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Insulin and Hypoglycemic Drugs > Insulin > Flashcards

Insulin Flashcards

1
Q

Types of Insulin

A

Rapid acting-Insulin Lispro (Humalog)
Short acting-Regular Insulin
Intermediate acting- Lente or NPH
Long-acting - Ultralente, Insulin Glargine (Lantus), Detemir (T1DM and T2DM)

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2
Q

Rapid acting insulin

A

Insulin Lispro (Humalog)

  • Onset: 0-15 minutes
  • Peak: 30-90 minutes
  • Duration: <5 hours

Covers insulin need for meals eaten at time of injection.
Used with longer acting insulin

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3
Q

Short acting insulin

A

Regular insulin

  • Onset: 30-45 minutes
  • Peak: 2-4 hours
  • Duration: 5-7 hours

Covers insulin need for meals eaten within 30-60 minutes

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4
Q

Intermediate acting insulin

A

Lente or NPH

  • Onset: 1-4 hours
  • Peak: 6-14 hours
  • Duration: 18-24 hours

Covers insulin need for half of the day or overnight.
Often combined with rapid or short acting insulin

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5
Q

Long acting insulin

A

Ultralente

  • Onset: 4-6 hours
  • Peak: 18-26 hours
  • Duration: >30 hours (varies)

Covers insulin needs for one full day.
Often combined with rapid or short acting insulin

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6
Q

Long acting insulin

A

Insulin Glargine (Lantus)

  • Onset: 1-2 hours
  • Peak: None (Steady level)
  • Duration: 20-24 hours

Covers insulin needs for one full day.
Often combined with rapid or short acting insulin

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7
Q

Long acting insulin

A

Determir (T1DM and T2DM)

  • Peak: 6-8 hours
  • Duration: Up to 24 hours

Covers insulin needs for one full day.
Often combined with rapid or short acting insulin

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8
Q

Complications of Diabetes

A

Acute
-Hypoglycemia (complication from treatment), ketoacidosis, diabetic coma

Long-term
-CV disease, blindness, difficultly healing

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9
Q

Chronic complications

A

retinopathy-most common cause of blindness in woking age people

nephropathy-16% of new pts needing renal repl. therapy

erectile dysfunction-up to 50% men w/long standing diabetes

foot problems-15% develop ulcers and 5-15% of those pts require amputations

neuropathy-20% diabetic pts and 50-75% non traumatic amputations

Coronary and CV disease-2-4x more likely to have stroke and coronary heart disease

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10
Q

T1DM characteristics

A
  • High to very high plasma glucose
  • low to absent insulin levels
  • age of onset is 1-20 y/o
  • Islet antibodies present
  • Obesity not common
  • Ketosis and diabetic coma
  • 10% Prevalence
  • require insulin therapy (oral drugs ineffective)
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11
Q

T2DM characteristics

A
  • High plasma glucose
  • high to normal insulin levels
  • age of onset is 12 y/o or older
  • No Islet antibodies
  • Obesity (60-90%)
  • Ketosis variable
  • 90% prevalence
  • can require insulin therapy, but oral hypoglycemics are effective
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12
Q

Classes of oral hypoglycemic agents

A

Secretagogues: Sulfonylureas, Meglitinides

Sensitizers: Biguanides, Thiazolidinedione

alpha glucosidase inhibitors: Acarbose, Voglibose, Miglitol

Incretins and DPP-4 inhibitors

Peptide analogs: Glucagon-like peptide (GLP) agonists, Dipeptidyl peptidase-4 inhibitors, Amylin analogues

SGLT2 blockers

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13
Q

Oral hypoglycemic agents
Secretagogue: Sulfonylureas

Tolbutamide/Glyburide

A

-increase insulin release
-decrease glucagon
-increase sensitivity to insulin
-increase weight gain
-no effect on lipid panel
ofton used in combo with metformin
Side effect: Hypoglycemia

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14
Q

Oral hypoglycemic agents
Secretagogue: Meglitinides

Repaglinide/Nateglinide

A
  • close K channels in islet cells which increases release of insulin
  • take before meal, but not without a meal!
  • half life 1hr so multiple uses (i.e. after meals)
  • use alone or in comination with Metformin
  • metabolized in liver (caution with impaired liver)
  • increase weight gain
  • no effect on lipid panel
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15
Q

Oral hypoglycemic agents
Sensitizers: Biguanides

Metformin

A

-decrease glucose production by liver
-decrease glucose absorption in gut
-increase insulin sensitivity in muscle & adipose
-does NOT cause insulin release
-no hypoglycemia when used alone
-DO NOT give to renal, liver, or heart failure pts
-GI distubances: diarrhea
-decrease in weight
-Increase HDL
decrease LDL/TG

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16
Q

Oral hypoglycemic agents
Sensitizers: Thiazolidinedione

Rosiglitazone (Avendia) / Pioglitazone (Actos)

A

-Agonists for nuclear peroxisome proliferator-activated receptor gamma (PPARgamma)
-decrease insulin resistance in peripheral tissues
-upregulation of genes that regulate carbohydrate and lipid metabolism (GLUT4 transporters)
-increase glucose transport in muscle and adipose
-increase weight
-increase HDL
Rosiglitazone increase in LDL

17
Q

Oral hypoglycemic agents
Sensitizers: Thiazolidinedione

Rosiglitazone (Avendia) / Pioglitazone (Actos)
Use

A

Use: monotherapy or combo with insulin or sulfonylureas

  • takes 6-12 wks for full effect
  • watch liver function
  • Rosiglitazone (Avendia) black box in US due to increased risk of heart failure; banned in Europe
18
Q

Oral hypoglycemic agents
Alpha-glucosidase inhibitors

Acarbose, Voglibose, Miglitol

A
  • inhibit alpha-glucosidase in gut (Give with a meal)
  • decreases absorption of starch, dextrin, disaccharides

Side effect: gas & bloating
can be used alone or in combination
-no effect on weight
-no effect on lipid panel

19
Q

Oral hypoglycemic agents

Incretins and DPP-4 inhibitors

A

Incretin

  • incretin is a glucagon like peptide-1 (GLP-1)
  • stimulates insulin release
  • inhibits glucagon release

DPP-4 inhibitors

  • block DPP-4 enzyme to inactivate GLP-1
  • results in decreased blood glucose
20
Q

Peptide analogs: glucagon-like peptide agonists

Exenatide (Byetta, Bydureon)
Liraglutide (Victoza)

A

given by injection

  • GLP-1 agonsts: increased 1/2 life
  • augment glucose-dependent insulin secretion
  • decrease glucagon release
  • use with diet and exercise

Exenatide injection: Byetta twice daily
Bydureon once per week
Liraglutide injection once daily

Interaction: reduce absorption of drugs that are taken orally

Side Effects: n/v, headache, pancreatitis, hypoglycemia, thyroid C-cell tumors, and (MI?)

21
Q

Oral hypoglycemic agents
Peptide analogs: Dipeptidyl peptidase-4 inhibitors

Sitaglipten (Januvia)
Saxaglipten (Onglyza)
Linagliptin (Tradjenta)

A
  • inhibit DPP-4 and increase blood concentration of the incretin GLP-1
  • can be used alone or in combination w/ Metformin (combo is Janumet)
  • administered PO
  • hypoglycemia when combined with glimepiride (Amaryl) or a sulfonylurea
  • DDP-4 targets tumors, so watch for tumors with these drugs

Side effects: nausea, pancreatitis?, cancer? due to tumor suppression, respiratory infection, sore throat, muscle pain

22
Q

Peptide analogs: Amylin analogues

Pramlintide (Symlin)

A

given by injection

  • a synthetic amylin (Islet amyloid polypeptide secreted by beta cells and is deficient in diabetics)
  • slows gastic emptying and increases glucose absorption, promotes satiety, suppresses glucagon
  • used for type 1 and type 2
  • sub q administration before meals
  • contraindicated in pts with delayed gastric emptying
  • side effects: hypoglycemia 3 hrs after injection, nausea
23
Q

Oral hypoglycemic agents
SGLT2 blockers

Dapagliflozin

A
  • not yet approved

SGLT2 (sodium-glucose transport proteins responsible for 90% glucose reabsorption in kidney)

MOA: blocks reabsorption of glucose and promotes elimination of glucose in urine
(associated with a small weight loss)

Use: Will likely be approved for type 1 and type 2 diabetes

May be used as a combination if approved

Side Effects: breast and bladder cancers? liver damage?

24
Q

How is insulin secreted?

A
  • increase bg
  • glucose enters beta cells via glut 2
  • glycolysis via kreb’s cycle And respiratory cycle
  • beta cell formation ATP
  • close k channels
  • increased membrane potential(inside cell) b/c if hyper polarization
  • depolarization
  • open ca 2 channels
  • release ca2 from ER
  • release insulin
25
Q

Production of insulin

A

80% B cells in islet of langerhans

Pro insulin a+b+c peptides

Storage in vesicles

Protease cleavage:
Remove c peptide
Mature insulin

26
Q

Insulin: MOA

A

Binds receptor

Activation if signaling cascade (translocation glut-4 to cell mb)

Influx glucose

Glycogen synthesis

Glycolysis

Fatty acid synthesis

Insulin and Hypoglycemic Drugs (1 decks)

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