Antidiabetic Med Classes- FINAL Flashcards
Insulin
-Polypeptide hormone secreted by B cells
-MOA:
-Triggered by glucose levels
-Exogenous in Type 1 to REPLACE absent insulin
-Exogenous in Type 2 to SUPPLEMENT insulin secretion
-Pharm: made by recombinant DNA
technology using strains of E. coli or yeast that are genetically altered
-Broken down in the GI tract, so it cannot be taken orally
-ADE: Low blood sugar
Weight gain
-Local injection site reactions (lipodystrophy)
-Bronchospasm can occur with
inhaled insulin
Bolus Insulin Therapy
-A meal bolus is determined by: the amount of CHO to be ingested; this amount is divided by the insulin-to-CHO ratio [the number of grams of CHO that 1 unit of insulin covers]
-1 Unit covers approx 15 carbs
-Correction bolus is used: to quickly reduce BS back to normal; the dose is determined by the sensitivity factor
[the amount the BS will decrease with 1 unit of insulin]
-1 Unit covers approx 20mg/dl of blood sugar
-Sensitivity factor= is calculated by dividing 2000 by the total daily dose of insulin
Basal Insulin Therapy
-This is the steady background insulin that controls BS in the fasting state [overnight and in between meals]
-Enables stored fat and glucose to be released in appropriate amounts to sustain metabolism during time when fuel is not being consumed and metabolized
-Can be added to orals for better BS control
Considerations for insulins
-Secreted at a constant basal rate with intermittent bursts in response to stimuli
-Lowers blood sugar by enhancing transport of glucose into tissues
-Increases [NO] production in blood vessels
-Acts as a vasodilator; inhibits platelet aggregation
-In a person with normal insulin sensitivity, insulin plays a protective role against atherosclerosis
Rapid and Short-Acting Insulins
-Are given to mimic mealtime release
of insulin and control postprandial glucose
-Usually used in conjunction with longer-acting basal insulin that
provides control of fasting BS
- Rapid acting should be injected 15 mins before meal (30 for regular insulin)
-Onset: 5-15 mins
-Peak levels: 60 mins approx
-Rapid duration: Approx 2 hours
-Ex: regular, inhaled insulin= SHORT lispro, aspart, glulisine= RAPID
NOTE– with REGULAR insulin, onset is 30 mins, peaks in 2 hours, but hangs around for 5-6 which is why we’re using it a lot more now in tube fed patients
Side note for INHALED insulin (Abrezza)
-Most be older than 18
-Can use for type I or II
-eliminated more rapidly
-Provides higher insulin levels with peak effects in about 2 hours
-Dosed beginning with largest meal
-Can affect lung function contraindicated in COPD [risk of
acute bronchospasm]
-Patient must have baseline PFTs, then repeated every 6- 12 months
-Should not be used in smokers or in those with severe
asthma
What are the goals of treatment for diabetes mellitus (DM)?
Maintain blood glucose within normal limits, prevent long-term complications, reduce insulin resistance through lifestyle modifications, and use pharmacologic interventions as needed.
What is the action of insulin on the liver?
Insulin inhibits gluconeogenesis, promotes glycogen storage, and decreases hepatic glucose production.
What is the action of insulin on muscle tissue?
Insulin stimulates glucose uptake, promotes glycogen storage, and enhances protein synthesis.
What is the action of insulin on adipose tissue?
Insulin facilitates glucose uptake, promotes lipid synthesis, and inhibits lipolysis.
What are the phases of insulin release in the body?
1) Fed State (Phase 1): Immediate insulin burst post-meal. 2) Postabsorptive State (Phase 2): Blood glucose from glycogen breakdown. 3) Early Starvation (Phase 3): Blood glucose from gluconeogenesis. 4) Preliminary Prolonged Starvation (Phase 4): Liver/kidney gluconeogenesis. 5) Secondary Prolonged Starvation (Phase 5): Reduced glucose use and gluconeogenesis.
What is the role of Amylin in the body?
Amylin delays gastric emptying, decreases postprandial glucagon secretion, and enhances satiety.
What is the difference between basal and prandial (bolus) insulin?
Basal insulin provides steady background insulin levels for fasting states, while prandial (bolus) insulin is used to manage post-meal glucose spikes.
What are the types of insulin based on their action?
1) Rapid-acting (onset: 5-15 min, peak: 1-3 hrs, duration: 2-4 hrs). 2) Short-acting (onset: 30-60 min, peak: 2-4 hrs, duration: 6-12 hrs). 3) Intermediate-acting (onset: 2-4 hrs, peak: 6-10 hrs, duration: 10-16 hrs). 4) Long-acting (onset: 2 hrs, no peak, duration: 20-24 hrs).
Which types of insulin target fasting blood sugar (FBS) vs. postprandial blood sugar (PPBS)?
Basal insulins (intermediate, long-acting) target FBS. Prandial insulins (rapid, short-acting) target PPBS.
Which insulins may be given IV?
Short-acting and rapid-acting insulins (Regular insulin, Insulin Aspart, Insulin Lispro, and Insulin Glulisine).
What laboratory monitoring is important for diabetic patients?
Hemoglobin A1C (every 3 months), fasting blood glucose, postprandial glucose, kidney function (creatinine, albuminuria), lipid profile, and blood pressure monitoring.
Which insulins can be used in pregnancy?
Regular insulin, NPH, Insulin Lispro, Insulin Aspart, Insulin Detemir, Insulin Glargine.
How do you adjust insulin dosage when switching between types? How do you convert intermediate insulin to base insulin?
Switching from rapid to basal insulin requires dose calculation based on total daily insulin needs. Switching from intermediate to basal insulin requires a 20% dose reduction for starting dose.
What are common complications and side effects of insulin use?
Hypoglycemia, weight gain, injection site reactions, lipodystrophy, and risk of bronchospasm with inhaled insulin.
How do Biguanides (Metformin) work?
Decreases hepatic glucose production, increases insulin sensitivity, and decreases intestinal glucose absorption.
What are the advantages and disadvantages of Biguanides?
Advantages: No hypoglycemia, weight neutral, cardiovascular benefits. Disadvantages: GI disturbances, risk of lactic acidosis, contraindicated in renal impairment.
What is the mechanism of action of Sulfonylureas and Glinides?
Stimulate insulin release from pancreatic beta cells by closing ATP-sensitive potassium channels.
What are the advantages and disadvantages of Sulfonylureas?
Advantages: Effective in reducing blood glucose. Disadvantages: Risk of hypoglycemia, weight gain, and loss of efficacy over time.
