0 good diabetic control treatment of niddm sometimes

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Unformatted text preview: dent: Type II • • • • Have some capacity for insulin production 80% obese, adult onset 10% stable adult onset (normal weight) 5% brittle, ketosis prone adult onset – similar to juvenile onset individuals--likely to become insulin dependent • Evaluate overall effectiveness of control by checking glycosylated hemoglobin (HbA1c) – under 8.0 = good diabetic control. Treatment of NIDDM • • • • Sometimes insulin injections Dietary measures Exercise Sometimes oral hypoglycemic agents – Controversy: • may do no real good in preventing complications and cardiovascular deaths • Use diet and exercise whenever possible. Oral Hypoglycemic Agents • • • • Sulfonylureas Alpha-glucosidase inhibitors Biguanides including Meglitinides Thiazolidinediones Oral Hypoglycemic Agents: Sulfonylureas • Up to 10 different drugs and 30 brand names • • • • tolbutamide (Orinase®) - short duration (6-12 hrs) chlorpropamide (Diabinese®) - long duration (60 hrs) glipizide (Glutrol®) glyburide (DiaBeta®, Micronase®) • Mechanism: – stimulate insulin release – alter receptor sensitivity to insulin – change liver's response to insulin. • Side Effects: – GI, dermatologic, hepatic, and hematologic – Severe hypoglycemia (Keep patient well nourished ) – weight gain. Oral Hypoglycemic Agents: Alpha-glucosidase inhibitors • acarbose (Precose®), miglitol (Glyset®) • Additive with sulfonylureas – work by different mechanism. Oral Hypoglycemic Agents: Biguanides • metformin (Glucophage®) • Monotherapy or in combination • Does not seem to cause hypoglycemic episodes seen with sulfonylureas. • No tendency for weight gain. – Meglitinides, a different type of biguanides • include repaglinide (Prandin®), nateglinide (Starlix®) Oral Hypoglycemic Agents: Thiazolidinediones • rosiglitazone (Avandia®), pioglitazone (Actos®) • Another Alternative Objective 7: • Identify major therapeutic uses and side or toxic effects of estrogen, bone density modifiers, progesterone, and androgens. Estrogens - (estradiol) • Therapeutic Uses – Suppress ovulation • used with progesterone for birth control – Lessen undesirable effects of transition in menopause – Sexual infantilism • estrogen develops uterus and secondary sex characteristics – Inhibition of lactation • Osteoporosis in postmenopausal women – does not reverse loss, merely prevents worsening of condition. • • • • Dietary calcium (1500 mg) and vitamin D (400-800 I.U.) can help. No totally satisfactory treatment available. O...
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This document was uploaded on 02/07/2014.

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