Antidiabetic Agents: INSULIN

• Subcutaneous

• Regular Insulin (IV)

All insulins are administered how, except for what

• Rapid acting

• Short acting

• Intermediate acting and Long acting

3 types of insulin

• Insulin Lispro

• Insulin Aspart

• Insulin Glulisine

Enumerate the Rapid acting insulins:

B chain of insulin (just insulin)

• amino acid 28 - Proline

• amino acid 29 - Lysine

B chain of Insulin Lispro

• amino acid 28 - Lysine

• amino acid 29 - Proline

Why is Insulin Lispro named like that

B chain of insulin (Just insulin)

• amino acid 28 is Proline

B chain of Insulin Aspart

• amino acid 28 is Aspartatic acid

Why is Insulin aspart named like that

B chain of insulin (just insulin)

• Amino acid 3 - Asparagine

• Amino acid 29 - Lysine

B chain of insulin glulisine

• Amino acid 3 - Lysine

• Amino acid 29 - Glutamic acid

Why is Insulin glulisine named like that

Hypoglycemia

• Symplathetic effect

  • Tachycardia

  • Palpitation

  • Sweatiness

  • Tremulousness

• Parasympathetic

  • Hunger

  • Nuasea

Complications of Insulin Therapy

• Fasting hypoglycemia of <50mg/dl

• Symptoms of hypoglycemia

• Immediate relief of symptoms with IV glucose

Whipple’s triad is characterized as?

• Convulsions

• Coma

If whipple’s triad continues, it can lead to?

• Candy

• Softdrinks

Treatment for Whipple’s triad

• Hypoglycemia

• Immunopathology of insulin therapy

• Lipodystrophy at injection site

Complications of insulin therapy

Abdomen

Fastest route of administration for insulin

thigh

Slowest route of administration for insulin

Sulfonylureas

One of the affordable OHA’s

Tolbutamide

Safest sulfonylurea for elderly diabetics

Chlorpropamide

Which OHA’s is contraindicated in patients with hepatic or renal insufficiency due to its long half life

Glipizide

Shortest half life among the 2nd generation sulfonylureas?

Glimiperide

Lowest required dose (most potent) among all second generation sulfonylureas

• Hypoglycemia

• Stevens-johnson syndrome

What to watch out for sulfonylureas

Meglitinides

If patient is allergic to sulfonylureas, what is the alternative?

Repaglinide

Indicated for use in controlling postprandial glucose excursions

• Hypoglycemia

• Weight gain

What to watch out for in meglitinides

Metformin

1st line therapy ofr type 2 diabetes (historically)

• Prediabetes

• PCOS

Biguanides (Metformin) are indicated for patients with

• GI therefore metformin is taken after meals

Common toxicities of Metformin therefor what is the remedy

• Lactic acidosis

• GI disturbances

• Vitamin B12 deficiency (need calcium supplements)

• Renal problem

What to watch out for biguanides

<30 eGFR

We don’t give metformin to patients with what eGFR

• Patients with edema

• Pregnant

• Patients w/ liver disease

• Obese

Thiazolidinediones are contraindicated to whom:

• MI

• HF

• LF

• Bladder cancer

What to watch out for thiazolidinediones

Troglitazone

This drug was withdrawn from the market due to its effect in the liver. what TZDs

Miglitol

6x more potent than acarbose

• Exenatide

• Lixinatide

short acting GLP 1 agonist

• Tirzepatide

• Semaglutide (ozemipic, wegovey

• Liraglutide

• Retatrutide

Long acting GLP 1 agonist

• Metformin

• Metformin + Sulfonylureas

GLP 1 agonist are used as adjunctive therapy for type 2 DM with