Drugs For Diabetes Mellitus (60) Flashcards by Ella Thorsteinson

How many people worldwide have diabetes

422 million

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(Canada) what population is more likely to develop diabetes

Indigenous

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T1DM

Lack of insulin production

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T2DM

Insulin resistance

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What are you measuring when testing for DM

HbA1C

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DM is measured over the past _ months

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Insulins function as

Substitute for endogenous hormone
-effects are the same as normal endogenous insulin

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Insulins improve the diabetics ability to

-take up glucose into cells
-make proteins and triglycerides
-make glycogen from glucose in liver
-convert glucose to fatty acids in adipose tissue

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Very important that we know what about the insulins

Time frames

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Rapid acting insulin (onset, peak, duration)

onset: 10-15 minutes
Peak: 60-90
Duration: 3-5 hours

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Rapid acting insulin

Most rapid onset of action with a short duration
-taken with EACH meal

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Examples of rapid acting insulin

Insulin lispro

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Short acting insulin (onset, peak, duration)

Onset: 30-60 minutes
Peak: 2-3 hours
Duration: 6-7 hours

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Example of short acting insulin

Regular insulin
-can be SC, IV, or IM

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Intermediate acting insulin (onset, duration, peak)

Onset: 1-3 hours
Peak: 5-8 hours
Duration: 10-18 hours

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Examples of intermediate acting insulin

NPH
-cloudy appearance

Basal therapy

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Human based insulins (onset, peak, duration)

Onset: 90 minutes
Peak: no pronounced peak
Duration: 24 hours

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Examples of long acting

Insulin glargine and basal therapy

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Diabetes Canada recommends use of what two insulins

Basal insulins + rapid acting insulins

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Combination insulin products

Come premixed in one solution

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Three components of BBIT

Basal insulins, bolus insulins, correction insulin
-basically: long acting, short acting, correction

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BBIT has a target range of

5 to 10 mmol/L

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BBIT prevents

Blood sugar highs and lows

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What is the level of hypoglycaemia

Less than 3.9mmol/L

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What causes hypoglycaemia

Too much insulin

Warning signs of hypoglycaemia comes as

-CNS effects -SNS activation -can lead to possible come and death

Symptoms of hypoglycaemia

Trembling, palpitations, sweating, anxiety, hunger, nausea, tingling, difficulty concentrating, confusion, weakness, drowsiness, vision changes, slurred speech, headache, dizziness

Interactions of B blockers and alcohol with insulins will…

Increase hypoglycaemic effect so will lower blood glucose levels

B blockers reduce

Glycogenolysis -and also masks signs of SNS activity which are symptoms of hypoglycaemia

Alcohol reduces

Liver glycogenolysis

When insulin is ordered, ensure

-correct route -correct type of insulin -timing of the dose -correct dose

diabetes drugs

Insulin secretagogues -increase insulin production in T2DM

Diabetes drugs act on

Beta cells of pancreas

2 classes of insulin secretagogues

1. Sulphonylureas 2. Non sulphonylureas

Example of sulphonylureas

Glyburide

Example of biguanides

Met Forman

Examples of thiazolidinediones

Rosiglitazone

Two examples of gliptins and incretin mimetic

Sitagliptin and excenatide

Biguanides act on what site of the body?

Liver

Metformin is administered

Orally

Metformin MOA (2)

1. decrease hepatic production of glucose 2. Increase tissue sensitivity to insulin = increase uptake of glucose

Oral drugs/Metformin does not

-Increase insulin secretion from the pancreas -hypoglycaemia -weight loss

AE of Metformin

-gi disturbances -lactic acidosis

Where in the body does glinidies and sulfonylureas work?

Pancreas

Glyburide MOA

-stimulate insulin secretion from beta cells -improves sensitivity to insulin in muscles, liver and fat -improves liver by decreasing rate of insulin metabolism

AE Glyburide

Hypogylcemia

Glyburide is taken

With breakfast -usually one a day

Intestinal contents release

In retina

Examples of in retina

GLP1 and GIP

Incretins stimulate

Insulin release

Incretins are broken down by what enzyme?

DPP-4

Where do DPP 4 act?

In the pancreas

Example of Incretins as a drug

Exenatide

Synthetic form of a saliva protein of the GLP 1 mimetic

Exenatide Incretins end in

“glutide”

Exenatide is given

Incretins decrease

Appetite -useful in obesity linked diabetes -weight loss drug

Major AE of Incretins

GI upset

New incretin mimetic

Tirzepatide -GIP and GLP 1 agonist

Result of Incretins DPP 4 enzyme inhibitors

Reduce incretin metabolism, resulting in higher plasma incretin level

Example of DPP 4 enzyme inhibitors

Sitagliptin

Used alone or in combination with Metformin -for type 2 diabetes only

What is the newest group of drugs for type 2 DM

Na-glucose transporter inhibtiors

Newest group of T2DM

Example of Na-glucose transporter inhibtiors

Canagliflozin

What is the glucose transporter in nephron

Sodium glucose transporter subtype 2

SGLT2 inhibitors AE

Increased urination and UTIs

Thiazolidinediones act in the

Muscle and fat cells

Thiazolidinediones

-Increase glucose uptake and use in skeletal muscle -inhibit glucose and triglycerides produce in the liver

Example of Thiazolidinediones

Rosiglitazone

Decrease insulin resistance -insulin sensitizing agents

Boxed warning for Rosiglitazone

Increased risk of angina, MI and heart failure

Amylin mimetic

Amylin co released with insulin -delaying gastric emptying and inhibits glucagon secretion -reduce postparandial glucose

Pramlintide

Acts as Amylin -supplement to insulins -SC

Alpha glucoseidase inhibitors

Reversible inhibit the enzyme alpha glucosidaase in the brush border of small intestine

Alpha glucoseidase inhibitors inhibits digestion of

Oligo and disaccharides

Result of Alpha glucoseidase inhibitors

Delayed absorption of glucose

Alpha glucoseidase inhibitors must be + why

Taken with meals to prevent excessive postprandial blood glucose elevations

Medication interactions with oral/non insulin agents

Glucocorticoids -decrease effect of hypoglycaemic medication -cortisol like drugs increase blood glucose

If hypoglycaemia occurs have the client eat

120 to 200mL of clear fruit juice, glucose tablets or gel

After the liquid snack have the client

Eat their meal soon or, give a small snack such as crackers or half a sandwich -carbohydrates and protein!!!!!