Читать книгу A Practical Approach to Special Care in Dentistry - Группа авторов - Страница 224

 Diet and regular physical exercise

  Oral hypoglycaemic agentsSulfonylureas (e.g. glipizide, glyburide, glimepiride and tolazamide)Meglitinides (e.g. repaglinide and nateglinide)DDP‐4 inhibitors (e.g. sitagliptin)Biguanides (e.g. metformin)Alpha‐glucosidase inhibitors (e.g. acarbose and miglitol)Thiazolidinediones (e.g. pioglitazone and rosiglitazone)

 InsulinSeveral types of human insulin according to the speed and duration of their effects (Table 5.1.4)Generally, individuals with diabetes are controlled with 2 administrations of subcutaneous fast‐acting or intermediate insulin (first hour of the morning and middle of the afternoon)Insulin can also be administered with a continuous release pump (especially indicated for patients with considerable blood glucose variability)

 Classically, glycaemic control has been performed with home (electronic glucometers) and professional monitoring (blood glucose and HbA1c levels)

 Continuous glucose monitoring systems consist of a subcutaneous sensor and a transmitter that sends the signal to a receiver by which the reading can be taken (Figure 5.1.4); this process can even be controlled with a smart phone; these devices are also the basis of the so‐called ‘artificial pancreas’, which injects the required insulin doses in real time

 Other treatments under development include the transplantation of pancreatic islets and pluripotent stem cell‐derived insulin‐producing cellsTable 5.1.4 Types of insulin and their action profiles.Main types of insulinInjection timingStart of actionMaximum effectDuration of effectFast‐acting insulin30 minutes before meals30 minutes1–3 hours6–8 hoursUltrafast‐acting insulin analogues10 minutes before meals10–20 minutes1–2 hours3–5 hoursIntermediate‐acting insulin30 minutes before meals60–120 minutes4–6 hours10–12 hoursLong‐acting insulin analoguesAt the same time every day60–90 minutes12 hours17–24 hours