Drugs in the management of diabetes (insulin and hypoglycaemic agents)

Question 1

What are the classes of insulin preparation

Answer 1

Rapid-acting: insulin lispro, aspart, glulisine
Short-acting: regular human insulin
Intermediate-acting: neutral protamine hagedorn (NPH)
Long-acting: Insulin glargine, demetir
Ultra-long-acting: Insulin degludec

Question 2

What are some combination preparations and which type of insulins cannot be mixed?

Answer 2

1. Regular human insulin + NPH
2. Rapid-acting + NPH
3. Rapid acting (Aspart) + Ultra-long-acting (Degludec)

• Never mix:
  1. Glargine and other insulins (incompatible pH)
  2. Glulisine and other insulins (except for NPH)
  3. Demetir and other insulins (manufacturer’s instructions)

Question 3

What are the AEs of insulin therapy?

Answer 3

1. Lipodystrophy at site of injection

2. Hypoglycaemia

Question 4

What are the hypoglycaemic agents for treatment of DM?

Answer 4

1. Biguanides: Metformin
2. Thiazolidinediones: Pioglitazone
3. Sulfonylureas:
   - 1st gen: Tolbutamide
   - 2nd gen: Glibenclamide, Glipizide, Gliclazide, Glimepride (Glipizide and Gliclasize have better safety profiles than the other 2nd gen SFUs)
4. Meglitinides: Nateglinide, Repaglinide
5. Alpha-glucosidase inhibitor: Acarbose
6. Dipeptidyl peptidase-4 (DPP-4) inhibitors: Sitagliptin, Vildagliptin, Linagliptin
7. Glugacon-like receptor-1 (GLP-1) receptor agonist: Exenatide, Liraglutide
8. Sodium glucose cotransporter 2 (SGLT2) inhibitors: Empagliflozin, Canaglifolozin, Dapagliflozin

Question 5

Which of the hypoglycaemic agents stimulate insulin release in a glucose-dependent manner?

Answer 5

1. Meglitinides
2. GLP-1 receptor agonists
3. DPP-4 inihibitors