Quiz 66: Pharmacotherapy of Diabetes Mellitus


Insulin is the only drug of choice for the treatment of type -I diabetes, which occurs due to the destruction of pancreatic islet cells (beta type). This results in decreased insulin secretion. Therefore, patients suffering from "Type I diabetes mellitus" have to take insulin from the external source in the form of injections. "Human Regular Insulin" is the only insulin that can be administered through the intravenous route (IV bolus or IV drip). The other forms of insulin must be given subcutaneous or intraperitoneal.

If the frequency of intake of food decreases, the plasma glucose levels decreases. Under this condition, body prefers to generate energy through lipolysis and proteolysis. The lipid metabolism produces ketone bodies and acetic acid as by-products. These ketone bodies impart acidic nature to the blood and urine and cause a pathological condition called "ketoacidosis," which is a type of metabolic acidosis. Acetone is one of the ketone bodies produced during lipid metabolism. The following are the treatment options available for the reversal of metabolic acidosis: • Bicarbonate ions are given in the form of sodium bicarbonate (NaHCO 3 - ) • Intravenous administration of bicarbonate ions in case of serious metabolic acidosis

Glyburide is a sulfonylurea compound, which increases the release of insulin from the pancreas. Metformin decreases the gluconeogenesis from the liver and also decreases the reabsorption of glucose from the intestine, while promoting the cellular glucose uptake. Glycemic control can be better achieved with the combination of drugs than with single anti-hyperglycemic drug. Therefore, Mrs. E is prescribed with two anti-hyperglycemic drugs to achieve better glycemic control.

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