DIABETES MELLITUS

Diabetes mellitus, commonly known as diabetes, is a disease that occurs when your blood glucose or blood sugar is too high. Foods breakdown and converted into glucose in the blood which works as a main source of energy. Insulin is a hormone made by pancreas, carry glucose into your cells to be used for energy. Sometimes your body doesn’t make enough or any insulin or doesn’t use insulin well. Glucose then stays in your blood and reach your cells.

General Symptom
  • Weight loss
  • Increase thirst
  • Increase hunger
  • Blurry vision
  • Sores that don’t heal
  • Frequent urination
  • Decrease *** drive, erectile dysfunction(ED), and poor muscle strength in men
  • Urinary tract infection (UTI), yeast infections, and dry, itchy skin in women


Type 1 Diabetes
Type 1 diabetes occurs when your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. People with type 1 diabetes need to take insulin every day to stay alive. Type 1 diabetes is usually occurs in children and young adults or at any age.

General Symptom
Rising blood sugar
  • Extreme hunger
  • Increased thirst
  • Unintentional weight loss
  • Frequent urination
  • Blurry vision
  • Tiredness
  • Mood change



Causes of type 1
Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses that might trigger the disease. Studies such as TrialNet External link are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease. African American, Hispanic/Latino American, American Indian, or Alaska Native, Pacific Islanders and Asian American are more likely to develop in type 2 diabetes.

Treatment of type 1:
Insulin is a hormone that made by B cells of pancreas which help to control your blood sugar in your body. When your body doesn’t make insulin then you can take manufactured insulin to help control your blood glucose in the body. There are many type of insulin help to treat different type of diabetes. They are classified by how fast they start to work and how long their effect last.
Insulin is given as a subcutaneous injection. It’s mostly used in type 1 diabetes.


Type of Insulin & Brand Names Onset Peak Duration Role in Blood Sugar Management
Rapid-Acting
Lispro (Humalog) 15-30 min. 30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection.
Aspart (Novolog) 10-20 min. 40-50 min. 3-5 hours
Glulisine (Apidra) 20-30 min. 30-90 min. 1-2 1/2 hours
Long-Acting
Insulin glargine (Basaglar, Lantus, Toujeo) 1-1 1/2 hours No peak time. Insulin is delivered at a steady level. 20-24 hours Long-acting insulin covers insulin needs for about one full day. This type is often combined, when needed, with rapid- or short-acting insulin.
Insulin detemir (Levemir) 1-2 hours 6-8 hours Up to 24 hours
Insulin degludec (Tresiba) 30-90 min. No peak time 42 hours
Intermediate-Acting
NPH (N) 1-2 hours 4-12 hours 18-24 hours Intermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with a rapid- or short-acting type.
Pre-Mixed
Humulin 70/30 30 min. 2-4 hours 14-24 hours These products are generally taken two or three times a day before mealtime.
Novolin 70/30 30 min. 2-12 hours Up to 24 hours
Novolog 70/30 10-20 min. 1-4 hours Up to 24 hours
Humulin 50/50 30 min. 2-5 hours 18-24 hours
Humalog mix 75/25 15 min. 30 min.-2 1/2 hours 16-20 hours

Amylinomimetic drugs:
Pramlintide (SymlinPen 120, SymlinPen 60) is an amylinomimetic drugs. It’s an injectable drug used before meals. Its slowdown the working of stomach takes to empty itself. After meal it reduce glycogen secretion after meals. This lower your blood sugar. It also reduce appetite through a central mechanism.

Type 2 diabetes
Type 2 diabetes occurs when your body does not make enough insulin or doesn’t use insulin well. You can develop type to diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 diabetes is the most common diabetes.

Symptom of type 2
  • Rising blood sugar
  • Increased hunger
  • Increased thirst
  • Increased urination
  • Blurry vision
  • Tingling or numbness in your hands or feet
  • Wound that don’t heal
  • Weight loss without trying
  • Tiredness
  • Sores that are slow to heal
  • Recurring infection



Causes of type 2
Type 2 diabetes the most common form of diabetes is cause by several factors, including lifestyle factors and genes.
Overweight, obesity, and physical inactivity. You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance, a condition in which muscle, liver, and a fat cells do not use insulin well and is common in people with type 2 diabetes. Belly fat, heart, and blood vessel disease is linked to insulin resistance.
Genes and family history may makes you to develop type 2 diabetes. The disease tends to run in families and occurs more often in these ethnic groups: African American, Hispanic/Latino American, American Indian, or Alaska Native, Pacific Islanders and Asian American.


Treatment of type 2:
If you have type 2 diabetes, your body makes insulin but no longer uses its well. The goal of treatment for you is to help your body use your insulin well or to get rid of extra sugar in your blood. Most medicine in type 2 is oral drugs. However, a few comes as injection. Some people may also take insulin.

There are many types of oral drugs and also some injectable drugs for the treatment of diabetes below:

BIGUANIDES decrease glucose release from liver, decrease intestinal absorption of glucose, improve insulin sensitivity so that your body uses insulin more effectively.
Metformin
  • Glucophage - 500 mg, 850 mg, 1000mg tablets
  • Fortamet- 500 mg, 1000 mg tablets
  • Glumetza -500 mg, 1000 mg tablets
  • Glucophage XR- 500mg, 750 mg tablets
  • Riomet- (liquid, 500mg/5ml)
  • Generic metformin- ER:500mg, 750mg tablets


Initial: 500 mg twice daily or 850 mg once daily
Range: 500-2550 mg
Dose: taken two or three times daily, take with meals
ER: Initial: 500 mg once daily
Range: 500-2000 mg
Dose: once daily, take with evening meal

Side effect:
  • Nausea
  • Abdominal pain
  • Bloating
  • Diarrhea
  • Cannot use if have liver or kidney problem


SULF0NYLUREAS help your body secrete more insulin from the pancreas.
Tolbutamide
  • Orinase -500 mg tablets
  • Various generics

Initial: 1000-2000 mg daily
Range: 250-3000 mg
Dose: Taken two or three times daily

Glimepiride
  • Amaryl- 1mg, 2mg, 4 mg tablets
  • Various generics


Initial: 1-2 mg daily
Range: 1-8 mg
Dose: Taken once daily

Glipizide
  • Glucotrol- 5 mg, 10 mg tablets
  • Glucotrol XL
  • Various generics- 2.5 mg, 5 mg, 10 mg tablets



Initial: 5 mg daily
Range: 2.5-40 mg2 (20 mg for XL)
Dose: Taken once or twice (If less then15 mg) daily

Glyburide
  • Micronase, Diabeta- 1.25 mg, 25 mg, 5 mg tablets
  • Various generics


Initial: 2.5-5 mg daily
Range: 1.25-20 mg2
Dose: Taken once or twice daily

Glyburide, micronized
  • Glynase PresTab- 1.5 mg, 3 mg, 4.5 mg, 6 mg
  • Various generics- micronized tablets


Initial: 1.5-3 mg daily
Range: 0.75-12 mg
Dose: Taken once or twice (if >6 mg) daily
Side effect:
  • Low blood sugar
  • Weight gain


GLINIDES stimulates the pancreas to secrete more insulin faster than sulfonylureas and the duration of their effect in the body is shorter.

Repaglinide
  • Prandin- 0.5 mg (White), 1 mg (yellow), 2 mg (red) tablets

Initial: 1-2 mg daily (0.5 mg if A1C<8%)
Range: 0.5-16 mg max dose per meal is 4 mg
Dose: Taken two, three, or four times daily, take within 15-30 minutes of meals
Duration: only 4 hours in action

Neteglinide

  • Starlix- 60 mg (pink), 120 mg (yellow) tablets

Initial: 120 mg three times daily (if A1C close to goal, use 60 mg)
Range: 180-360 mg
Dose: take three times daily, take within 30 minutes of meal
Duration: 2 hours in action
Side effect:
  • Low blood sugar
  • Safe for elderly


THIAZOLIDINEDIONS(Glitazones or TZDs) make the body’s tissues and fat more sensitive to insulin.
Pioglitazone(preferred over rosiglitazone)
  • Actos-15 mg, 30 mg, 45 mg (white to off-white) tablets

Initial: 15-30 mg daily
Range: 15-45 mg
Dose: Taken once daily

Rosiglitazone
  • Avandia- 2 mg (pink), 4 mg (orange), 8 mg ,(red- brown ) tablets

Initial: 4 mg daily
Range: 4 -8 mg
Dose: Taken once or twice daily
Side effect:
  • Risk of congestive heart failure
  • Anemia
  • Swelling(edema) from fluid retention
  • Risk of bladder cancer (pioglitazone)
  • Risk of bone fractures
  • High cholesterol (rosiglitazone)
  • Weight gain
  • Cannot use if have liver problem


ALPHAGLUCOSIDASE INHIBITORS blocked the starch in the body and delay digestion and absorption of carbohydrates
Acarbose
  • Precose- 25 mg, 50 mg, 100 mg tablets
  • Various generics


Initial: 25 mg three times daily
Range: 75-300 mg (max 150 mg if<60 kg)
Dose: Taken three times daily, take with first bite of meal
Side effect:
  • Flatulence



DPP-4 INHIBITORS increase insulin secretion and help to reduce glucose release from liver after meals.
Alogliptin
  • Nesina- 6.25 mg (light pink), 12.5 mg (yellow), 25 mg (light red) tablets

Initial: 25 mg PO daily
Dose: Taken once daily
  • Sitagliptin


  • Januvia-25 mg (pink), 50 mg (light beige), 100 mg (beige) tablets

Initial: 100 mg daily
Range: 25-100 mg daily
Dose: Taken once daily
Saxagliptin
• Onglyza- 2.5mg (pale to light yellow), 5 mg (pink) tablets
Initial: 2.5 or 5 mg daily
Range: 2.5 mg daily
Dose: Taken once daily
Linagliptin
• Tradjenta- 5 mg (light red) tablets
Initial: 5 mg daily
Dose: Taken once daily
Side effect:
• Risk of pancreatitis
• Joint paint
• Stuffy or runny nose
• Throat
• Headache
• Upper respiratory infection
• Rare severe allergic reactions
• Swelling of tongue, throat, face or body
• Severe rash

GLP-1 ANALOGS are injectable medications that slow digestion and help lower glucose levels. Their use is often associated with weight loss, some may reduce the risk of heart attack and stroke.
Exenatide
• Byetta- 5 mcg per dose and 10 mcg per dose
Initial: 5 mcg SQ twice daily
Range: up to 10 mcg SQ twice daily
Dose: Taken twice daily
Liraglutide
• Victoza- 3 ml pen that deliver doses of 0.6 mg, 1.2 mg, or 1.8 mg
Initial: 0.6 mg SQ once daily
Range: up to 1.8 mg SQ once daily
Dose: Taken once daily
Albiglutide
• Tanzeum- 30 mg or 50 mg dose
Initial: 30 mg once weekly
Range: can increase to 50 mg once weekly if inadequate response
Dulaglutide
• Trulicity- 0.75 mg or 1.5 mg per dose
Initial: 0.75 mg once weekly
Range: may increase up to 1.5 mg once weekly if inadequate response
Method: Injected under the skin (subcutaneous/SQ)
Side effect:
• Risk of pancreatitis
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Injection site reaction
• Headache

SGLT2 INHIBITORS affect the blood-filtering functions in your kidneys by inhibiting the return of glucose to the bloodstream. As a result, glucose is excreted in the urine. These drugs may reduce the risk of heart attack and stroke in people with a high risk of those conditions.
Canagliflozin
• Invokana: 100 mg (Yellow, capsule-shaped), 300 mg(white, capsule-shaped) tablets
Initial: 100 mg daily
Range: 100-300 mg daily
Dose: Taken once daily
Dapagliflozin
• Farxiga: 5 mg(yellow, round shaped), 10 mg (yellow, diamond shaped) tablets
Initial: 5 mg once daily
Range: up to 10 mg daily
Empagliflozin
• Jardiance: 10 mg ( pale, beige, round), 25 mg (pale, beige oblong) tablets
Initial: 110 mg once daily
Range: up to 25 mg daily
Side effect:
• Risk of amputation (canagliflozin)
• Risk of bone fracture (canagliflozin)
• Risk of gangrene
• Vaginal yeast infection
• Urinary tract infection
• Low blood pressure
• High cholesterol
COMBINATION ORAL ****S
Alogliptin/Metformin
• Kazano: 12.5 mg/500mg (pale yellow), 12.5 mg/ 1000 mg ( pale yellow) oblong tablets
Initial: 12.5 mg/ 500 mg once or twice daily
Range: up to 25/2000
Dose: Taken twice daily with food
Alogliptin/Pioglitazone
• Oseni: 12.5 mg/ 15 mg ( pale yellow), 12.5 mg/30 mg (pale peach), 12.5 mg/45 mg (pale red), 25 mg /15 mg (yellow), 25 mg/30 mg (peach), 25 mg/45 mg (red) round tablets
Initial: 12.5 mg/15 mg once daily
Range: up to 25/45 mg
Dose: Taken once daily with or without food
Empagliflozin/Linagliflozin
• Glyxambi: 10mg/5mg ( pale yellow), 25mg /5mg (pale pink) triangular tablets
Initial: 10mg/5mg once daily
Range: up to 25mg/5mg
Dose: once daily
Empagliflozin/Metformin:
• Synjardy: 5mg/500mg (orange yellow), 5mg/1000mg (brownish yellow), 12.5mg/500mg(pale brownish purple), 12.5mg/1000mg (dark brownish purple) oval film coated tablets
Initial: 5mg/500mg or 5mg/1000mg
Range: up to 25mg/2000mg
Dose: Taken in two divided doses
Canagliflozin/Metformin:
• Invokamet: 50mg/500mg (white), 50mg/1000mg (beige), 150mg/500mg (yellow), 150mg/1000mg (purple) capsule-shaped film coated tablets
Initial: 50mg/500mg or 50mg/1000mg
Range: up to 300mg/2000mg
Dose: Taken in two divided doses
Dapagliflozin/Metformin XR
• Xigduo XR: 5mg/500mg (orange), 5mg/1000mg (pink to dark pink), 10mg/500mg (pink), 10mg/1000mg (Yellow to dark yellow) oval film coated tablets
Initial: base on patient’s current regimen
Range: up to 10mg/2000mg daily
Glyburide/Metformin
• Glucovance: 1.25mg/250mg, 2.5mg/500mg, 5mg/500mg tablets
• Various generics
Initial: 1.25mg/250mg once or twice daily
Range: up to 20/2000mg
Dose: Taken once or twice daily
Glipizide/Metformin:
• Metaglip: 2.5mg/250mg, 2.5mg/500mg, 5mg/500mg tablets
• Various generics
Initial: 2.5mg/250mg daily or 2.5mg/500mg twice daily
Range: up to 20/2000 mg
Dose: Taken once or twice daily
Linagliptin/Metformin
• Jentadueto: 2.5mg/500mg(light yellow), 2.5mg/850 mg (light orange, ovale), 2.5mg/1000mg(light pink) oval tablets
Initial: 2.5mg/500mg twice daily with food
Range: up to 2.5mg/1000mg
Dose: Twice daily with food
Rosiglitazone/MetforminBRange: up to 8mg/2000mg
Dose: Taken twice daily
Pioglitazone/Metformin
• Actoplus Met- 15mg/500mg, 15mg/850mg (white to off- white) oblong tablets
• Various generics
Initial: 15mg/500mg or 15mg/850mg once or twice daily
Range: up to 45mg/2550mg
Dose: Dosed once or twice daily
Pioglitazone/Glimepiride
• Duetact- 30mg/2mg, 30mg/4mg (white to off white) tablets
Initial: 30mg/2 mg or 30mg/4mg once daily
Range: max of one tablets daily
Dose: Taken once daily
Rosiglitazone/Glimepiride
• Avandryl- 4mg/1mg (yellow), 4mg/2mg (orange), 4mg/4mg (pink) rounded triangle tablets
Initial: 4mg/1mg or 4mg/2mg once daily
Range: up to 8mg/4mg
Dose: taken once daily
Various generics
Sitagliptin/Metformin
• Janumet- 50mg/500mg (light pink), 50mg/1000mg (red) oblong tablets
Initial- 50mg/500mg or 500mg/1000mg twice daily
Range- up to 100mg/2000mg
Dose: Taken twice daily
Sitagliptin/Metformin
• Janumet XR- 50mg/500mg (light blue), 50m/1000mg (light green), 100mg/1000mg (blue) oval tablets
Initial: 100mg/1000mg daily
Range: up to 100mg/2000mg daily
Dose: Taken once daily
Repaglinides/Metformin
• PrandiMet- 1mg/500mg (yellow), 2mg/mg (pink) tablets
Initial: 1mg/500mg twice daily
Range: 10mg/2500mg, Max per dose 4mg/1000mg
Dose: Taken twice or three times daily
Pioglitazone/Metformin XR
• ActoPlus Met XR- 15mg/1000mg, 30mg/1000mg (white to off-white) round tablets
Initial: 15mg/1000mg or 30mg/1000mg once daily
Range: up to 45mg/2000mg
Dose: Taken once daily
Saxagliptin/Metformin XR
• Kombiglyze XR- 5mg/500mg (light brown to brown), 5mg/100mg (pink), 2.5 mg/100mg (pale yellow to light yellow) capsule- shaped tablets
Initial: 5mg/500 mg or 5mg/1000mg once daily
Range: up to 5mg/2000mg
Dose: Taken once daily
Gestational diabetes
Gestational diabetes is high blood sugar during pregnancy. Insulin blocking hormones produced by placenta cause this type of diabetes.
Symptom
It’s doesn’t cause noticeable signs or symptoms. Increased thirst and more frequent urination are possible symptom.
Causes of gestational diabetes.

Researcher don’t yet know why some women get gestational diabetes and other don’t. Excess weight before pregnancy often plays a role.
Normally, various hormones work to keep your blood sugar levels in check. But during pregnancy, hormone level change, making it harder for your body to process blood sugar efficiently. This makes our blood sugar rise.
Gestational diabetes usually goes away after your baby is born but increases at risk for type 2 diabetes later in life. Your baby is more likely to have obesity as a child or teen, and is more likely to develop type 2 diabetes later in life too.
African American, Hispanic/Latino American, American Indian, or Alaska Native, Native Hawaiian, Pacific Islander, are more likely to develop prediabetes.

Treatment of gestational diabetes:
If you have a gestational diabetes, Doctors advice you to maintain your lifestyle, take a healthy diet. If it’s not work then you have to take medication for control blood sugar. Some people have to take insulin. It is safer to take oral medication then injection to control blood sugar in gestational diabetes.
Metformin
• Glucophage - 500 mg, 850 mg, 1000mg tablets
• Fortamet- 500 mg, 1000 mg tablets
• Glumetza -500 mg, 1000 mg tablets
• Glucophage XR- 500mg, 750 mg tablets
• Riomet- (liquid, 500mg/5ml)
• Generic metformin- ER:500mg, 750mg tablets
Initial: 500 mg twice daily or 850 mg once daily
Range: 500-2550 mg
Dose: taken two or three times daily, take with meals
ER: Initial: 500 mg once daily
Range: 500-2000 mg
Dose: once daily, take with evening meal

Side effect:
• Nausea
• Abdominal pain
• Bloating
• Diarrhea
• Cannot use if have liver or kidney problem
Glyburide
• Micronase, Diabeta- 1.25 mg, 25 mg, 5 mg tablets
• Various generics
Initial: 2.5-5 mg daily
Range: 1.25-20 mg2
Dose: Taken once or twice daily
Side effect:
• Low blood sugar
• Weight gain

Prediabetes
Prediabetes occurs when blood sugar is higher than normal, but is not high enough for a diagnosis of type 2 diabetes.
Cause of prediabetes
Overweight, 45 years old, family history, physically active less than 3 times a week, have ever had gestational diabetes or given birth to a baby who weighted more than 9 pounds.
African American, Hispanic/Latino American, American Indian, or Alaska Native, Pacific Islander, Asian American are more likely to develop prediabetes

Monogenic diabetes
Monogenic diabetes is an inherited form of diabetes, and cystic fibrosis-related diabetes. Which is less common type.

Diabetes insipidus
Diabetes insipidus is not related to diabetes mellitus, it’s a different condition in which your kidneys remove too much fluid from your body. It’s a rare type.