Drugs for Diabetes
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| Type I Diabetes | develops during childhood, causes destruction of pancreatic beta cells
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| Type II Diabetes | insulin resistance and impaired insulin secretion
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| Diabetic Ketoacidosis | severe insulin deficiency, causes hyperglycemia, ketoacids, acidosis, and coma
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| Bicarbonate | treats acidosis in DK
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| Diagnosis of DM | HgbA1C >6.5%, fasting glucose >= 126, casual glucose >= 200, OGTT 2hr glucose >=200
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| Primary goal of DM tx | prevent long-term complications, control glucose, control BP and lipids levels
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| Step 1 in tx of Type II DM | initiate lifestyle changes with metformin
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| Step 2 in tx of Type II DM | initiate lifestyle changes with metformin and add a 2nd drug
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| Step 3 in tx of Type II DM | 3 drug combination
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| Step 4 in tx of Type II DM | more complex insulin regimen
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| Rapid Acting Insulin | short duration: Lispro, Aspart, Glulisine
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| Slower Acting Insulin | short duration: regular
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| Intermediate duration Insulins | NPH, Detemir
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| Long duration Insulins | Glargine
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| Mixing Insulin | Only NPH with short-acting & short-acting should be drawn first
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| Non-DM uses of insulin | hyperkalemia (promote updake of K+) and dx of GH deficiency
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| Complications of Insulin Tx | hypoglycemia, lipohypertrophy, allergic rxn, hypokalemia, drug interactions
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| Drugs that interact with Insulin | sulfonylureas, glinides, ETOH, thiazide diuretics, glucocorticoids, sympathomimetics, and beta blockers
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| Biguanides Prototype | Metformin
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| Metformin | decrease insulin resistance by inhibiting glucose production in the liver, reducing glucose absorption in gut, and increasing glucose uptake
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| Side effects of Metformin | GI disturbances, lactic acidosis, has NO WEIGHT GAIN
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| Drug interactions for Metformin | ETOH-can intensify lactic acidosis
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| 1st Generation Sulfonylureas | tolbutamide, Tolazamide, Chlorpropamide
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| 2nd Generation Sulfonylureas | glyburide, glipizide, glimepride
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| Sulfonylurea MOA | promote insulin release from pancreas
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| Sulfonylureas Side Effect | hypoglycemia, WEIGHT GAIN, cardiotoxicity....avoid in pregnancy and lactation
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| Drugs that interact with Sulfonylureas | ETOH, beta-blockers, hypoglycemic-inducing drugs
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| Meglitinide Drugs | Repaglinide (Prandin), Nateglinide (Starlix)
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| Meglitinide MOA | stimulate beta cells to release insulin
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| Meglitinide side effects | well tolerated, can cause hypoglycemia
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| Drugs that interact with Meglitinides | Gemfibrozil (Lopid)-inhibits metabolism of repaglinide and cause hypoglycemia
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| Thiazolidinediones Drugs | Rosiglitazone (Avandia), Pioglitazone (Actos)
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| Thiazolidinediones MOA | reduce glucose by decreasing insulin resistance. Increases the number of glucose transporters by stimulating transcription of PPARs.
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| Side Effects of Thiazolidinediones | low risk of hypoglycemia when used alone, WEIGHT GAIN, liver toxicity, heart failure
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| Alpha-Glucosidase Inhibitors | Acarbose (Precose) and Miglitol (Glyset)
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| MOA of Alpha-Glucosidase Inhibitors | inhibits alpha-glucosidase, an enzyme that breaks down starch to glucose so it can be absorbed, delays absorption of carbohydrates
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| Side effects of Alpha-Glucosidase Inhibitors | flatulence, cramps, abd distention, borborygmus, diarrhea, and liver dysfunction
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| DPP-4 Inhibitors (Gliptin) Drugs | Sitaglipitin, saxagliptin, vildagliptin, linagliptin, alogliptin
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| DPP-4 Inhibitors MOA | promote glycemic control by enhancing the actions of incretin hormones
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| Side effects of DPP-4 Inhibitors | well tolerated, NO WEIGHT GAIN, NO HYPOGLYCEMIA
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| SGLT-2 Inhibitor Drugs | Canagliflozin, dapagliflozin, empagliflozin
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| SGLT-2 Inhibitor MOA | block reabsorption of filtered glucose int he kidney, leading to glucosuria
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| SGLT-2 Inhibitor Side effects | genital fungal infections in females, urinary tract infections, increased urination
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| Pramlintide (Symlin) | Amylin mimetic....synthetick analog of amylin, peptide hormone co-released with insulin (NON-INSULIN INJECTABLE)
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| Pramlintide MOA | reduces post-prandial levels of glucose, delays gastric emptying and increases full sensation. Compliments the effects of insulin
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| Pramlintide Side effects | severe hypoglycemia and nausea
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| Incretin Mimetics (GLP-1 receptor agonists) | Exanatide, liraglutide, dulaglutide, albiglutide
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| Incretin Mimetics (GLP-1 receptor agonists) side effects | hypoglycemiia, GI effects, pancreatitis
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| HGB A1C | average of blood glucose levels over the past 2-3 months
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