Insulin therapy NIDDM

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-... 

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... 

Diabetes mellitus (DM) is an increasingly common disease of sugar metabolism. Juvenile-onset diabetes, also known as Type I or insulin-dependent diabetes (IDDM), is an autoimmune disease that results in decreased release of insulin by the pancreas. Late-onset diabetes, also known as Type II or non-insulin-dependent diabetes (NIDDM), results from reduced sensitivity of cells to the insulin signal. A convenient animal model for studying diabetes and testing alternative therapies is the streptozotocin-freated diabetic rat. Streptozotocin (STZ) attacks the pancreas and decreases insulin production and release, thus, mimicking many aspects of the human disease. Since insulin is not orally absorbed, the oral administration of vanadium compounds that are insuhn-mimetic or insulin-enhancing would be a very attractive therapy ... 

In islets, A-4166 causes a steep rise in insulin release followed by a slow sustained rise to twice the basal level. The insulinotropic effect is not glucose-dependent and takes place in the absence of glucose [191, 192]. The in vivo pharmacodynamic profile (rapid and short-term action) appears to result from a rapid plasma appearance and disappearance of the compound rather than an intrinsic feature of the mechanism [191]. A-4166 may be useful as therapy for NIDDM patients with secondary failure to sulphonylureas [190]. 

According to modern pathophysiological understanding of Type-II diabetes and the mechanism of sulphonylurea action, combined insulin-sulphonylurea therapy appears to be an interesting alternative for treating NIDDM patients with secondary failure to sulphonylureas. Several recent clinical trials confirmed favourable results (Stenman et al., 1988). Holman et al. (1987) studied the metabolic profiles of 24 Type-II diabetics who were treated... 

In conclusion, the best indication for acarbose is in the early stages of NIDDM and in overweight diabetic patients who do not respond well to diet therapy. Acarbose can be used as monotherapy and also in association with sulphonylureas and insulin. It lowers postprandial and fasting blood glucose, decreases hypertriglyceridaemia and hyperinsulinaemia, and improves HbAj. It is therefore justified to expect also a beneficial effect of acarbose on the development of long-term diabetic complications. 

Shank ML, Del Prato S, DeFronzo RA. Bedtime insulin/daytime glipizide. Effective therapy for sulfonylurea failures in NIDDM. Diabetes 1995 44 165-172. 

Miglitol is an alpha-glucosidase inhibitor that inhibits intestinal enzymes that digest carbohydrates, thereby reducing carbohydrate digestion after meals, which lowers postprandial glucose elevation in diabetics. It is used in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have failed dietary therapy. It may be used alone or in combination with sulfonylureas. 

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