Insufficient insulin secretion ① Hyperglycemia → Glycosuria → Polyuria → Dehydration → Polydipsia ② Insufficient energy supply → Hunger → Eat more ③ Enhanced decomposition of protein and fat → Weight loss

Type 1 (insulin-dependent diabetes): caused by cell-mediated autoimmune damage to pancreatic beta cells - absolute insulin deficiency (insulin therapy)

Type 2 (non-insulin-dependent diabetes): caused by insulin resistance and defects in insulin secretion - relative insulin deficiency (diet control, exercise, oral hypoglycemic drug treatment)

Promote glycogen synthesis and storage, accelerate glucose oxidation, inhibit glycogen decomposition and xenoogenesis (reduce sugar sources, increase sugar outlet), ↓blood sugar

Promote fat synthesis, inhibit lipolysis, reduce the production of free fatty acids and ketone bodies, and increase fatty acid and glucose transport

Increase amino acid transport, promote protein synthesis, and inhibit protein breakdown

Promote potassium ions to enter cells and reduce blood potassium concentration

Increase heart rate, strengthen myocardial contractility, and reduce renal blood flow

type 1 diabetes

Type 2 diabetes: newly diagnosed patients; patients who cannot be controlled by diet control or oral hypoglycemic drugs

Complicated diabetes: ketoacidosis; nonketotic hyperosmolar coma

Various types of diabetes combined with severe infection, wasting disease, high fever, pregnancy, trauma, and surgery

Patients with intracellular potassium deficiency (polarizing fluid: insulin, glucose, potassium chloride - to prevent and treat myocardial infarction and arrhythmia, used for patients with potassium deficiency who cannot eat after burns or surgery)

Hypoglycemia - the most important and common

Allergic reaction (reasons: ① Structural differences between animal-derived insulin and human insulin - allogeneic protein ② Low preparation purity)

Insulin resistance

Redness, swelling and fat atrophy at the injection site

①First generation - tolbutamide, chlorpropamide ②Second generation-glyburide (excellent hypoglycemic), glipizide ③Third generation-gliclazide, glimepiride

Pharmacological effects and clinical applications

Adverse reactions

Metformin (methformin), phenformin (phenformin)

Pharmacological effects

Clinical use: Mild type 2 diabetes, especially suitable for obesity and those who are ineffective in controlling diet alone (preferred drug) Adverse reactions: gastrointestinal reactions, allergic reactions, lactic acidemia (most serious)

Rosiglitazone, pioglitazone

Enhance the sensitivity of target tissues to insulin and improve the utilization of glucose by tissue cells Clinical applications - Insulin resistance, type 2 diabetes Adverse reactions - edema, use with caution in patients with heart failure

Apopkarose, Voglibose

Pharmacological effects: Inhibit glycoside hydrolase activity, slow down the rate of hydrolysis of carbohydrates to produce glucose, delay glucose absorption, and reduce postprandial blood sugar. Clinical application: used alone or in combination with other hypoglycemic drugs to reduce postprandial blood sugar in patients. Adverse reactions: increased bacterial fermentation and gas production, belching, abdominal distension, and diarrhea

The pharmacological effect is similar to that of sulfonylureas, simulating the physiological secretion of insulin. It has a fast, strong and short-lasting effect and is not needed unless eating. Clinical application: type 2 diabetes, especially postprandial blood sugar elevation; elderly diabetes; diabetic nephropathy; patients allergic to sulfonylureas and unable to eat regularly