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Chapter 5: Drugs for Diabetes Mellitus

Chapter Objectives

Chapter Objectives

After reading this chapter, the student will be able to:

  1. Differentiate between the two major classifications of diabetes mellitus.

  2. Understand the etiology of type 1 and type 2 diabetes mellitus.

  3. Recognize the signs and symptoms, adverse effects, and complications of diabetes mellitus.

  4. Understand basic glucose metabolism and how insulin affects diabetes mellitus control.

  5. Recognize and identify appropriate blood glucose levels for an individual with diabetes.

  6. Recognize the benefits of diet and exercise for an individual with diabetes.

  7. Identify and recognize the different devices for insulin administration and injection.

  8. Differentiate between the types, onset, duration, and peak action of insulin.

  9. Differentiate between the types and responses of oral antidiabetic agents for treatment of diabetes mellitus.

  10. Recognize the adverse affects of insulin and oral antidiabetic agent therapy.

According to the American Diabetes Association, approximately 18.2 million people in the United States have diabetes.1 However, only a third of the individuals with diabetes actually know that they have the disease. It is estimated that 5 to 10 percent who are diagnosed with diabetes have type 1 diabetes and the remaining 90 to 95 percent have type 2 diabetes1 (Table 5–1). A third type, gestational diabetes, emerges during pregnancy and is usually reversible after delivery.

Table 5–1Characteristics of Types 1 and 2 Diabetes
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Table 5–1 Characteristics of Types 1 and 2 Diabetes
Characteristics Type 1 Type 2
Incidence (relative to all persons with diabetes except the gestational type) 10% 90%
Age of onset Adolescence Usually >35 years
Onset Abrupt Gradual over years
Family history Usually negative Usually positive
Etiology Autoimmune Unknown—strong genetic association, obesity, sedentary lifestyle
Symptoms Polyurea, polyphagia, polydipsia, weight loss, ketosis, blurred vision, slow-healing sores, tingling in feet Can be asymptomatic for years; have similar symptoms to those of type 1 diabetes, including tiredness and dry, itchy skin
Body weight Usually underweight or normal Overweight or obese
Insulin levels Reduced or deficient Normal or slightly decreased
Management Insulin, diet, exercise Diet, exercise, oral antidiabetic agents

Diabetes is the sixth leading cause of death in the United States, with 213,000 individuals dying of complications of the disease in the year 2000 alone.1 Complications include blindness, kidney disease, heart disease, stroke, impotence, and nontraumatic lower limb amputations (Box 5–1). Individuals from specific ethnic backgrounds, such as Latinos, African-Americans, Native Americans, Asian-Americans, and Pacific islanders, are at a higher risk of developing diabetes. Obesity is also a risk factor.

BOX 5–1 Complications of Diabetes

Retinopathy

Nephropathy

Neuropathy

 Peripheral

 Autonomic

Cardiovascular

 Atherosclerosis

 Myocardial infarction

 Hypertension

 Dyslipidemia

Vascular

 Peripheral vascular disease

 Stroke

Ketoacidosis

Skin and connective tissue disorders

Insulin resistance

Hyperinsulinemia

Impotence

Nontraumatic amputations

Dental disease

Pregnancy complications

The cost of managing diabetes is increasing each year. In 2002, direct and indirect health-care expenditures of persons with diabetes totaled $132 billion....

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