Medications for treatment T2 DM - Term Paper Example

Thus the medications for type 2 diabetes mellitus are aimed at administering insulin to combat tissue resistance and adjusting the lipid profile back to normal. Different preparations of insulin and a number of oral hypoglycemic drugs are used to treat diabetes mellitus type 2. The oral hypoglycemic drugs are further divided into sulfonylureas, biguanides, thiazolidinediones and alpha glucosidase inhibitors (Trevor et al 2008). Insulin is a protein molecule so it is not given orally to avoid degradation in the gastrointestinal tract; instead it is administered subcutaneously to the patients to lower the blood glucose levels (Finkel et al 2009).

The available preparations of Insulin can be categorized as rapid acting, short acting, intermediate and long acting insulin. The rapid acting insulin preparations are insulin lispro and insulin aspart. Due to their rapid onset of action, they mimic the natural prandial insulin secretion. Lispro Insulin was the first insulin analogue developed by recombinant DNA technology. The lysine and proline amino acids at its carboxyl end are reversed. This structure has no effect on binding to insulin receptor, immunogenecity or the half life, as these all are similar to the natural human insulin.

The advantage of this structural alignment is that it decreases the propensity of insulin to form dimers, thus more amount of insulin is available in monomer form. It starts working within 15 minutes and achieves peak activity within one hour. The effect lasts for 3 to 5 hours. Insulin aspart has B28 proline in its structure replaced by negative aspartic acid, this modification inhibits insulin self aggregation. The regular insulin comes in the short acting insulin category. It is a soluble crystalline zinc insulin molecule.

When injected subcutaneously in substantial amount (a vial), the molecules aggregate antiparallel and create dimers which stabilize around zinc to form insulin hexamers. This structural configuration renders the regular insulin the ability of delayed onset of action, so the peak action is achieved slowly. The involved mechanism of slow prolonged action is that initially, the hexamers are too large for the vascular transport, but as the interstitial fluid dilutes them, their concentration begins to decrease locally.

The hexamers break and slowly change into mononers. This insulin is administered 30 to 45 minutes before meals. This is the only insulin type that can be given intravenously as well (Trevor et al 2008). Neutral protamine hagedron (NPH) or isophane insulin is the intermediate acting insulin formed by combining protamine and insulin in 1 ratio 10, in the form of isophane complex. In the complex form, insulin and protamine, both lose all their free binding sites. When injected, protamine is degraded by proteolytic enzymes and insulin is then absorbed.

It starts acting after 4 to 5 hours of administration. Insulin glargine and insulin detemir are the types of long acting insulin. Insulin glargine, also called as peak-less insulin has the isoelectric point lower than that of human insulin, so it precipitates at the injection site, allowing slow prolonged hypoglycemic effect and provides a background insulin replacement. Insulin detemir has a fatty acid side chain in its structure. It binds with tissue albumin at the site of injection and then dissociates