Description of Insulin and Anti Diabetic
Session 34: Description of Insulin and Anti Diabetic
Agents
Total Session Time: 120 minutes
Prerequisites
Learning Tasks
By the end of this session students are expected to be able to:
Resources Needed:
• LCD
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning tasks
Presentation/ Indications of Insulin and Anti Diabetics
2 20 minutes
Buzzing Agents
Presentation/ Contraindication of Insulin and Anti Diabetics
3 20 minutes
brainstorming Agents
Dose, Dosage of Insulin and Anti Diabetics
4 30 minutes Presentation
Agents
Presentation/ Side Effects and Adverse Effects of Insulin
5 20 minutes
brainstorming and Anti Diabetics Agents
Interaction and Precaution of Insulin and Anti
6 15minutes
Presentation Diabetics Agents
7 05 minutes Presentation Key Points
8 05 minutes Presentation Evaluation
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SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)
READ or ASK students to read the learning tasks and clarify
ASK students if they have any questions before continuing.
STEP 2: Indications of Insulin and Anti Diabetics Agents (20 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the following question for 2 minutes
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
of a patient. They include Short-acting insulins, Rapid-acting insulin and Intermediate
action Insulin
o Treatment with insulin injection is indicated in Type I Diabetes Mellitus or in
uncontrolled Type II Diabetes Mellitus, Hyperglycemic emergencies, Pancreatitis,
Pregnancy and trauma or Surgery
o Insulin preparations are divided into 3 types:
Short-acting insulins those of short duration which have a relatively rapid onset of
action, namely soluble insulin. Soluble insulin is the most appropriate form of
insulin for use in diabetic emergencies e.g. diabetic ketoacidosis and at the time
of surgery
Rapid-acting insulin analogues, insulin as part, insulin glulisine, and insulin lispro
Intermediate action Insulin, e.g. isophane insulin
o Chlorpropamide: Is used in the treatment of type 2 diabetes mellitus in patients who
cannot control blood sugar levels by diet and exercise alone. It is used along with diet
and exercise. It may be used alone or with other ant diabetic medicines
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o Glibenclalmide: Is used in the treatment of type 2 diabetes mellitus
o Gliclazide: It is indicated in Non-insulin dependent diabetes mellitus, maturity onset
diabetes and in insulin resistant diabetes
o Tolbutamide : It is indicated in type 2 diabetes mellitus
o Metformin: Is used in the treatment of diabetes mellitus.
Metformin is used for the symptomatic management of polycystic ovary
syndrome [unlicensed indication];
It improves insulin sensitivity, may aid weight reduction, helps to normalize
menstrual cycle (increasing the rate of spontaneous ovulation), and may improve
hirsutism
STEP 3: Contraindication of Insulin and Anti Diabetics Agents
(20 minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
o Insulin: Is contraindicated in persons who have Hypersensitivity to any ingredient of
the product and during episodes of hypoglycemia
o Chlorpropamide : Is contraindicated in pregnancy, heart disease, liver problems,
recent operation, body temperature more than 101 0F, severe nausea and vomiting that
has lasted a long time, weakened patient, injury, low blood sugar, pituitary hormone
deficiency, Addison's disease, hepatic porphyria, G6PD Anemia, Hemolytic Anemia
o Glibenclalmide: Is contraindicated in diabetic emergencies (ketoacidosis,
hyperosmolar coma), advanced hepatic or renal insufficiencies, pregnancy and
nursing period
o Gliclazide: Is contraindicated in following conditions, pregnancy, lactation,
hypersensitivity, renal impairment, juvenile onset diabetes, unstable or brittle
diabetes, diabetic ketoacidosis
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o Tolbutamide: Is contraindicated in patients with known hypersensitivity or allergy to
the drug, diabetic ketoacidosis, with or without coma, Metformin Is contraindicated in
patients with any condition that could increase the risk of lactic acidosis, including
kidney disorders , lung disease and liver disease
STEP 4: Dose, Dosage of Insulin and Anti Diabetics Agents (30minutes)
o Gliclazide for Noninsulin dependent diabetes, oral dose: The drug is increased in
given in division
meals or as a single dose with or immediately after breakfast
o Metformin – Dose Diabetes mellitus, ADULT and CHILD over 10 years initially 500
STEP 5: Side Effects and Adverse Effects of Insulin and Anti Diabetics
Agents (20 Minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
ALLOW few students to respond?
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
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o Insulin: Hypoglycemia, Headache, Allergic reactions, Flu like symptoms, Weight
gain, Hypokalemia, Lipoatrophy, Itching, Rash , Injection site reaction
o Chlorpropamide: Has appreciably more side effects, mainly because of its very
prolonged duration of action and the consequent hazard of hypoglycaemia and it
should no longer be used. It may also cause facial flushing after drinking alcohol; this
effect does not normally occur with other drugs
o Glibenclamide: Common side effects include stomach upset and low blood sugar
(hypoglycaemia), weight gain, constipation
o Gliclazide: Hypoglycemia (low blood sugar) hyperglycemia (high blood sugar) oat,
cough back, muscle and joint pain headache high blood pressure angina (chest pain)
leg swelling diarrhea, constipation, abdominal pain, nausea dizziness skin rash/itching
depression
o Tolbutamide: Hypoglycemia, weight gain, hypersensitivity: cross allergicity with
sulfonamides
o Metformin: Anorexia, nausea, vomiting, diarrhea (usually transient), abdominal pain,
taste disturbance, lactic acidosis, decreased vitamin B12 absorption, erythema,
pruritus and urticaria. Hepatitis also reported
STEP 6: Interaction and Precaution of Insulin and Anti Diabetics Agents
(20minutes)
o Precaution
A regular self-monitoring of the blood sugar is necessary during an intensified
insulin therapy. Urgent hospital treatment with intravenous injection is indicated
when there is a ketoacidosis or hyperosmolar breakdown
During pregnancy and breast-feeding, insulin requirements may alter and doses
should be assessed frequently by an experienced diabetes physician. The dose of
insulin generally needs to be increased in the second and third trimesters of
pregnancy
o Interactions
The following drugs May increase hypoglycemic effects of insulin: ACE
inhibitors, anabolic steroids, clofibrate, disopyramide, fibrates, fluoxetine,
guanethidine, MAOIs, oral antidiabetics, propoxyphene, salicylates,
sulfinpyrazone, sulfonamide antibiotics, tetracyclines
Atypical antipsychotics, corticosteroids, danazol, diazoxide, diltiazem, glucagon,
isoniazid, oral contraceptives, phenothiazines, protease inhibitors, somatropin,
sympathomimetics, thyroid hormone May decrease hypoglycemic effects of
insulin.
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o Precaution
Before taking chlorpropamide, tell your doctor or pharmacist if you are allergic to
it; or if you have any other allergies
This product may contain inactive ingredients, which can cause allergic reactions
or other problems
Talk to your pharmacist for more details.
o Interaction
The hypoglycaemic effect of gliclazide is potentiated by Phenylbutazone, aspirin,
clofibrate, sulphonamides, oral anticoagulants and MAO inhibitors
Rifampicin, barbiturates, alcohol, diuretics, diazoxide, glucocorticoids,estrogens
and sympathomimietic drugs antagonise the hypoglycaemic action of gliclazide.
o Precaution
Glibenclamide should be used with caution in the elderly as it may increase the
risk of hypoglycaemia (low blood sugar levels)
Glibenclamide is not safe to take if you are, or are planning to become, pregnant
o Interaction
Glibenclamide shows interaction with most drug used to treat high blood pressure
like ACE inhibitors e.g. captopril Beta blockers e.g. propranolol (including eye
drops) Bosentan Diazoxide
o Precaution
Tolbutamide should be used with caution in the elderly as it may increase the risk
of hypoglycaemia (low blood sugar levels)
Tolbutamide is not safe to take if you are, or are planning to become, pregnant. it
may produce birth defects
o Interaction
Increased hypoglycemia with cimetidine, insulin, salicylates, and sulfonamides
Salicylates displace tolbutamide from its binding site on plasma binding proteins
which lead to increase in free tolbutamide concentration, thus hypoglycemic
shock
o Precaution: Metformin should be used cautiously in renal impairment because of the
increased risk of lactic acidosis
o Interaction: The H2-receptor antagonist cimetidine causes an increase in the plasma
concentration of metformin, by reducing clearance of metformin by the kidneys
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STEP 7: Key points (5 minutes)
Metformin are common used in management of type 2 diabetes mellitus
should be monitored regularly to balance the blood sugar
meal
agent because may cause drug-drug interaction
sugar. These include feeling shaky or anxious, sweating, looking pale, feeling hungry,
having a feeling that your heart is pounding (palpitations), and feeling dizzy
STEP 7: Evaluation (5 minutes)
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References
Pharmacotherapy: A pathophysiologic approach (9th ed.). New York, McGraw-Hill
Education.
Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines &
National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam,
Tanzania government printers.
Sally S.R, & Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed)
New York, Lippincott Williams and Wilkins.
School of Pharmaceutical sciences. (2011). Tanzania Pharmaceutical Handbook (2nd ed.).
Dar es Salaam, ARDHI University press.
The Royal Pharmaceutical Society of Great Britain. (2007). Martindale: The Extra
Pharmacopoeia (5TH ed). London, pharmaceutical press.
The Royal Pharmaceutical Society of Great Britain. (2009). British National
Formulary (59th ed). London, BMJ Group and RPS Publishing.
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