Antidiabetic Meds Flashcards
What predisposes individuals by destroying the beta cells leading to type 1 DM
Toxins and viruses
Is a contributing factor to the development of cardiovascular disease, hypertension, renal failure, blindness and stroke.
Diabetes Mallory’s
An autoimmune disorder in which beta cells of the pancreas are destroyed in a genetically susceptible person
Type 1 DM
NO insulin is produced
Type 1 DM
10% of diabetes population, occurs in childhood of adolescence mostly, causes or to be thin and underweight
Type 1
What can lead to ketoacidosis?
Type 1
A metabolic disease that results from either the loss of receptor sensitivity to insulin, poor control of liver glucose output, and decreased beta cell function
Type 2 DM
More frequent among obese, represents 90% of diabetic population, usually in middle age, older adults.
Type 2 DM
Insulin resistant: decreased ability to respond to insulin, increased hepatic glucose production
Type 2 DM
Glucose intolerance with onset or first recognition during pregnancy.
Gestational diabetes mellitus
What is gestational DM diagnoses based on?
OGTT/ 100-g oral glucose tolerance test
What population is most affected by diabetes?
African American, American Indian, and Hispanic.
Level of glycosylated hemoglobin (HbA1c) to be diabetes
> /= 6.5%
Level of fasting plasma glucose to be diabetes
> 126mg/dL
2-hr plasma glucose to be diabetes
> 200 mg/dL post 75-g oral glucose challenge
Random plasma glucose level for diabetes
> 200 mg/dL with symptoms of diabetes (polyuria, polyphagia, and polydipsia)
Biguanide class
Glucophage (metformin) and glucophage XR
Glucophage (metformin)
2-3 times a day
What lowers A1c by 1-2% and decreases glucose production
Metformin (glucophage)
Is weight neutral or weight loss and is FIRST line of therapy after diet and exercise
Metformin
Has GI side effects, transient, start slow then increase, take with food to decease GI effects
Metformin
What should be discontinued when having general anesthesia or procedure with contrast dye?
Glucophage (don’t restart for 48-72 hours until serum creatinine is documented)
1st generation sulfonlyureas
Orinase and diabenese
2nd generation sulfonlyureas
Glucotrol, glynase, diabeta
Tends to have fewer side effects but are more predictable and expensive
2nd generation sulfonlyureas
3rd generation sulfonlyureas
Amaryllis
Main site of action for sulfonlyureas
Pancreas (stimulates beta cell production by pancreas)
Side effects of sulfonlyureas
Hypoglycemia and weight gain
Lowers A1c by 1-2% and stimulates insulin production
Sulfonlyureas
Meglitinides
Prandin (repaglinide) and starlix
Meglitinides main site if action
Pancreas (stimulates pancreas to produce more insulin)
Side effects of meglitinides
Hypoglycemia and weight gain
Onset more rapid than sulfonlyureas and duration shorter
Meglitinides
Take only with meals!
Meglitinides
Lowers A1c by 1-1.5% and targets pp glucose to mimic insulin secretion, must be taken 15- 20 min before each meal
Meglitinides
Alpha glucosidase inhibitor
Precose (acarbose) glyset (migitol)
Main site of action of alpha glucosidase inhibitors
Small intestine (slows digestion of starchy food in small intestine so absorption of sugar into blood is delayed helping prevent surge of it)
Side effects if alpha glucosidase inhibitors
Flatulence, diarrhea, abdominal discomfort
Thiazolidinediones
Actos (pioglitazone) and Avandia (rosiglitazone)
Main site of action for thiazolidibediones
Peripheral tissues (increases sensitivity of peripheral tissues to insulin, thus improving glucose control)
Side effects of thiazolidinediones
Weight gain (increase intravascular volume so may not be used in patients with CHF)
Lowers A1c 1-1.5%, insulin sensitizer, edema, may have connection to bladder cancer
TZDs (actis and Avandia)
What function must be monitored for TZDs?
Liver
DPP4
Januvia, onglyza, trajenta –DPP-4 inhibitor
Increases insulin made in pancreas and decreases glucose produced by liver
DPP4
Lowers A1c by 0.5-1.0%, increases glucose-dependent insulin release and suppresses glucagon secretion.
DPP4 inhibitor
Weight neutral, oral, nausea and pancreatitis reported
DPP4
Metabolized in liver and excreted thru kidney
DPP4
Bike acid sequestrant
Welch ok
Now indicated for treatment of type 2 diabetes, lowers A1c 0.5-1%, clean drug, rare side effects
Bike acid sequestrant
Also treats cholesterol, take 2 tabs x3 a day, constipation side effect
Bile acid sequestrant
GLP
Byetta, Victoza, pre filled injectable pens
Injectable med for type 2 but NOT and insulin, inject twice a day within 60 min of bfast and dinner
Byetta
Inject once daily
Victoza
Signals pancreas to make right amount of insulin after eating. Decreases glucose production by liver, reduces appetite
GLP - 1
Side effects of GLP-1
Nausea and vomiting, take within 1 hour of eating
Natural hormone released from small intestine, 1-1.5% A1c lowering, inhibits hepatic glucose production
GLP1- receptor agonist, Victoza
For type 1 and 2 who don’t have good control with insulin
Smylin
Amylin mimetics
Smylin (pramlintide)
Hormone secreted by beta cells of pancreas which carry glucose from bloodstream into cells binding to receptors on the cell membrane allowing glucose to make energy
Insulin
Controls glucose in between meals and suppresses overnight hepatic glucose production, background insulin
Basal insulin
Controls post- prandial glucose spikes or correct hyperglycemia, covers amount of food eaten
Prandial insulin or bolts insulin
Rapid acting insulin U-100
Humalog, novolog, apidra
Short acting insulin U-100
Regular
Intermediate acting insulin
NPH
Long acting insulin
Lantus and Levemir
Combination
Human 70/30, novolog mix 70/30, humalog mix 75/25, humalog mix 50/50
What can you not mix with other insulin?
Lantus and Levemir
Basal insulin
NPH and glargine (lantus) and detemir (Levemir) daily or BID
Prandial or Bolus insulin
Rapid acting insulin analogue or regular
Onset, peak, and duration of NPH (intermediate)
Onset: 1-3 hours
Peak: 4-10 hours
Duration: 10-18 hours (12 mostly)
Lantus and Levemir peak, onset and duration
Virtually peak less
Onset: 1 hour
Duration: 24 hours
Why don’t you mix lantus and Levemir with other insulin?
They can crystallize
Regular (short acting) onset, peak, and duration
Onset: 30 min to 1 hour
What is being used more in insulin pump
U-500 R, 5X stronger than regular insulin
Onset, peak, and duration or rapid acting insulin
Onset: 10-15 min
Peak: 1-2 hours
Duration: 3-5 hours
Must be given no more then 15 min before eating but can be given immediately after meals
Rapid-acting
Human 70/30 and human 50/50 onset peak and duration
Onset: 30 min to 1 hour
Humalog 75/25 and humalog 50/50 onset peak and duration
Onset: 10-15 min
Peak: 1-3 hours
Duration: 10-16 hours
Novolog 70/30 onset peak and duration
Onset 10-20 min
Peak 1-4 hours
Duration 10-16 hours
Availability of insulin
All available in 10cc vials of U-100
Expiration of insulin
Good for 30 days once opened or until expiration date if never opened and refrigerated
What to teach
Insulin type, technique, response, storage, and complications
Spongy swelling at it around injection site, need to rotate sites to prevent
Lipodystrophy/lipohypertrophic
Loss of subcutaneous fat in areas of repeated injection, need to rotate sites to prevent
Lipoatrophy
