Exam 3 - Diabetes Flashcards
What are the rapid acting insulins?
- insulin lispro (Humalog)
- insulin aspart (Novolog)
- Insulin glulisine (Apidra)
What is the onset and duration of rapid acting insulins (homolog, novolog)?
- very rapid onset (4-15min)
- peak (30-90min)
- short duration (3-5hr)
- Taken immediately before a meal
- onset of action similar to insulin release from pancreas
- monomeric insulin - aa subs have been made so the insulin molecules don’t dimerize and form aggregates
What is a short acting insulin?
-Humalin R
-Novolin R
“normal insulin”
What is the onset and duration of short acting insulin (humalin)?
- rapid onset (30-45 min)
- peak (2-3hr)
- short duration (4-6hr)
- only insulin prep used IV, can be IM
What is an intermediate acting insulin?
-NPH
Neutral protamine hagedon or insulin isophane
What is the onset and duration of NPH(int acting)?
- onset 2-5hrs
- duration 4-12hrs
What are 2 long acting insulins?
- insulin glargine (lantus)
- insulin detemir (levemir)
What is the onset and duration of long acting insulins (lantus and levemir)?
- insulin glargine (lantus)
- –onset 1-1.5 hr
- –duration 11-24hr
- –can be injected once or twice a day
- –soluble at acid pH
- –aggregates at phys pH after inj
- insulin detemir (levemir)
- –onset 1-2hr
- –duration >12hr
- –very reproducible kinetics
- –myristic a res promotes self aggregation at phys pH
- *These 2 cannot be used in the same syringe as other preparations since they will aggregate at physiological pH
What is an ultra long acting insulin?
insulin degludec (tresiba)
What is the onset and duration of tresiba (ultra long acting insulin)?
- onset 30-90min
- 25hr half life
- duration >24hr
When are insulin combos used? (NPH/reg insulin)
d/t lack of flexibility in dosing and meals
What are routes of admin of insulin?
- SC (MC) in abdomen, butt, ant thigh, dorsal arm
- IM - faster onset than SC
- IV - ER situations
- Reg insulin is only form IV
What are some side effects of insulin?
- hypoglycemia
- immunopathology > allergies, immune resistance
- lipodystrophy at inj site
What are 6 classes of oral anti diabetic agents?
- biguanindes
- sulfonylureas
- meglitinides
- D-phenylalanine derivative
- thiazolidinediones
- alpha-glucosidase inhibitors
Metformin
-biguanide
MOA: decrease hepatic glucose production > decreases fasting and postprandial hyperglycemia
*1st line for T2DM
SE: GI distress, high doses=lactic acidosis
Contra: pts with renal/hepatic/pulmonary dz, alcoholism, and uncompensated heart failure d/t risk of lactic acidosis
Sulfonylureas
Insulin secretagogue
MOA: inhibition of the ATP-sensitive K channels > increases release of insulin > decreases glucagon secretion
SE: hypoglycemia rarely, n/v, jaundice, anemias, hypersensitivity
What are the 1st generation sulfonylureas?
-tolbutamide > short half life (T 4-5hr)
-chlorpropamide > long duration (T 32hr)
SE: Contra in elderly d/t risk of hypoglycemia. Also jaundice and alcohol induced flush similar to disulfram
-tolazamide - int duration (T 7hr)
What are 2nd gen sulfonylureas?
- glyburide > SE: hypoglycemia, Contra in pts w/ hepatic/renal dz
- glipizide > short half life (2-4hr) Contra in pts with hepatic/renal dz
- glimepride - longer duration (T 5hr) mono therapy or combo with insulin
Meglitinides (Repaglinide)
Insulin secretagogue
MOA: inhibition of ATP sensitive K channels
- fast onset, peak 1hr, duration 4-7hr
- used for postprandial glucose control
- should be taken before meal
D-phenylalanine derivatives (Nateglinide)
Insulin secretagogue
MOA: inhibition of ATP-sensitive K channels > suppression of glucagon secretion and decreases hepatic production
- rapid onset and peak 1hr
- stimulates insulins secretion under glucose load, but not during normoglycemia
- lowest incidence of hypoglycemia of secretagogue drugs
Thiazolodinediones
(pioglitazone, rosiglitazone)
(insulin sensitizer)
MOA: increase sensitivity to insulin, agonist for the peroxisome proliferation activated receptor gamma (PPAR-y)
Effects of carb met: increase insulin stimulated uptake of glucose, hepatic uptake, reduce hepatic gluconeogenesis
Effects of lipid met: reduce plasma FA by increasing clearance and reducing lypolosis, increases differentiation of adipocytes, shifts fat deposits from visceral stores to SC deposits, weight gain
SE: wt gain, edema, increased risk of HF, demineralization of bone and increased risk of bone fractures in women
pioglitazone (
-thiazolidinedione
-reduces plasma triglycerides and raises HDL
increase risk for bladder cancer
rosiglitazone
-thiazolidinedione
“Black box warning”
-CV risks
-removed from shelves
