Diabetes Flashcards
Insulin Physiology
- Metabolic actions: overall anabolic effect, anabolism- constructive part of metabolism
- insulin promotes cell growth and division
What is used for insulin overdose?
Glucagon
Types of insulin (4)
I. Rapid-acting (onset <30 min, short duration 3-5hr)
II. Regular or short (onset 15-60 min, duration 6-10 hrs)
III. Intermediate acting (onset 1-2hrs, duration 14-24hrs)
IV. Long-acting (onset 70 min, duration 14-24hrs)
Insulins (7)
- Insulin lispro [Humalog] - rapid
- Insulin aspart [Novolog] - rapid
- Insulin glulisine [Apidra] - rapid
- Regular insulin [Humulin R, Novolin R], natural insulin - regular or short
- Neutral protamine hagedorn (NPH) insulin [Novolin N, Humulin N] - intermediate
- Insulin detemir [Levemir] - long
- Insulin largine [Lantus] - long
Which insulin should not be mixed with other insulins?
Insulin detemir [Levemir] - long acting
Which insulin is the only one able to be administered IV?
Regular insulin
Insulin AE
hypoglycemia
lipodystrophies (depositions of subq fat at site of injection)
allergic rxns
Oral Hypoglycemics (7)
- Sulfonylureas (SU)
- Meglitinides (GLN)
- Biguanides
- Thiazolidinediones - TZD (Glitazones)
- Alpha-glucosidase Inhibitors (AGI)
- New agent: “DPP-4 inhibitors”
- New agent: SGLT2 inhibitors
Sulfonylureas (SU) (4)
Glipizide [Diabeta] *
Glyburide [Glucotrol] *
Glimepiride [Amaryl]
Chlorpropamide [Diabenes] - 1st gen
Insulin Secretagogues
Meglitinides (GLN) (2)
Repaglinide [Prandin]*
Nateglinide [Starlix]
Insulin Secretagogues
Sulfonylureas & Meglitinides AE
hypoglycemia
weight gain
Insulin Secretagogues
MOA: Stimulate insulin release from pancreatic islets -> lower bloo dglucose levels
risk of hypoglycemia!!!
Biguanides (1)
Metformin [Glucophage]
Insulin Sensitizers
Biguanides AE
GI effects: decrease appetite, nausea, diarrhea
May reduce vitamin B12 absorption
BBW: lactic acidosis if improperly prescribed
Thiazolidinediones - TZD (Glitazones)
Pioglitazone [Actos] *
Rosiglitazone [Avandia]
Insulin Sensitizers
Thiazolidinediones - TZD (Glitazones) AE
fluid retention -> peripheral edema, weight gain
increase HDL, LDL cholesterol and TG
BBW: increase risk of CHF and potential increase risk for heart attacks
Insulin Sensitizers
MOA: decrease insulin resistance -> increase muscle and adipose tissues sensitivity to insulin -> increase glucose uptake by muscle and adipocytes -> decrease blood glucose
Alpha-glucosidase Inhibitors (AGI) (2)
Acarbose [Precose] *
Miglitol [Glyset]
Alpha-glucosidase Inhibitors
MOA: retard degredation of polysaccharides into monosaccharides
delay intestinal carbohydrates absoprtion -> decrease rise of nlood glucose levels after meal
Alpha-glucosidase Inhibitors AE
GI effects: flatulence, diarrhea or abdominal discomfort
Glp-1 and incretin enhancers
MOA: inhibitors of DDP-4 prevent the degredation of incretin hormones and Glp-1 -> increase the action of Glp-1 -> enhance the fxn of Glp-1
Glp-1 and incretin enhancers
Dipeptidyl peptidase 4 (DDP-4) inhibitors
Gliptin Drugs
- Sitagliptin [Januvia] *
- Saxagliptin [Onglyza]
- Linagliptin [Tradjenta]
Sodium glucose co-transporter inhibitor
SGLT2 inhibitors
Gliflozin Drug
- Canagliflozin [Invokana] *
- Empagliflozin [Jardiance]
- Dapagliflozin [Farxiga]
Sodium glucose co-transporter inhibitor
MOA: SGLT2 inhibitor prevent the renal reabsorption o fglucose and increas eurinary excretion of glucose
SGLT2 inhibitors AE
hypoglycemia
female genital mycotic infections, UTI’s, and increase urination
ketoacidosis
AKI
Incretin mimetic- Glp-1 agonists (Glp1-RA) (2)
Exenatide [Byetta] [Byduron = extended release] *
Liraglutide [Victoza]
Route: subq
Incretin mimetic- Glp-1 agonists (Glp1-RA)
MOA: synthetic analogues of Glp-1 (glucagon like peptide-1) a peptide hormone in the incretin family -> decrease postprandial levels of glucose
Incretin mimetic- Glp-1 agonists (Glp1-RA) AE
GI- N/V, diarrhea
hypoglycemia
weight loss
BBW: thyroid cancer seen in rats
Synthetic Analogue of amylin
MOA: act like amylin which is a neuroendocrine peptide produced by the pancreatic beta cells and released with insulin to assist postprandial glucose control -> slow down gastric emptying, decrease glucagon secretion and increase satiety -> decrease postprandial levels of glucose
Synthetic Analogue of amylin (1)
Pramlintide [Symlin]
Route : subq
Synthetic Analogue of amylin AE
hypoglycemia
BBW: co-administration with insulin may induce severe hypoglycemia (usually within 3 hrs following administration)
Glp1-RA- Semaglutide MOA
MOA: synthetic analogues of GLP-1 (glucagon like peptide-1), a peptide hormone in the incretin family -> decrease postpandial levels of glucose -> suppress appetite, decrease calorie intake -> weight loss
Glp1-RA- Semaglutide Indications
Type 2 DM
Obesity
disorder of CV system
prophylaxis DM and obesity
Route: Subq [Ozempic], oral [Rybelsus] *
Glp1-RA- Semaglutide AE
GI- N/V, diarrhea
hypoglycemia
weight loss
BBW: thyroid cancer seen in rats
