Insulin and Oral Antidiabetic Agents Flashcards
What are the two things that happen with insulin deficiency?
- Anabolic/catabolic balance is disturbed and catabolic reactions prevail
- Metabolic changes similar to those that occur during fasting/starvation
Type 1 DM
- Common cause
- Insulin Level
- Treatment
- Autoimmune destruction of B cells in the pancreas
- Very low or undetectable, insulin secretion cannot be stimulated
- Has to be treated with insulin (alone or in combination with pramlintide)
Type 2 DM
- Cause
- Insulin Level
- Treatment
- Decreased responsiveness of peripheral tissues to insulin
- Subnormal levels, blunted insulin response upon stimulation
- Does not have to be treated with insulin
**90% of cases, often overweight
Gestational DM
- Cause
- Treatment
- Long term outcomes
- Steroid (progestin and estrogen) induced insulin resistance
- Insulin is the only FD approved treatment
- Reversible after delivery, but potentially higher likelihood for DM2 later on in life
Drug induced DM-like state
- Drugs that cause this
- Treatment
- Glucocorticoids and growth hormone
2. Termination of treatment
Why use BS levels for DM goal treatment?
Used as a convenient indicator of all the metabolic abnormalities that occur in DM
Regular Insulin
- Human or analog?
- Modifier present
- Duration
- Human
- None
- 4-6hr
NPH Insulin
- Human or analog?
- Modifier present
- Duration
- Human
- Protamine (makes more of it a dimer so slower absorption)
- 12-16hr
Rapid acting insulins
- Names
- Modifiers
- Duration
- Lispro, aspart, glulisine
- None
- 3-4hrs
Name the three intermediate/long acting insulin analogs and their durations
- Glargine –> 18-20hrs
- Detemir –> 16-18hrs
- Degludec –> 20-24hrs
Inhalable Insulin
- Name
- Type of insulin
- Duration
- Afrezza
- Regular Human Insulin
- Same as lispro/aspart/glulisine, faster than SQ regular human insulin
Intensive Insulin Therapy
- Which patients receive this?
- What does it entail?
- All type 1 and some type 2
- Rapid/short acting before meals AND intermediate or long acting once or twice a day
OR
Continuous SQ insulin infusion pump –> rapid or regular insulin
Conventional Insulin Therapy
- Which patients receive this?
- What does it entail?
- Type 2 diabetics
- Constant doses
- intermediate or long acting once a day
- several injections at constant doses
- disposable patch pumps
- What are the side effects of insulin therapy?
2. How does exercise affect insulin need?
- Hypoglycemia and lipodystrophy
2. Increasing exercise decreases insulin need
Name the three sulfonylureas and their duration of action
- Glipizide –> 12-24 hrs
- Glyburide –> 12-24 hrs
- Glimepiride –> 12-24 hrs
Name the two meglitinides and their duration of action
- Repaglinide –> 5-8 hrs
2. Nateglinide –> 2-4 hrs
Sulfonylureas and meglitinides
- Mechanism of action
- Side effects
- Bind to the K+ channels and act similarly to ATP causing depolarization–> Ca++ comes in and induces insulin release
- Hypoglycemia and MANY drug interactions
Metformin
- Mechanism of action
- Side effects
- Biguanide: Reduces gluconeogenesis –> decreases hepatic glucose output, enhances insulin action, impaired glucagon action
- GI discomfort, **Lactic acidosis, Vit B12 deficiency
**COMMON FIRST LINE DRUG FOR DM2
Pioglitzaone
- Mechanism of action
- Side effects
- Thiazolidinedione: Agonist of PPARy –> intracellular steroid-like receptor that increases insulin sensitivity in target tissue (by regulating gene transcription
- **Increased risk of CV disease, **Weight gain
Rosiglitazone
- Mechanism of action
- Side effects
- Thiazolidinedione: Agonist of PPARy –> intracellular steroid-like receptor that increases insulin sensitivity in target tissue (by regulating gene transcription
- **Increased risk of CV disease, **Weight gain, fluid retention and edema
Exenatide
- Mechanism of action
- Side effects
- Incretin Agonist: Agonists at incretin (GLP-1) receptors on pancreatic B cells and increase glucose-induced insulin release
- Nausea, HA, Diarrhea
**SubQ
Liraglutide
- Mechanism of action
- Side effects
- Incretin Agonist: Agonists at incretin (GLP-1) receptors on pancreatic B cells and increase glucose-induced insulin release
- Nausea, HA, Diarrhea
**SubQ
Sitagliptin
- Mechanism of action
- Side effects
- Incretin Degradation Inhibitor: Inhibit DPP-1 enzyme that degrades endogenous incretins, increasing endogenous incretins and glucose-induced insulin release
- Cold symptoms, photophobia, joint pain, ??pancreatitis
**Oral
Saxagliptin
- Mechanism of action
- Side effects
- Incretin Degradation Inhibitor: Inhibit DPP-1 enzyme that degrades endogenous incretins, increasing endogenous incretins and glucose-induced insulin release
- Cold symptoms, photophobia, joint pain, ??pancreatitis
**Oral
Pramlintide
- Mechanism of action
- Side effects
- Synthetic amylin analog: hormone that acts on a cells to inhibit glucagon secretion and has appetite suppressant effect
- Hypoglycemia, N/V
**SubQ
Canagliflozin
- Mechanism of action
- Side effects
- Na+/glucose co-transporter (SGLT2) inhibitor: inhibit glucose reabsorption in the kidney thus promoting glucose excretion in the urine
- UTI**, increased amputation
**Oral
Empagliflozin
- Mechanism of action
- Side effects
- Na+/glucose co-transporter (SGLT2) inhibitor: inhibit glucose reabsorption in the kidney thus promoting glucose excretion in the urine
- UTI**, increased amputation
**Oral
What drugs promote hypoglycemia?
Ethanol, B-adrenergic antagonists
Salicylates and sulfonylureas
What drugs promote hyperglycemia?
Glucocorticoids and epinephrine
Clonidine, Ca++ channel blockers, and thiazide diuretics
