Diabetes mellitus type insulin therapy

The other type of diabetes mellitus, type II, is far more common. In contrast, type II is not an autoimmune process and may or may not be insulin dependent that is, a diabetic state that is most effectively managed by insulin therapy. Frequently, NIDDM is used interchange-... 

First-line therapy for the control of hyperglycemia and its associated symptomatology in patients with non-insulin-dependent diabetes mellitus (Type II) ... 

For the first time in history there was clear, unambiguous clinical evidence, in humans, that symptoms of diabetes mellitus could be controlled with the exogenous administration of the active factor of the pancreas—insulin. Thus, replacement therapy with the newly discovered hormone, insulin, had arrested what was clearly an otherwise fatal metabolic disorder. From that point forward, diabetes mellitus (type 1) became a manageable disease by pharmacological intervention. 

Diabetes mellitus ( sweet urine ) involves relative over-production of glucose by the liver and under-utilization by other organs. Diabetes is the most serious metabolic disease in terms of its social impact. Obesity and the indulgent Western diet correlates with mature age diabetes. Type 1 diabetes (juvenile diabetes) typically manifests at less than 20 years from autoimmune destruction of the insulin-producing pancreatic (3 cells. Type 1 diabetes is insulin-dependent diabetes mellitus (IDDM) and is fatal without exogenous insulin. Type 2 diabetes mellitus (mature age diabetes) occurs later in life and typically involves both deficient insulin production and insulin resistance , that is, the target cells are less responsive to insulin. Type 2 diabetes is initially non-insulin-dependent diabetes (NIDDM) but insulin therapy (in addition to oral antidiabetics) may eventually be required. Hyperglycaemia due... 

Tolazamide, a sulfonylurea oral hypoglycemic agent (100 mg p.o. daily with breakfast), is indicated as an adjunct to diet to lower blood glucose levels in patients with non-insulin-dependent diabetes mellitus (type II), and it is indicated as a medication for switching patients from insulin to oral therapy (see Table 1). 

DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus Scientific review. IAMA 2003 289 2254-2264. 

Therapy for insulin-dependent diabetes mellitus is usually achieved by daily subcutaneous injections of insulin, and insulin-mimetics which can be orally administered may be useful for the treatment of type I diabetes (insulin dependent) if suitable complexes of low toxicity can be identified (510, 511). 

Patients with type 1 diabetes mellitus make no insulin. The classic symptoms of Type 1 diabetes are excessive hunger, constant thirst, and frequent urination. Prior to the availability of exogenous insulin, a diagnosis of type 1 diabetes was a death sentence. The optimal therapy was to restrict food intake, usually to a few hundred calories a day. This extended life. However, toward the end, the only question was whether death would come as a consequence of the disease or through starvation. 

Type 1 diabetes mellitus For type 1 diabetes, as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy. 

Hypersensitivity to sulfonylureas diabetes complicated by ketoacidosis, with or without coma sole therapy of type 1 (insulin-dependent) diabetes mellitus diabetes when complicated by pregnancy. 

Diabetes mellitus is a heterogeneous group of disorders characterized by abnormalities in carbohydrate, protein, and lipid metabolism. The central disturbance in diabetes mellitus is an abnormality in insulin production or action or both, although other factors can be involved. Hyperglycemia is a common end point for all types of diabetes mellitus and is the parameter that is measured to evaluate and manage the efficacy of diabetes therapy. 

Mudaliar S and Henry RR. New oral therapies for type 2 diabetes mellitus The glitazones or insulin sensitizers. Annu Rev Med 2001 52 239-257. 

Medicinal chemistry has many examples of the development of successful therapeutics based on an exploration of endogenous compounds. The treatment of diabetes mellitus, for example, is based upon the administration of insulin, the hormone that is functionally deficient in this disease. The current treatment of Parkinson s disease is based upon the observation that the symptoms of Parkinson s disease arise from a deficiency of dopamine, an endogenous molecule within the human brain. Since dopamine cannot be given as a drug since it fails to cross the blood-brain barrier and enter the brain, its biosynthetic precursor, L-DOPA, has been successfully developed as an anti-Parkinson s drug. Analogously, the symptoms of Alzheimer s disease arise from a relative deficiency of acetylcholine within the brain. Current therapies for Alzheimer s-type dementia are based upon the administration of cholinesterase... 

Mudaliar S et al New oral therapies for type 2 diabetes mellitus The glitazones or insulin sensitizers. Annu Rev Med 2001 52 239. [PMID 11160777] Nathan DM et al Management of hyperglycemia in type 2 diabetes mellitus A consensus algorithm for the initiation and adjustment of therapy. Diabetes... 

Ratner RE et al Amylin replacement with pramlintide as an adjunct to insulin therapy improves long term glycemic and weight control in type 1 diabetes mellitus A 1-year randomized controlled trial. Diabetic Med 2004 21 1204. [PMID 15498087]... 

United Kingdom Prospective Diabetes Study (UKPDS) Group Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus Progressive requirement for multiple therapies UKPDS 49. JAMA 1999 281 2005. 

In a post-marketing surveillance study of 1142 patients in whom acarbose was added to insulin therapy for type 2 diabetes mellitus, HbAlc improved by 0.9% and there were 108 adverse effects in 6.9% of the patients (45). Most of the complaints were gastrointestinal (flatulence, abdominal pain, diarrhea) and more than half were reported in the first week of acarbose therapy. 

Gerstein HC, Rosenstock J. Insulin therapy in people who have dysglycemia and type 2 diabetes mellitus can it offer both cardiovascular protection and beta-cell preservation Endocrinol Metab Clin N Am 2005 34 137-54. 

Kaneto H, Ikeda M, Kishimoto M, Iida M, Hoshi A, Watarai T, Kubota M, Kajimoto Y, Yamasaki Y, Hori M. Dramatic recovery of counter-regulatory hormone response to hypoglycaemia after intensive insulin therapy in poorly controlled type I diabetes mellitus. Diabetologia 1998 41(8) 982-3. 

Takaike H, Uchigata Y, Iwasaki N, Iwamoto Y. Transient elevation of liver transaminase after starting insulin therapy for diabetic acidosis or ketoacidosis in newly diagnosed type 1 diabetes mellitus. Diabetes Res Clin Pract 2004 64 27-32. 

Jeha GS, Karaviti LP, Anderson B, O Brian Smith E, Donaldson S, McGirk TS, Haymond MW. Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. Diabetes Technol Ther 2005 7 876-84. 

Linkeschova R, Raoul M, Bott U, Berger M, Spraul M. Less severe hypoglycaemia, better metabolic control, and improved quality of life in type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy an observational study of 100 consecutive patients followed for a mean of 2 years. Diabet Med 2002 19(9) 746-51. 

Persson B, Swahn ML, Hjertberg R, Hanson U, Nord E, Nordlander E, Hansson LO. Insulin lispro therapy in pregnancies complicated by type 1 diabetes mellitus. Diabetes Res Clin Pract 2002 58(2) 115-21. 

Thrailkill KM, Fowlkes JL, Hyde JF, Litton JC. The effects of co-therapy with recombinant human insulin-like growth factor I and insulin on serum leptin levels in adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2001 2(l) 25-9. 

In a randomized trial in 74 patients with chronic hepatitis C treated with interferon alfa-2b and ribavirin, plus placebo or amantadine, two developed glutamic acid decarboxylase (GAD) autoantibodies, but none developed IA-2 or insulin autoantibodies (543). One had an increased titer of GAD autoantibodies during a first sequence of interferon alfa monotherapy, then a further rise during subsequent combination therapy, and finally developed diabetes mellitus after 5 months of treatment. The authors suggested that repetitive treatment with interferon alfa could increase the risk of type 1 diabetes in patients previously positive for islet antibodies. 

Insulin-dependent diabetes mellitus (IDDM) is an example of a metabolic disease under active consideration for inducible gene therapy strategies. In this disorder, inflammatory cytokines have been shown to activate apoptosis in pancreatic beta cells. Experimental studies indicate that expression of insulinlike growth factor-1 (IGF-1) can prevent the cytokine-mediated destruction of beta cells of the pancreas (Giannoukakis et al., 2001). Regulated expression of IGF-1 in human pancreatic islets, to preserve beta cell function, may be a useful approach in the treatment of certain types of diabetes (Demeterco and Levine, 2001). 

Hirsch IB. Intensifying insulin therapy in patients with type 2 diabetes mellitus. Am J Med. 2005 118(suppl 5A) 21S-26S. 

Jacqueminet S, Masseboeuf N, Rolland M, et al. Limitations of the so-called intensified insulin therapy in type 1 diabetes mellitus. Diabetes Metab. 2005 31 4S45-4S50. 

Dewitt, Dawn E. and Hirsh, Irl B. (2003). Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus Scientific ReviewA Journal of the American Medical Association 289(17) 22 54-22 64. 

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