Anti-Diabetics Flashcards
Insulin
Rapid acting: LISPRO, ASPART; Short Acting: Regular; Intermediate acting: NPH, Isophane, Long acting: Detemir
Oral Hypoglyemic agents
DPP4 inhibitors, sulfonylureas, glinides, biguanides, thiazolidinediones, alpha glucosidase inhibitors
DPP4 inhibitors
alogliptin, saxagliptin
Sulfonylureas
Glimepiride, glyburide, glipizide
Glinides
repaglinide
Biguanides
metformin
Thiazolidinediones
pioglitazone, rosiglitazone
Alpha glucosidase inhibitors
acarbose, miglitol
Objective in treatment
maintain glycemia levels as close to normal as possible without complications (micro and macroangiopathy)
Antidiabetic pharmacological treatment does not exclude
strict diet and control of physical effort
Indications for insulin administration
Diabetes type 1, diabetes type 2 after more than 10 years with oral antidiabetic drugs/ glycemia levels too high, diabetes type 2 in case of infections, tuberculosis, acute myocardial infarction, stroke, diabetes 2 with contraindication to oral anti diabetic drugs, diabetes during pregnancy
Insulin administration method
subcutaneously, 1-1,5 cm needles into abdomen (fastest absorption), thighs, or deltoid (slowest absorption), absorption rate must be taken into consideration before changing region
Administration of different types of insulin
short acting: 30 minutes before meal, intermediate acting: 45 minutes before meal, long acting: 60 minutes before meal
Each patient older than 12
should know how to self inject insulin
Insulin administration should be
painless. Reason for pain could be intradermic administration (delayed absorption), traces of alcohol on skin or cold insulin. Insulin should be stored at 5 degrees in fridge and warmed up before administration. Intermediate and slow insulins should be agitated before administration.
Side effects of insulin
Hypoglycemia (sweating, tachycardia, hunger, nervousness, confusion) corrected by fruit juice or other soluble carbohydrates, intramuscular glucagon in profiled syringe; local reactions like lipoatrophy rotating sites of injection, infection, local allergic reactions, blurred vision due to refraction areas at the beginning of treatment, with fluctuations of glycemia level, disappears in 2-3 weeks; insulin resistance, patient requires 100 IU/day, antigenic response, with excessive antibodies, patient receiving animal origin insulin.
Drugs modify response to insulin
read
Treatment with insulin can be
read
Sulfonylureas
most widely used anti diabetic drugs, administered 15-20min before meal (during meal in digestive intolerance)
Side effects of sulfonylureas
hypoglycemia (more frequent in elderly/liver/renal diseases), digestive problems (diarrhea, anorexia, nausea, vomiting, abdominal pain), pruritus and maculopapular rash
Hypoglycemic effect of sulfonylureas
read
Administration of sulfonylurea should be avoided during
pregnancy, because of risk of inducing malformations
When efficiency of treatment of sulfonylurea decreases
they are associated with other oral anti diabetic drugs, if still no satisfactory response, patient will take insulin.
Biguanides are administered in patients with
type 2 diabetes and obesity 3 doses per day before meal. May reduce excessive weight and plasmatic concentration of triglycerides and VLDL
Side effects of biguanides
digestive intolerance (diarrhea, intense anorexia, metallic taste, nausea and vomitting), decreased absorption of B12 and folic acid, lactic acidosis occurs rarely (dangerous, favored by high doses of biguanides)
Alpha glucosidase inhibitors are administered
as adjuvant therapy, to decrease digestive glucose absorption
Thiazolidinediones are administered as
monotherapy, or in association with biguanides, no longer considered as first line treatment because of side effects: stroke, myocardial infarction, bone fractures, edema, anemia, risk of urinary bladder cancer (after pioglitazone)
