Diabetes Melitus Drugs

Question 1

Type 1 and Type 2 Diabetes Melitus therapy

Answer 1

Drug Class - Insulin Preparations

A) Insulin, rapid acting (NO LAG)

• Lispro
• Aspart
• Glulisine

B) Insulin Short Acting
- Regular: only insulin preparation suitable for DKA

C) Insulin Intermediate Acting
- NPH

D) Insulin Long Acting

• Detemir
• Glargine

Question 2

Type 2 Diabetes Melitus therapy

Answer 2

Drug Class - Oral hypoglycaemic drugs

A) biguinides
- metformin

B) sulfonylureas
+ Gen 1:
- chlorpropamide
- tolbutamide

+ Gen 2:

• glimepiride
• glipizide
• glyburide

C) glitazones/thiazolidinediones

• Pioglitazobe
• Rosiglitazone

D) Meglitinides

• Nateglinide
• Repaglinide

E) GLP-1 Analogs

• Exenatide
• Liraglutide

F) DDP-4 inhibitor

• Linagliptin
• Saxagliptin
• Sitagliptin

G)Amylin analogs
- Pralintide (subcutaneous injection)

H) Sodium-Glucose Co-transporter 2 (sglt inhibitor)

• Canagliflozin
• Dapagliflozin
• Empagliflozin

I) alpha glucosidase inhibitors

• acarbose
• miglitiol

Question 3

Metformin

Answer 3

Biguanide

Unknown mechanism
⬇️ gluconeogenesis
⬆️glycolysis
⬆️peripheral glucose uptake (⬆️ insulin sensitivity)

Use

• First line therapy for Type 2 DM
• modest weight loss medication

Method of administration-
Oral.

Side effect -

• lactic acidosis (therefore, do not give to patients with renal insufficiency)
• upset GI

Notes -
- can be used in patients with ZERO islet function.
-

Question 4

Chlorpropamide

Answer 4

Generation 1 Sulfonylurea

Mechanism -
closes K channel on the Beta cell membrane➡️ cell depolarization ➡️ insulin release via calcium influx.

Clinical use -
Stimulates the release of endogenous insulin in Type 2 DM.
- requires that some islets are functional, so drug is useless in Type 1 DM.

Risks/side effects:
- Patients with renal failure - have an increased risk of hypoglycaemia and weight gain

• Disulfiram like effects

-

Question 5

Tolbutamide

Answer 5

Generation 1 Sulfonylurea

Mechanism -
closes K channel on the Beta cell membrane➡️ cell depolarization ➡️ insulin release via calcium influx.

Clinical use -
Stimulates the release of endogenous insulin in Type 2 DM.
- requires that some islets are functional, so drug is useless in Type 1 DM.

Risks/side effects:
- Patients with renal failure - have an increased risk of hypoglycaemia and weight gain

• Disulfiram like effects

Question 6

Glimepiride

Answer 6

Generation 2 Sulfonylurea

Mechanism -
closes K channel on the Beta cell membrane➡️ cell depolarization ➡️ insulin release via calcium influx.

Clinical use -
Stimulates the release of endogenous insulin in Type 2 DM.
- requires that some islets are functional, so drug is useless in Type 1 DM.

Risks/side effects:
- Patients with renal failure - have an increased risk of hypoglycaemia and weight gain

• Hypoglycemia

Question 7

Glipizide

Answer 7

Generation 2 Sulfonylurea

Mechanism -
closes K channel on the Beta cell membrane➡️ cell depolarization ➡️ insulin release via calcium influx.

Clinical use -
Stimulates the release of endogenous insulin in Type 2 DM.
- requires that some islets are functional, so drug is useless in Type 1 DM.

Risks/side effects:
- Patients with renal failure - have an increased risk of hypoglycaemia and weight gain

• Hypoglycemia

Question 9

Pioglitazone

Answer 9

Glitazone/thiazolidinedione class of oral hypoglycaemic drugs

Mechanism:
⬆️ insulin sensitivity in the peripheral tissue. Binds to PPAR-gamma nuclear transcription regulator

Use:
Single therapy for Type 2 DM or used in combination with others.

Side effects:
-weight gain
- edema
- liver damage (hepatotoxicity) 
- heart failure
- increases risk of fractures
Notes:
Safe for use with renal patients

Question 10

Rosiglitazone

Answer 10

Glitazone/thiazolidinedione class of oral hypoglycaemic drugs

Mechanism:
⬆️ insulin sensitivity in the peripheral tissue. Binds to PPAR-gamma nuclear transcription regulator

Use:
Single therapy for Type 2 DM or used in combination with others.

Side effects:
-weight gain
- edema
- liver damage (hepatotoxicity) 
- heart failure
- increases risk of fractures
Notes:
Safe for use with renal patients

Question 11

Glyburide

Answer 11

Generation 2 Sulfonylurea

Mechanism -
closes K channel on the Beta cell membrane➡️ cell depolarization ➡️ insulin release via calcium influx.

Clinical use -
Stimulates the release of endogenous insulin in Type 2 DM.
- requires that some islets are functional, so drug is useless in Type 1 DM.

Risks/side effects:
- Patients with renal failure - have an increased risk of hypoglycaemia and weight gain

• Hypoglycemia