New Therapies in Diabetes

This chapter contains sections titled: What is the continuous subcutaneous insulin infusion pump? What kinds of insulin pumps are available? How does the insulin pump function? How is the basal rate determined? How are the boluses determined? What are the indications for the use of an insulin pump? Why does hypoglycaemia unawareness constitute an indication for treatment with an insulin pump? What other requirements are therefor the use of an insulin pump? What undesirable effects can occur when using an insulin pump? Can insulin pump users remove the pump when they want? How is the follow-up done of individuals with DM who carry an insulin pump? What are the results of studies that compared treatment with a continuous subcutaneous insulin infusion pump to intensive treatment with multiple insulin injections? If the use of a continuous subcutaneous insulin infusion pump is considered as advantageous compared to the intensive regimen of multiple insulin injections, why isn't it imposed as a treatment for individuals with Type 1 DM? What characteristics render the lungs an easy point of entry of insulin in the blood circulation? What are the pharmacotechnical forms of inhaled insulin? What is the fate of insulin after its entry into the respiratory system? How does the action of inhaled insulin differ from the action of the subcutaneously administered insulin? What is the main benefit of the use of inhaled insulin? What problems exist with regard to the use of inhaled insulin? How is the action of inhaled insulin influenced by smoking? How is the action of inhaled insulin influenced by asthma and acute respiratory tract infections? Has inhaled insulin been tried in all types of DM? What results were obtained? Case Study 1 Why is kidney and pancreas transplantation today considered to be the treatment of choice for patients with Type 1 DM with end stage renal disease? What are its advantages compared to the transplantation of the kidney alone? How is the transplantation of the kidney and pancreas done? Why is intestinal drainage of the exocrine part of the transplanted pancreas preferred today compared to drainage in the urinary bladder of the recipient, which was preferred in the past? Which medicines are administered postoperatively, after a simultaneous kidney and pancreas transplantation? How is the transplanted patient monitored for episodes of rejection? What are the pancreatic islets and how is their transplantation performed? What technical problems exist in the transplantation of the pancreatic islets? What are the up to date results of the pancreatic islet transplantations? What other research protocols for the treatment of DM with transplantation have been tried? What is the Glucagon-like peptide 1 (GLP-1) and with what mechanisms does it act beneficially in Type 2 DM? Are there data to show that GLP-1 improves the control of individuals with Type 2 DM? What is the big advantage of the use of GLP-1 in the treatment of Type 2 DM? What other advantages does it generally have? What restrictions are there in the therapeutic use of GLP-1, and how were they overcome? What medicines of the GLP-1 type are in the pipeline? What is amylin? Why isn't human amylin used in practice? How does pramlintide act? Are there studies showing that pramlintide is effective for the treatment of DM? What is the current state of pramlintide in the market? PPARac AGONISTS Further reading