (non-insulin-dependent diabetes mellitus, NIDDM) Other type: secondery Treatment and control Medications (insulin vs. hypoglycaemic agents) Increase physical activity at least walk for 30 min. most days Appropriate diet vegetables fruit low in fat and carbohydrates Lifestyle changes Classification of drugs (1) Insulin (2) Orally hypoglycemic agents Insulin sensitizers Sulfonylureas Biguanides Inhibitor of ?-glycosidase Chinese herbs PART 1 insulin Chemistry : small protein with a MW of 56 KD (in human) Two chains (A and B) source : once from bovine and porcine pancreas, now by recombinant DNA techniques Pharmacokinetics will be degraded in the gastrointestinal tract if taken orally. often administered by subcutaneous injection. Half life:9-10 min Elimination in liver and kindney 胰岛素制剂及其作用时间 Pharmacological effects The main effects of insulin are affecting metabolism of glucose, lipids and protein. 1.Effects on glycometabolism (hypoglycemia) Increase the synthesis and storage of glycogen stimulating the up