Diabetes Pharmacological Management Flashcards
What are the patterns of insulin and glucose throughout the day?
glucose mimmics insulin
higher after meal, lower 3 hours after meal
What are the bolus types of insulin?
Rapid-acting –> Lispro
Short-acting –> Regular
What are the basal types of insulin?
Intermediate-acting –> NPH
Long-acting –> Glargine
***Premixed –> 30/70 (30% reg/70% NPH) –> on its own group
What is the
- brand name
- onset
- peak
- duration
for rapid acting Lispro insulin?
- brand name: Humalog
- onset: 10-15 min
- peak: 1-2h
- duration: 3-5h
What is the
- brand name
- onset
- peak
- duration
for Short-acting –> Regular insulin?
- brand name: Humulin-R
- onset: 30min
- peak: 2-3h
- duration: 6.5h
What is the
- brand name
- onset
- peak
- duration
for Intermediate-acting –> NPH insulin?
- brand name: Humulin-N
- onset: 1-3h
- peak: 5-8h
- duration: 10-18h
What is the
- brand name
- onset
- peak
- duration
for Long-acting –> Glargine insulin?
- brand name: Lantus
- onset: 30-60 min
- peak: no peak
- duration: 10-16h
What is the
- brand name
- onset
- peak
- duration
for Premixed –> 30/70 (30% reg/70% NPH) insulin?
- brand name: Humulin-R 30/70
- onset: 30-60min
- peak:dual
- duration: 10-16h
Basal vs Bolus insulin
Basal
- same molecular form as human insulin, made from microbes = ecoli
- they are mimicking human insulin but they have some specificity, slower release better action by the pharma companies
Bolus
- rapid acting
- acts immediately after injection
What are the considerations for premixed?
- premixed is for old people, uneducated and don’t know how to use these medications
- lunch time the glucose will be higher than insulin so the person might have hyperglycemia
- it mostly covers the breakfast and dinner
What are the types of insulin regimens?
Conventional : premixed or fixed insulin plan
Intensive: recommended for better control
What are some considerations for intensive insulin therapy?
¢ Basal insulin + injections of rapid insulin before meals: more closely mimics physiology
¢ More flexibility in timing and content of meals: insulin is adjusted according to CHO intake –> must learn carb counting
¢ Insulin dose may be adjusted to exercise
¢ SMBG frequent
¢ Intensive therapy delays onset and slows progression of complications
Conventional vs intensive treatments in terms of risk reduction of nonfatal MI, stroke or death from CVD
intensive insulin treatments reduces more risk than conventional insulin treatments
What are the techniques used to deliver insulin?
Syringe
Pen
Continuous glucose sensor (closed-loop system)
Insulin pump
What are some antihyperglycemic agents?
- Metformin (GlucophageTM)
- α-glucosidase inhibitors
- Insulin secretagogues*, meglitinide, sulfonylurea
- Incretin mimetics, DPP-4 inhibitors GLP-1 receptor agonists
- Thiazolidinediones (TZDs)
What is the recommended initial drug to treat T2DM
Metformin (GlucophageTM)
What is the class name of Metformin (GlucophageTM)?
biguanide
What is the mechanism of action of biguanide?
↓ GNG → ↓ glucose production
↑ insulin sensitivity → ↑ glucose uptake
Where does the source of Metformin come from?
Galega officinalis
What are the advantages of Metformin?
Known safety, no hypoglycemia, helps with weight control
What are some side effects of Metformin?
mostly GI (transient), B12 deficiency (10-30% of cases)
What are some contraindications of Metformin?
renal insufficiency, liver or heart failure
What is the mechanism of action of α-glucosidase inhibitors?
Delay intestinal glucose absorption
What is the mechanism of action of Insulin secretagogues*
meglitinide sulfonylurea?
Stimulate insulin secretion
Short-acting (4-7h)
Long-acting (once daily)
What is the mechanism of action of Incretin mimetics
DPP-4 inhibitors GLP-1 receptor agonists?
Stimulate insulin and reduce glucagon secretion; delays gastric emptying
What is the mechanism of action of Thiazolidinediones (TZDs)?
Increase insulin sensitivity in peripheral tissues and liver
What is the mechanism of action of DPP-4 inhibitors specifically?
inhibit DPP-4 enzyme that inhibits GLP-1
What are the functions of GLP-1?
- Stimulates insulin release
- Inhibits glucacon release
- Slows gastric emptying
- Increase satiety
What is the mechanism of action of GLP-1 receptor agonists specifically?
promote GLP-1
What are the drug-nutrient interactions or concerns of buigandes?
Reduce folate and vit B12 absorption, take with meals
What are the drug-nutrient interactions or concerns of α-glucosidase inhibitors?
Take with first bite of meal, limit alcohol
What are the drug-nutrient interactions or concerns of Insulin secretagogues?
avoid alcohol
What are the drug-nutrient interactions or concerns of Thiazolidinediones (TZDs)?
none
What is the mechanism of action of SGLT2 inhibitors?
Block glucose transport in the proximal renal tubule –> glycosuria –> lower blood glucose and body weight
When added to SGLT 2 Inhibitors, ______ has better efficacy on lowering A1C than other agents
metformin
What are some advantages of SGLT2 inhibitors?
rare hypoglycemia, lower BP, raise HDL
What are some contraindications of SGLT2 inhibitors?
renal failure, loop diuretics, T1DM
Also: elevate LDL modestly (CVD risk remains to be
evaluated)
What are some side effects of SGLT2 inhibitors?
risk of urinary tract infections, genital mycotic infections, hypotension (due to osmotic diuresis), more risk of diabetic ketoacidosis
What is conventional insulin treatment? Explain how it is done and the considerations?
- insulin injections (1-3/d) and meals must be consistent from day to day
- strict meal plan: CHO content , meals should not be skipped
- physical activity may lead to hypoglycemia
How is intensive insulin treatment done?
- multiple daily injections (≥3/d) or continuous subcutaneous insulin infusion (CSII, insulin pumps)
