1. Revision of the most important information about antidiabetics

• Overview of drug groups incl. insulin preparations
• General and specific mechanisms of action
• Routes of administration
• Typical adverse effects
• Important pharmacokinetic data
• Essential representative drugs

2. Identify antidiabetics X based on the mini-case reports

a) An elderly obese woman with T2DM and diabetic nephropathy had nausea and vomited for several days, and then collapsed. She was admitted to a hospital but died. She spontaneously increased her dose of antidiabetic X before the deterioration of her health status. Last available laboratory tests: eGFR < 30 mL/min, blood pH 6.9, anion gap 47 mEq/L (normal range: 4–11 mEq/L), lactate 30.5 mmol/L (normal range: 0.6–2.2 mmol/L).

b) A 50-year-old overweight man with T2DM was treated with antidiabetic X. For about 10 days, he noticed redness, swelling and itching of his penis, and mucopurulent discharge. Microbiological examination showed Candida albicans infection.

c) A 70-year-old man with T2DM was unusually physically active and had a knee pain for which he took an ibuprofen pill in the evening. Within 30 minutes, he became sweating, he had nausea and palpitations, and he suspected hypoglycemia. After eating a light meal, the symptoms subsided. In the morning, he took his usual dose of antidiabetic X, had a light breakfast, and again an ibuprofen pill for knee pain. The same symptoms occurred (sweating, nausea and palpitations), the patient later collapsed and was unconscious. At emergency, his glycemia was 2.2 mmol/L.

d) Parents of a 10-year-old girl with diabetes (T1DM) noticed changes in her skin around the navel, the formation of skin depression and its gradual enlargement during the last year. The girl has been treated for 6 years, a year ago, there was a change in the therapy to antidiabetic X and a change in the administration device. 

e) 85-year-old woman with T2DM had severe pain in the epigastrium with serum lipase 6720 IU/L (normal level: ≤ 60 IU/L). After the CT examination, a diagnose of interstitial pancreatitis (non-biliary type) was done. Antidiabetic X added 5 months ago to therapy was now discontinued. Lipase levels gradually decreased and the symptoms disappeared on the 4th day. After 2 weeks, antidiabetic X was re-introduced, and abdominal pain with serum lipase 2940 IU/L and amylase 2120 IU/L (normal range: 30–160 IU/L) occurred again. Antidiabetic X was discontinued, this time definitively.

3. Insulin regimens

Graphical representations will help you better understand the principles of insulin substitution and individualization of each patient's therapy. Solve the tasks in the worksheet according to the teacher's assignment.

4.  Pharmacotherapy for acute and specific states in diabetology

Create an overview of the pharmacotherapy of gestational diabetes, severe hypoglycemia with coma, mild hypoglycemia without consciousness impairment, ketoacidosis, and hyperosmolar hyperglycemic state using the following ppt presentation.