Insulin and Oral Hypoglycemic Agents
About 100 years have elapsed since the classic experiments of von Mering and Minkowski demonstrated that pancreatomized dogs exhibited signs and symptoms resembling those seen in diabetes mellitus. The pioneering efforts of Banting and Best revealed that pancreatic extracts could sustain the life of patients suffering from severe diabetes, thereby providing the link between insulin deficiency and the disease. Insulin was subsequently crystallized by Abel and was eventually chemically synthesized in the laboratory. Recently, synthetic insulin derived from recombinant DNA technologies has been approved for clinical trials. Therapy employing animal insulin has been used in the clinical management of diabetes mellitus for many years. Despite the experience with hormone replacement therapies, it is now recognized that diabetes mellitus is a very complex metabolic disorder, and the simple concept that its pathogenesis is due solely to insulin deficiency is no longer tenable. Indeed, contributing to the reduced production of insulin are contributing factors such as excess glucagon, which aggravate both hyperglycemia and ketosis. Insulin resistance, as demonstrated in insulin-dependent diabetes mellitus (IDDM) (i. e., type I), is yet another complicating factor and may be due to both a decrease in insulin receptors and a postreceptor defect.
KeywordsGrowth Hormone Insulin Receptor Human Insulin Oral Hypoglycemic Agent Insulin Pump
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