Diabetes drugs

Question 1

DM start with meds

Answer 1

Metformin(M) + Lifestyle changes (LC)

LC + M + Sulfas if failed

LC + M + Lantus

Or LC + M + Pioglitazone or LC + M + Exenatide

LC + M + C + sulfas

Else

LC + M + Basal insulin

Question 2

DPP-IV inhibitors (Sitagliptin) gliptins

Answer 2

0.5-0.8 %

• Weight neutral
• No Hypoglycemia
• Can be used with Renal insufficiency

Sitagliptin (januvia), Saxagliptin, Linagliptin

By preventing GLP-1 and GIP inactivation, they are able to increase the secretion of insulin and suppress the release of glucagon by the pancreas.

As the blood glucose level approaches normal, the amounts of insulin released and glucagon suppressed diminishes, thus tending to prevent an “overshoot” and subsequent low blood sugar (hypoglycemia) which is seen with some other oral hypoglycemic agents.

Question 3

GLP 1 Receptor agonist -natide(Exenatide “Byetta”)

Answer 3

• Weight loss
• Low hypoglycemia risk

Enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying, although the mechanism of action is still under study.

Question 4

Insulin

Answer 4

1.5-3.5%

• A1C > 8.5 Start basal
• IF A1C > 10 Start basal and prandial
• Weight gain and hypglycemia

Question 5

Insulin

Short acting - onset of action / duration

• Regular
• Analogs (aspart/lispro)
• Long Acting
• NPH
• Glargine
• Detemir

Answer 5

• Regular / 2-3 / 8-10
• Analogs (aspart/lispro) 0.5-1 / 4-6
• Long Acting
• NPH 4-8 / 12-18
• Glargine None / 20-14
• Detemir None / 16-20

Question 6

Pioglitazone (TZDs)

Answer 6

1-1.5%

• If can not tolerate Metformin / sulfas
• Weight gain, edema, CHF, bone fracture, Bladder cancer
• Low risk of hypoglycemia
• Can be used with renal insufficiency

Question 7

Sulfonylureas

Answer 7

1-2 %

Metformin failure

weight gain / hypoglycemia

Question 8

Biguanides

Answer 8

Metformin (Glucophage®, Glucophage XR®, Glumetza™, Riomet®, Fortamet®)

it decreases the amount of sugar (glucose) made by the liver. It can also decrease the amount of sugar absorbed into the body (from the diet) and can make insulin receptors more sensitive, helping the body respond better to its own insulin. All of these effects cause a decrease in blood sugar levels.

Question 9

Meglitinide

Neteglinide / Repaglinide

Answer 9

Repaglinide lowers blood glucose by stimulating the release of insulin from the pancreas. It achieves this by closing ATP-dependent potassium channels in the membrane of the beta cells. This depolarizes the beta cells, opening the cells’ calcium channels, and the resulting calcium influx induces insulin secretion.

Question 10

Lantus

Answer 10

ph 4