INSULIN DAN OBAT HIPOGLIKEMIK ORALDIABETES MELLITUSsyndromes characteried !y hy"er#$ycemia% a$tered meta!o$ism o& $i"ids'car!ohydrates' and "roteins% and an increased ris( o& com"$ications &rom )asc*$ar diseaseThe American Dia!etes Association +ADA,sym"toms o& DM +e-#-' "o$y*ria' "o$ydi"sia' and *ne."$ained /ei#ht $oss,a random "$asma #$*cose concentration o& #reater than 011 m#2d$ +33-3 mM,DM4a &astin# "$asma #$*cose concentration o& #reater than 305 m$2d$ +6 mM,a "$asma #$*cose concentration o& #reater than 011 m#2d$ +33 mM, 0 ho*rs a&ter the in#estion o& an ora$ #$*cose $oad 7$assi8cationTy"e 3 dia!etes me$$it*s 9 IDDM Ty"e 0 dia!etes me$$it*s 9 NIDDMTy"e : dia!etes me$$it*sTy"e ; dia!etes me$$it*sRis( &actor:? m#2dL +1-@1 mmo$2L, and2or a tri#$yceride $e)e$ =0?1 m#2dL +0-A0 mmo$2L, Po$ycystic o)ary syndromeINSULINIns*$in contains ?3 amino acidst/o chains +A and B, $in(ed !y dis*$8de !rid#es"rec*rsor B "re"roins*$in "roins*$inThe is$et o& Lan#erhans is com"osed o& &o*r ty"es o& ce$$s in the +B, ce$$B ins*$in in the +A, ce$$B #$*ca#on in the +D, ce$$B somatostatin in the PP or < ce$$B "ancreatic "o$y"e"tideIns*$in "rod*ction and re#*$ation o& secretion Pre"roins*$in "roins*$in B in ro*#h endo"$asmic retic*$*mProins*$in ins*$in B in #o$#i com"$e.Ins*$in stored in #ran*$esIns*$in secretion main$y de"ends on !$ood #$*cose $e)e$The is$ets o& Lan#erhans are rich$y inner)ated !y !oth adrener#ic and cho$iner#ic ner)esIntrace$$*$ar 7a0C acts as the ins*$in secreta#o#*eDistri!*tion and de#radation o& ins*$inUnder &astin# conditions;1 # +3 *nit, o& ins*$in "er ho*r into the "orta$ )ein to achie)e a concentration o& ins*$in in "orta$ !$ood o& 0 to ; n#2m$ +?1 to 311 *nits2m$, 1-? n#2m$ +30 *nits2m$, or a!o*t 1-3 nM in the "eri"hera$ circ*$ationA&ter in#estion o& a mea$' there is a ra"id rise in the concentration o& ins*$in in "orta$ !$ood' &o$$o/ed !y a "ara$$e$ !*t sma$$er rise in the "eri"hera$ circ*$ationDist4and de#rade4 The ha$&D$i&e o& ins*$in in "$asma is a!o*t ? to 5 min*tesDe#radation o& ins*$in occ*rs "rimari$y in $i)er' (idney' and m*sc$eThe com"$e. o& ins*$in and its rece"tor is interna$ied into sma$$ )esic$es termed endosomes' /here de#radation is initiatedThe "rimary ins*$inDde#radin# enyme is a thio$ meta$$o"roteinase7$assi8cation o& ins*$intype Appear.Add. Prot.Zn contentBuferOnsetPeakDuration Ra"id Re#*$ar7$ear 1-13E1-1;None1-?E1-6 3-?E;?EALis"ro 7$ear 1-10 Phos"hat1-0? 1-?E3-? 0E?As"art 7$ear 1-13@5 Phos"hat1-0? 1-5E1-A :E?G$*$isine7$earNone1-?E3-?3E0-?Intermediate NPH 7$o*dyProtamine1-135E1-1; Phos"hat3E0 5E30 3AE0;Lente7$o*dy1-0E1-0? Acetate 3E0 5E303AE0;S$o/U$tra $ente7$o*dy1-0E1-0? Acetate ;E5 35E3A01E:5Protamine n7$o*dyProtamine 1-0E1-0?Phos"hat;E53;E01 0;E:5G$ar#ine 7$ear1-1: None0E??E0; 3AE0;Ins*$in a!sor"tionIns*$in *s*a$$y is inFected into the s*!c*taneo*s tiss*es o& the a!domen' !*ttoc(' anterior thi#h' or dorsa$ arm AGectin# &actorsBs*!c*taneo*s !$ood Ho/Post*re)o$*me or concentration o& inFected ins*$in7SII IIIAd)erse reactionHy"o#$ycemiaIns*$in a$$er#y and resistanceLi"oathro"hy and $i"ohi"ertro"hyIns*$in edema Dr*# interactionDr*#s /ith Hy"o#$ycemic EGects e-#B Adrener#ic rece"tor anta#onistsSa$icy$atesEthano$An#iotensinDcon)ertin# enyme inhi!itorsTheo"hy$$ine7a$si*m4interactDr*#s /ith Hy"er#$ycemic EGectsE"ine"hrineG$*cocorticoids Di*retics Aty"ica$ anti"sychoticsJHIKD3 "rotease inhi!itorsLA Adrener#ic rece"tor a#onists7a0CDchanne$ !$oc(ersPhenytoin H0Drece"tor !$oc(ersMor"hineHe"arinMariF*anaNicotineMOra$ hy"o#$ycemic a#ent c$assi8cationINSULIN SE7RETAGOGUES*$&ony$*reaMe#$itinide Nate#$inideBIGUANIDETHIANOLIDINEDIONEO GLU7OSIDASE INHIBITORS*$&ony$*reaMechanism o& actionstim*$atin# ins*$in re$ease &rom "ancreatic P ce$$s+may, red*ce he"atic c$earance o& the hormoneStim*$ate re$ease o& somatostatin' and they may s*""ress the secretion o& #$*ca#on s$i#ht$y-A!sor"tion' &ate' and e.cretion&ood and hy"er#$ycemia can red*ce the a!sor"tion o& s*$&ony$*reasshort ha$&D$i)es$ar#e$y +@1Q to @@Q, !o*nd to "roteinmeta!o$ied !y the $i)ermeta!o$ites are e.creted in the *rineAd)erse eGectB hy"o#$ycemia7IB ty"e 3 DM' "re#nancy' $actation' and &or si#ni8cant he"atic or rena$ ins*RciencyDosin#B +#i)en :1 min*tes !e&ore eatin#,#$y!*ride is 0-? to ? m#' and dai$y doses o& more than 01 m# are not recommended#$i"iide ? m# #i)en once dai$y- The ma.ima$ recommended dai$y dose is ;1 m#+ dai$y doses o& more than 3? m# sho*$d !e di)ided,#$ic$aide is ;1 to A1 m#2day' and the ma.ima$ dai$y dose is :01 m#G$ime"iride B as $o/ as 1-? m# once "er day- The dai$y ma.ima$ eGecti)e is A m# Me#$itinideRe"a#$inidederi)ati)e o& !enoic acidstim*$ates ins*$in re$ease !y c$osin# ATPDde"endent "otassi*m channe$sa!sor!ed ra"id$y &rom the GI tractha$&D$i&e o& the dr*# is a!o*t 3 ho*rm*$ti"$e "re"randia$ *seDose B 1'?D0 m#7IB he"atic ins*RciencyNate#$inide deri)ed &rom DD"heny$a$aninestim*$ates ins*$in secretion !y !$oc(in# ATPDsensiti)e "otassi*m channe$s