Treatment of Diabetes Mellitus

The American Diabetes Association currently makes the following nutritional recommendations for people with diabetes  

Derive 55 to 60% of total caloric intake from carbohydrates. 

Consume foods containing unrefined carbohydrate with fiber, attempting to take in 40 g of soluble fiber per day. 

Insulin preparations that are commercially available differ in their relative onset of action, maximal activity, and duration of action. Conjugation of the insulin molecule with either zinc or protamine, or both, will convert the normally rapidly absorbed parenterally administered insulin to a preparation with a more prolonged duration of action. The various formulations of insulin are usually classified as short acting (0.5 to 14 h), intermediate acting (1 to 28 h), and long acting (4 to 36 h). The duration of action can vary, however, depending on injection volume, injection site, and blood flow at the site of administration. 

Insulin preparations are fast, intermediate, or long acting, as summarized in Table 52.1. Crystalline (regular) insulin may be used as a supplemental injection or for instituting corrective measures in the management of infection and trauma, for postoperative stabilization, and for the rehabilitation of patients recovering from ketoacidosis and coma. In addition, NPH (isophane) contains regular insulin. 

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Antidiabetic drugs is the general term for drugs that lower blood glucose concentrations and are used in the treatment of diabetes mellitus. Antidiabetic drugs are... 

TABLE 40-10. Non-insulin Injectible Agents for the Treatment of Diabetes Mellitus... 

Pope E.J.A., Peterson K., Peterson C., Sol-gel bioatificial organs for the treatment of diabetes mellitus, in proc.on SOL-GEL 97 9th International Workshop on Glasses, Ceramics, Hybrids and Nanocomposites from Gels, Sheffield, UK, 1997. 

As in the case of other cardiovascular diseases, the possibility of antioxidant treatment of diabetes mellitus has been studied in both animal models and diabetic patients. The treatment of streptozotocin-induced diabetic rats with a-lipoic acid reduced superoxide production by aorta and superoxide and peroxynitrite formation by arterioles providing circulation to the region of the sciatic nerve, suppressed lipid peroxidation in serum, and improved lens glutathione level [131]. In contrast, hydroxyethyl starch desferrioxamine had no effect on the markers of oxidative stress in diabetic rats. Lipoic acid also suppressed hyperglycemia and mitochondrial superoxide generation in hearts of glucose-treated rats [132],... 

Glucagon-like peptide 1 abasis of a new class of treatment for type 2 diabetes. Journal of Medicinal Chemistry, 47, 4128 134 (b) Vahl, T.P. and D Alessio, D.A. (2004) Gut peptides in the treatment of diabetes mellitus. Expert Opinion on Investigational Drugs, 13, 177-188 (c) Meier, J.J. and Nauck, M.A. 

Large quantities of pure insulin are required for the treatment of diabetes mellitus (see p. 160). The annual requirement for insulin is over 500 kg in a country the size of Germany. Formerly, the hormone had to be obtained from the pancreas of slaughtered animals in a complicated and expensive procedure. Human insulin, which is produced by overexpression in genetically engineered bacteria, is now mainly used (see p.262). 

Treatment of blood disorders such as haemophilia A or B Vaccination against various diseases Passive immunization against various diseases Treatment of diabetes mellitus Thrombolytic agents, digestive aids, debriding agents (i.e. cleansing of wounds)... 

Repaglinide en nateglinide are not sulfonylurea agents but their mechanism of action is very alike. Repaglinide is the first carbamoylmethyl-benzoic acid derivative that has been registred for the treatment of diabetes mellitus. It closes ATP-dependent potassium channels in the beta cell membrane with consequent depolarization, opening of calcium channels and increased insulin release. It is rapidly absorbed with peak plasma levels after 1 hour. It has a protein binding of over 98%. 

Hypoglycaemic and hyperinsulinemic effects of some Egyptian herbs used for the treatment of diabetes mellitus (type II) in rats. Egypt J Pharm Sci 1995 36(1-6) 331-342. 

Lin, C. C. Crude drugs used for the treatment of diabetes mellitus in Taiwan. Amer J Chin Med 1992 20(3/4) 269-279. 

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... 

Vigneri R, Goldfine ID. Role of metformin in treatment of diabetes mellitus. Diabetes Care 1987 10(l) 118-22. 

Colucciello M. Vision loss due to macular edema induced by rosiglitazone treatment of diabetes mellitus. Arch Ophthalmol 2005 123 1273-5. 

Several peptide products used in the treatment of diabetes mellitus, in addition to insulin, are currently administered by subcutaneous injection and these drugs are candidates for development of nasal formulations. Glucagon-like peptide-1 (GLP-l)-related peptides stimulate the insulin response to glucose and diminish the release of glucagon after a meal. These effects diminish the excessive postprandial increase in glucose observed after a meal in persons with type 2 diabetes mellitus. GLP-1-related peptides must be administered by subcutaneous injection before meals in order to be effective. This requirement for injection before each meal is likely to impact the utilization of these products by persons with type 2 diabetes. Exendin-4 is a GLP-1-related peptide with a molecular mass of 4.2 kDa. The development of a GLP-1-related peptide nasal formulation containing an absorption enhancer would allow patients to scll-administer one of these drugs just before a meal without the need for a subcutaneous injection. 

It appears that insulin and certain growth factors may exert their effects by acting through this type of tyrosine kinase receptor-enzyme system.21,44 Insulin, for example, binds to the extracellular component of a protein located on skeletal muscle cells, thereby initiating activation of this protein s enzymatic activity on the inner surface of the cell membrane. This change in enzyme function causes further changes in cell activity, which ultimately result in increased glucose uptake in the muscle cell. The function of insulin receptors and their role in the cause and treatment of diabetes mellitus are discussed in more detail in Chapter 32. 

The purpose of this chapter is to review the normal physiologic roles of the pancreatic hormones and to describe the pathogenesis and treatment of diabetes mellitus. Diabetes mellitus has many sequelae that influence patients neuromuscular and cardiovascular functioning. Patients with diabetes mellitus often undergo physical rehabilitation for problems related to the condition. Consequently, the nature of diabetes mellitus and the pharmacotherapeutic treatment of this disease are important to physical therapists and occupational therapists. 

Artemisia herba-alba It is widely used for the treatment of diabetes mellitus. 

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