Diabetes And Minerals Vitamins And Dietary Supplements

It is important for patients with diabetes to be counseled about the importance of consuming adequate amounts of minerals and vitamins from natural food sources and to be aware of the potential toxic effects of megadoses of vitamin and mineral supplements. Interest in antioxidant vitamins in people with diabetes has increased with the knowledge that diabetes may be a state of increased oxidative stress. At present, megadoses of dietary antioxidants, such as selenium, P-carotene, vitamin E, and...

Metformin and Sulfonylurea

Metformin sulfonylurea is the most popular combination and provides additive glucose-lowering and lipid-lowering effects, with metformin preventing weight gain and reducing triglyceride-cholesterol and LDL-cholesterol concentrations. This is particularly important because close to 80 of type 2 diabetic patients are overweight and almost all have some type of dyslipidemia. Metformin was the only oral agent shown to reduce myocardial infarction, stroke, and cardiovascular mortality in the UKPDS 7...

Preface

Diabetes has become an increasing problem throughout the world, with an estimated 300 million people expected to be diagnosed with the disease in the next 10 years. One hundred and fifty million people worldwide and 18.2 million people in the United States are currently afflicted, an additional 5.2 million are undiagnosed, and close to 16 million are insulin-resistant. More than 9 million women, 8 million men, and 120,000 children under 18 years of age currently have this disease 1 . Increasing...

Diabetic Nephropathy

Diabetic nephropathy is the most frequent cause of end-stage renal disease in the United States, Japan, and Europe. In Europe and the United States, the incidence of diabetic nephropathy has increased substantially, rising by 150 in the past 10 years in the United States alone. Among patients who require dialysis, 40 had diabetic nephropathy, with a 15 higher mortality at 5 years and a 22 higher mortality at 1 year than their nondiabetic cohorts 35 . The American Diabetes Association ADA...

The Meglitinides

The meglitinides are more properly referred to as the glinides because repaglinide and nateglinide are not members of the same chemical class. Repaglinide is a benzoic acid derivative and nateglinide is a phenylalanine derivative. The glinides specifically target postprandial hyperglycemia, and, compared with sulfonylureas, have less risk of hypoglycemia and less continuous stimulation of the P-cells. The glinides are designed to return insulin levels to baseline between meals and to stimulate...

Triple Oral Agent Therapy

Although triple oral agent therapy is effective when all three agents are used synergis-tically, little data exists with regard to triple-agent therapy. Before its withdrawal from the market, the addition of troglitazone to patients with type 2 diabetes poorly controlled with sulfonylureas and metformin produced an additional 1.3 decrease in hemoglobin A1-C. Similar results have been reported with pioglitazone and rosiglitazone 21 . Adding an a-glucosidase inhibitor to metformin and a...

Risk Determinants

The ATP-III has upgraded diabetes to a coronary artery disease equivalent. Patients with coronary artery disease risk equivalents carry a risk of major coronary events of greater than 20 in the next 10 years. In addition to diabetes, the other risk equivalents are as follows 1. Symptomatic carotid artery disease. 2. Peripheral vascular disease. The metabolic syndrome is soon to be elevated to a coronary artery disease equivalent. The presence of multiple risk factors can increase risk to...

AGlucosidase Inhibitors and Sulfonylurea

Introduced in 1996, miglitol and acarbose are currently approved for monotherapy and in combination with sulfonylureas, insulin, metformin, and the TZDs. Miglitol and acarbose do not cause malabsorption but delay the digestion of carbohydrates with subsequent absorption shifted to the more distal parts of the small intestine and colon. Miglitol and acarbose can be very effective in blunting postprandial plasma glucose elevations, allowing the P-cells enough time to increase insulin secretion....

Oral Agent Classes Sulfonylureas

Sulfonylureas are indicated when hyperglycemia cannot be controlled with exercise, diet, and therapeutic lifestyle changes. They bind to a specific receptor on the pancreatic P-cells that enhances the effect on glucose lowering resulting from a closure of the potassium-dependent adenosine triphosphate K-ATP channel. Glimepiride Amaryl binds to a different protein than the other sulfonylureas, but on the same site as the potassium channel. The subsequent reduction in plasma glucose results in...

References

Steiner G. 200 Lipid intervention trials in diabetes. Diabetes Care 23 Suppl 2 B49-B53. 2. Mykkanen L, Laakso M, Penttila I, Pyorala K. 1991 . Asymptomatic hyperglycemia and cardiovascular risk factors in the elderly. Atherosclerosis 88 153-161. 3. Best JD, O'Neal DN. 2000 Diabetic dyslipidemia, current treatment and recommendations. Drugs 59 1101-1111. 4. Lamarche B, Tchernof A, Moorjani S, et al. 91997 Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic...

Diabetes Care 537-544

Olson DE, Norms SL. 2004 Diabetes in older adults. Overview of AGS guidelines for the treatment of diabetes mellitus in geriatric populations. Geriatrics 59 18-24. 2. Pietropaolo M, Le Roith D. 2001 Pathogenesis of diabetes our current understanding. Clin Cornerstone 4 1-16. 3. Ramlo-Halsted BA, Edelman SV. 1999 The natural history of type 2 diabetes. Implications for clinical practice. Prim Care 26 771-789. 4. Engelgau MM, Narayan KM, Herman WH. 2000 Screening for type 2 diabetes. Diabetes...

Blood Pressure Control

Interestingly, blockage of the angiotensin II type I receptor has been shown to improve endothelial function and diminish endothelial adhesiveness. Angiotensin II promotes sodium retention, vasoconstriction, slows progression of glomerular injury at the renal level, and induces cardiac and vascular myocyte hypertrophy, fibromuscular proliferation, and endothelial cell apoptosis 22 . With this in mind, the concept of combined therapy with angiotensin-converting enzyme ACE inhibitors and...

Novel Therapeutics

Implantable insulin pumps have not yet been approved for use in the United States. Generally, patients using these pumps are more satisfied with their treatment and experience less weight gain. This technique delivers insulin directly into the abdominal cavity, closely resembling normal insulin physiology and production even more than subcutaneous injections. This technology, along with an implantable glucose sensor, may provide an important breakthrough and advance in insulin-pump therapy....

Diabetic Neuropathy

Diabetic neuropathy afflicts up to 70 of patients with type 2 diabetes. Diabetic neuropathy does not represent one distinct disease but rather an adverse group of conditions that effect the peripheral nervous system, attacking the peripheral, proximal, and autonomic nerves, and causing both focal and systemic disease. Patients with diabetic neuropathy may have pain or impaired sensation in the feet and hands, slow digestion, carpal tunnel syndrome, or impaired cardiovascular responses 17 ....

Shortacting Insulins And Their Analogs

The first genetically altered rapid-acting analog insulin, lispro Humalog , was formed by switching lysine and proline at the 28 and 29 position of the P-chain in the insulin molecule. This insulin was approved in 1996. The insulin aspart NovoLog , formed by substituting aspartic acid for proline at the 28 position of the P-chain, was introduced in 2000. Both lispro and aspart analogs have similar rapid onsets of action of 5-15 minutes, which allows doses at, or even just after, a meal with...

Longacting Insulins

Ultralente is usually given before the evening meal or at bedtime, has a duration of action that is quite variable 13-18 hours ,and has variable peaking times between 8 and 14 hours. Ultralente has fallen into disfavor because of the peaks and valleys in its coverage. Glargine Lantus is an analog insulin with significant advantages over the Ultralente preparation. Glargine has an onset of action of 1-2 hours, is virtually peakless, and has a duration of action of 24 hours. Glargine is produced...

Combination Therapy

The ADA recommends the use of dihydropyridine CCBs only in combination with but not instead of ACE inhibitors or ARBs for patients with diabetes and elevated blood pressure. The combination therapy approach to hypertensive management in the patient with diabetes is extremely appealing. The increased efficacy of the combination over monotherapy has been well-established. The decreased side effects with combination therapy along with the increased efficacy and improved patient compliance make it...