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DIABETES MELLITUS, PREVENTION, If glycemic target is not achieved (HbA1c…
DIABETES MELLITUS
TYPE I DM
INSULIN TREATMENT
Short-acting insulin
Intermediate-acting insulin
Long-acting insulin
Rapid-acting insulin
PREVENTION
Regular Blood Glucose Monitoring
Healthy Diet
Regular Exercise
:check: caused by insulin deficiency due to beta cells destruction
:check: Pancreas unable to produce insulin
:check: Insulin-dependent
Onset: under 30 years old
Symptoms: thirst, polyuria, feeling hungry, fatigue, blurred vision, bed-wetting (for children), and polyphagia, weight loss
TYPE II DM
PHARMACOLOGICAL TREATMENT
First-line (Monotherapy)
Biguanides
Example + Brand names
Metformin (Glucophage, Glucoxit, Glucovance
, GlyMet
, Diamide*)
Function:
Decrease liver glucose production
C/I:
Kidney problems, Liver disease, etc.
Sulphonylurea (-ide)
Example + Brand names
:check: Glibenclamide (CLAMIDE, Glucovance, GlyMet, Diamide)
:check: Gliclazide (Diamicron, Diamicron MR, Remicron MR, Pharmaniaga Gliclazide, Glimicron)
:check: Glimepiride (Amaryl, Proglutrol G2)
Function
: increase insulin secretion
C/I
: DKA
S/E
: Hypoglycemia
Second-line
Thiazolidinediones (TZDs) (-glitazone)
Example + Brand names
Rosiglitazone
Function:
Increase cell sensitivity to insulin
C/I
: Heart failure or liver disease
S/E:
Fluid retention
DPP-4 Inhibitors (-gliptin)
Examples + Brand names
:check: Saxagliptin (Onglyza, QTern)
:check: Sitagliptin (Januvia, Janumet
)
:check: Linagliptin (Trajenta, Trajenta Duo
)
:check: Vildagliptin (Galvus, Galvus Met*)
Function:
increase incretins which stimulates beta cells to secrete more insulins
C/I:
Pre-existing heart failure
S/E:
Upper respiratory tract infection
Alpha-glucosidase inhibitor
Example + Brand names
Acarbose (Carbose, Glucobay)
Function:
prevent the release and absorption of glucose from dietary carbohydrate
S/E:
Flatulence, bloating
SGLT2 Inhibitors (-gliflozin)
Example + Brand names
:check: Dapagliflozin (Forxiga)
:check: Empagliflozin (Jardiance, Glyxambi*)
:check: Luseogliflozin (Lusefi)
:check: Canagliflozin
Function:
prevent kidney from reabsorbing the glucose into the blood. Any excess glucose will be excreted through urine.
S/E:
yeast infection, sudden urge to urinate
:check: caused by progressive insulin resistance
:check: Defective insulin production
:check: Insulin resistant
Onset: over 40 years old
Common symptoms include increased, thirst, polydipsia, polyuria, lethargy, weight loss, blurring of vision, tingling, pain, numbness in hands/feets, and increased risk of infection
PREVENTION
SUPPLEMENT
Examples
Abbott Glucerna Gold
Powerlife Diareso5
Metabolic + Sauver
Appeton Wellness 60+
Vitahealth Fenugreek & Cinnamon Complex
Live-well Mecomin 500mcg
Livvon Diabegard
Nestle Nutren Diabetik
Vitahealth Debtin 6 Plus
Important
:check:
Cinnamon:
to stimulate insulin receptors on cells, which improves their ability to absorb blood sugar.
:check:
Chromium:
for carbohydrate metabolism. to improve glucose tolerance, reduce fasting blood sugar level and HbA1c level by enhancing the effect of insulin and its activity.
:check:
Gymnema:
It works by reducing the absorption of sugar in the gut, promoting the uptake of blood sugar into the cells and increasing insulin secretion from pancreatic cell.
:check:
Vitamin B1 & B12:
help to relieve pain of nerve damage
:check:
Turmeric:
may increase insulin production and improve our body’s responsiveness to insulin.
:check:
Omega-3 fatty acids:
important for people with diabetes, who are at high risk for heart disease as Omega 3s may reduce inflammation, regulate rhythm heartbeats.
:check:
Bitter melon:
contains anti-diabetic properties including charantin, vicine and an insulin-like compound known as polypeptide-p which contribute to blood-lowering effect.
:check:
Magnesium:
improve insulin sensitivity
:check:
Fenugreek:
help reducing blood sugar in people with diabetes. It contains alkaloids which increases the serum insulin in the body.
If glycemic target is not achieved (HbA1c < 6.5% FPG < 6 mmol/L) with lifestyle modification within 3 months, we should initiate oral antidiabetic drugs.
if intolerant to metformin or shows any weight loss symptoms