Weitere ähnliche Inhalte Ähnlich wie Diabetes Mellitus and Sulfonylureas (20) Mehr von Richin Koshy (20) Kürzlich hochgeladen (20) 1. Diabetes Mellitus - Long term side effects of
Sulfonylureas
The pancreas is a gland that produces hormones insulin, glucagon, somatostatin and digestive
enzymes. These hormones play an important role in regulating the metabolic activities of the
body and particularly regulation of blood glucose. Diabetes Mellitus is characterised by an
elevation of blood glucose caused by a relative or absolute deficiency of insulin. Diabetes
Mellitus can be divided into two main groups Insulin dependent Diabetes Mellitus (Type 1) and
Non insulin dependent Diabetes Mellitus (Type 2). Other types of Diabetes have also been
identified which are Maturity onset Diabetes of the young (Type 3) and Gestational Diabetes.
2. Insulin dependent Diabetes Mellitus (Type 1) commonly affects individuals around puberty but
can occur at any age. Prevalence of Type 1 Diabetes is 510 %. It is associated with absolute
deficiency of insulin caused by a loss in beta cell function. Loss of beta cell function is usually
attributed to environmental factors and autoimmune mediated process against beta cell. It is
often triggered by the invasion of virus or chemical toxins. Unlike Type 1 prevalence of non
insulin dependent Diabetes Mellitus (Type 2) is 9095 %. Type 2 Diabetes is influenced by
genetic factors, aging, obesity and peripheral insulin resistance. In Type 2 Diabetes pancreas
retains some beta cell function but variable insulin secretion is insufficient to maintain glucose
homeostasis. Maturity onset Diabetes of the young (Type 3) is associated with dysregulation of
glucose sensing or insulin secretion due to mutation in particular genes. Type 3 Diabetes is
hereditary in nature occurs before the age of 25 years. It is estimated that prevalence of Type 3
Diabetes is around 5 %. Gestational Diabetes Mellitus classified as (Type 4) is defined as
glucose intolerance associated with pregnancy. Hyperglycemia associated with it can lead to
congenital abnormalities and hence tight glycemic control is mandated during pregnancy.
Incidence of Diabetes Mellitus is growing rapidly worldwide. It is estimated that 135 million of the
world's population is affected by Type 2 Diabetes Mellitus. Each year about 650,000 people
learn they have the disease. Diabetes Mellitus is the seventh leading cause of all deaths and
the sixth leading cause of all deaths caused by disease. 16 million people suffer from Diabetes
mellitus in the US and only half of these individuals are diagnosed. Diabetes can develop
gradually, often without symptoms over many years. In fact many learn that they have diabetes
only on developing one of its common cardiovascular, renal or vision complications. In people
with diabetes, glucose levels build up in the blood and urine causing excessive urination, thirst,
hunger and weight loss associated with problems with fat and protein metabolism. Diabetes is
detected by measuring the amount of glucose in the blood after the individual has fasted
(abstained from food) for several hours, either overnight or several hours after breakfast. In
some cases, physicians diagnose diabetes by administering an oral glucose tolerance test, the
measurement of glucose levels before and after a specific amount of sugar is ingested.
The goal in treating Type 2 Diabetes Mellitus is to maintain blood glucose concentration within
normal limits and prevent long term complications associated with it. Emphasis has been laid on
weight reduction, exercise and dietary modification. It has shown to decrease insulin resistance
and correct hyperglycemia of Type 2 Diabetes without medical intervention. However failure in
maintaining blood glucose levels with lifestyle measures often leads to therapeutic intervention.
Use of therapeutics generally center on clinical presentation. Current pharmacologic
intervention for management of Type 2 Diabetes Mellitus are oral hypoglycemic agents and
insulin therapy. During early 1903s many people died from diabetes because insulin treatment
was unavailable. Frederick Banting and Charles Best extracted insulin from the pancreases of
pigs and cows and injected them into diabetic animals. Their experiments were a dramatic
success. In 1955,oral hypoglycemic agents were introduced to help lower blood glucose levels
and in 1960 the purity of insulin was improved. Over the years, the methods of insulin
manufacturing have changed. Porcine and bovine insulin was common for diabetic use but
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3. some did not respond to it. Further research by drug companies produced human insulin with a
structure identical to insulin in 1978.
Over the past few years oral hypoglycemic agents are among the top 10 drugs that have been
prescribed worldwide. Sulfonylureas and Biguanides are the first line oral hypoglycemic agents
used based on severity. Sulfonylureas are insulin secretagogues and they promote insulin
release from beta cells of the pancreas Therapy with Sulfonylureas can sometimes work "too
well," producing more insulin than actually is needed. Excess insulin reacts with available sugar
in the bloodstream which causes the blood sugar to dip abnormally low. Hypoglycemia is what
is commonly referred as low blood sugar .Normal fasting blood glucose level is between 70 and
105 mg/dl. Hypoglycemia is diagnosed by monitoring of blood glucose levels. At levels below 50
mg/dl, the diagnosis is fasting hypoglycemia. Symptoms of hypoglycemia usually include
headache, depression, anxiety, irritability, blurred vision,excessive sweating,mental
confusion,incoherent speech,psychological disturbances and convulsions. Other side effects
include weight gain, hyperinsulinemia, renal impairment, gastrointestinal upset and rash.
Despite these adverse reactions many Type II diabetics benefit from the pills.
Recent prospective cohort study done by Dr. Li and her colleagues from Harvard school of
Public health revealed longterm use of sulfonylureas could increase coronary heart disease risk
in diabetic women. Dr.Oz show recently commented on the concept of Natural medication better
than prescription drugs. His show discussed a recent survey that revealed 70 % of Americans
take one prescription drug every year. Adverse reactions to those medications are the fourth
leading cause of death in the US. 70 % of chronic daily headaches are drug induced.
Prescription drugs are now commonly referred to as a biochemical bandage that suppress the
symptoms but don't get to the cause of the underlying disorder. This underlying rationality in
prescribing medications has led to the cause of adverse drug reactions. Diet lifestyle and
attitude is now gaining impetus knowing the impact of adverse side effects from prescription
medication. Over the recent years a lot of attention has been laid on the use of natural
medications to treat chronic diseases. There are number of clinical studies that have been
carried out in recent years that show potential links between herbal therapies and blood glucose
control. Many people with diabetes have resorted to the use of more 'natural' ingredients to help
manage their condition. Mulberry extracts are known to have special soluble fiber blend which
has shown to reduce the severity of hypoglycemia. Although it should be kept in mind that
certain herbs, vitamins and supplements may interact with diabetes medications (including
insulin) and accentuate the drugs hypoglycemic effects. Few experts also argue that the use of
natural therapies could reduce blood sugars to dangerously low levels and raise the risk of other
diabetes complications. There are not many natural remedies known for counteracting
hypoglycemia. Hence advice should be taken from an expert before availing natural remedies
for drug induced adverse effects.
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