Diabetes may be classified as. i) Type - I Diabetes mellitus. Type - II Diabetes mellitus. Type Diabetes mellitus. Gestational Diabetes INSULIN

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1 HYPOGLYCEMIC AGENT Diabetes mellitus is a chronic metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. The effects of diabetes mellitus include long term damage, dysfunction and failure of various organs. Diabetes mellitus may present with characteristic symptoms such as thirst, polyuria, blurring of vision and weight loss. In its most severe forms, ketoacidosis or a non ketotic hyperosmolar state may develop and lead to stupor, coma and in absence of effective treatment, death. Classification of Diabetes mellitus Diabetes may be classified as i) Type - I Diabetes mellitus ii) iii) iv) Type - II Diabetes mellitus Type Diabetes mellitus Gestational Diabetes INULIN Peptides hormones are secreted by the pancreas occupy a central role in the regulation of metabolism of carbohydrates, lipids and amino acids. They are Insulin, Glucagon and omatostatin. Insulin is the primary hormone which is responsible for controlling the storage and utilization of cellular nutrients. It activates the transport system and the intracellular utilization and storage of glucose, amino acids and fatty acids. Insulin inhibits catabolic processes such as the breakdown of glycogen, fat and protein, whereas the overall effect of insulin is hypoglycaemic. The other pancreatic hormone Glucagon mobilize glucose from its stores and causes hyperglycaemia. The third pancreatic hormone omatostatin, inhibit secretion of both Insulin and Glucagon. Deficiency of effective insulin in the body causes a disease called diabetes mellitus (meaning in Greek is excessive thirst) which alters the metabolism of lipids, carbohydrates and proteins. This results in hyperglycaemia and glycosuria. Insulin was purified and crystallized by J.J.Abel in The amino acid sequence of the hormone was established by F.anger and the co-workers in Its total synthesis was achieved by several groups in 1970 s. Hodgkin and co-workers established the three dimensional structure of Insulin. Recently the cloning of human Insulin gene and its transfer into bacteria Escherichia coli have been achieved, it is now produced by recombinant DNA technology.

2 Gly Ile Val Glu Chain - A Gln Cys Cys Thr er Ile Cys er Leu Tyr Gln Leu Glu Asn Tyr His Leu Cys Gyl er His Leu Val Glu Ala Leu Tyr Leu Val Gln Cys Cys Gly Asn Asn Val Phe Chain - B Thr Lys Pro Thr Tyr Phe Phe Glu Arg Gly Animal and Human Insulin pecies Chain A Chain B Human Thr I1e Thr Porcine Thr I1e Ala Bovine Ala Val Ala Currently available Insulin Preparations Generic Name Administration Options Rapid-acting Insulins Humalog (insulin lispro) NovoLog (insulin aspart) Apidra (insulin glulisine) hort-acting Insulins Humulin R (regular) Available in: U-100 and U-500 Insulin pen, vial or 1.5-mL and 3-mL pen cartridge Insulin pen, vial or 3-mL pen cartridge U-100, 10-mL vial U-500, 20-mL vial

3 Novolin R (regular) Intermediate-acting Insulins Insulin pen, vial or 3-mL pen cartridge and InnoLet NPH Humulin N Novolin N Lente Humulin L Long-acting Insulins Humulin U (ultralente) Lantus (insulin glargine) Pre-mixed Insulins, prefilled pen, prefilled pen, and InnoLe Lente Long-acting insulins Pre-mixed insulin analogs Humalog Mix 75/25 (75% neutral protamine lispro, 25% lispro) Novolog Mix 70/30 (70% aspart protamine suspension, 30% aspart), prefilled pen, prefilled pen, 3-mL pen cartridge NPH-regular combinations Humulin 70/30 Novolin 70/30 Humulin 50/50, prefilled pen, pen cartridge, innolet ORAL HYPOGLYCEMIC AGENT Oral hypoglycemic agents are the drugs that lower blood glucose levels and are effective orally. The main disadvantage of insulin and its preparations is that they must be given by injection or inhalation. Hence, orally active drugs have always been searched. CLAIFICATION i) ulfonyl ureas. a. First generation: eg. Carbutamide, Tolbutamide, Chlorpropamide, Tolazamide, Acetohexamide. b. econd generation: eg. Glibenclamide, Glipizide, Gliclazide, Glimepiride. ii) Biguanides: eg. Metformin, Phenformin, Buformin. iii) Glitinides: eg. Repaglinide, Nateglinide.

4 iv) Thiazolidinediones: eg. Pioglitazone. v) α - Glucosidase inhibitors: eg. Acarbose, Miglitol,Voglibose. vi) Aldose reductase inhibitors: eg. orbinil, Tolrestat. vii) DPP- 4 inhibitors: eg. itagliptin, axagliptin, Vildagliptin, Alogliptin. viii) GLP-1 agonist: eg. Exenatide. Miscellaneous: eg. Ciglitazone, Linogliride, Pirogliride, Palmoxivate sodium Tolbutamide (Rastinone) CH 3 Chlorpropamide (Chloroformin) O 2 NHCONH(CH 2 ) 3 CH 3 1- Butyl -3- (p-tolyl sulfonyl) urea Cl Glibenclamide (Daonil, Glinil) O 2 NH.CONH(CH 2 ) 2 CH 3 1-[(p- Chlorophenyl) sulfonyl)] -3- propylurea CO.NH.(CH 2 ) 2 O 2.NH.CO.NH OCH 3 Cl 5- Chloro -N-{2-[4[[[(cyclohexyl amino) carbonyl] amino] sulfonyl] phenyl] ethyl} - 2- methoxy benzamide Glipizide (Diaglip, Dibizide)

5 N CO.NH.(CH 2 ) 2 O 2.NH.CO.NH N 1-Cyclohexyl -3-{[p-[2-(5-methyl pyrazine carboxamide) ethyl] phenyl] sulfonyl} urea Biguanides The general chemical structure of biguanide is follows. R 1 NH NH N C NH C NH 2 R 2 Metformin (Riomet, Glumet) NH NH N C NH C NH 2 1,1- Dimethyl biguanide It is used to treat type II diabetes with an advantage of weight reduction and absence of significant hypoglycemia

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