Drugs to Treat Diabetes Flashcards
What is the standard treatment for type 1 diabetics?
insulin replacement therapy
What are the goals of therapy for treating type 1 diabetics?
maintain normal blood glucose levels (pre-meal: 90-130 mg/dL, post-meal: <180 mg/dL) and prevent tissue damage associated with hyperglycemia
What is the mechanism of action of insulin?
-activate insulin receptors
-regulate gene expression
-promote glucose transport
-promote synthesis of glycogen, lipid, and protein
Describe the structure of REGULAR insulin preparations
chain A & B linked with disulfide bonds, form hexamers conjugated with zinc
What is the onset of action of regular action insulin?
0.5-1h
When is the peak concentration after injection for regular injection?
2-3h
What is the duration of action of regular insulin?
3-8h
What preparations are fast-acting?
-aspart
-glulisine
-lispro
Describe the structure of FAST-ACTING insulin
chain A & B linked with disulfide bonds, forms monomers (makes it fast-acting)
What is the onset of action of fast-acting insulin?
less than 15 minutes
When is the peak concentration after injection for fast-acting insulin?
0.5-3h
What is the duration of action of fast-acting insulin?
2-4h
What preparations are intermediate acting?
NPH
Describe the preparation of NPH
NPH= neutral protamine Hagedorn, insulin complex with zinc and protamine intended to gradually release insulin
What is the dosing of intermediate insulin?
usually given 1-2 times a day in combination with short acting insulin
What is the onset of action of intermediate insulin?
2-5h
When is the peak concentration after injection of intermediate insulin?
4h
What is the duration of action of intermediate insulin?
4-12h
What preparations are long-acting?
-detemir
-glargine
-degludec
What is the duration of action of long-acting insulin?
20-25h
When is the peak concentration after injection for long-acting?
no peak
What insulin is used in insulin pumps?
short-acting
What are the adverse effects of insulin?
-hypoglycemia
-hypertrophy of subcutaneous fatty tissue if repeated injections at the same site
-insulin hypersensitivity (rare)
-hypokalemia (encourages K+ to go into the cell)
What are the drug interactions of insulin?
potassium-lowering medications due to the risk of hypokalemia, PPAR-gamma agonists (thiazolidinediones) may cause fluid retention and heart failure
What is the treatment for hypoglycemia?
-ingestion of sugary food or drinks
-glucagon for severe symptoms (SC, IM, IV injection)