Drugs for Diabetes Mellitus

Eliminate symptoms and metabolic stabilization

Short term diabetes goals:

1. maintin normal physical and psychological functionin

2. prevent complications

3. normoglycemia (difficult

4. HbA1C within recommended limits

Long term treatment goals of diabetes [4]

People were on a starvation diet and would die within a year/year and a half

Diabetes treatment before insulin was discovered

Have many different types of insulin

Reason for additives to insulin:

Lipid solubility. The higher it is, the faster a drug gets absorbed.

Long acting insulin additives affects what?

It acts at insulin receptor and does something Insu

What does it mean to say insulin is an agonist?

1. increases glucose uptake, oxidation, storage

2. increases glycogen synthesis and storage in the liver

3. decreases glycogenolysis

4. decreases gluconeogenesisInsu

Insulin MOA on carbohydrates

increases amino acid uptake and protein synthesis in muscle

decrease amino acid release in muscle

Insulin MOA on proteins [2]

1. increases triglyceride synthesis

2. decreases free fatty acids and glycerol

3. decreases oxidation of FFA to ketoacids (liver)

Insulin MOA on lipids (adipose tissue)

Hyperglycemia. To keep SMBG less than 6mmol/L and keep HbA1C less than 7%

indications for inulin

hypoglycemia

contraindications for insulin

Self monitored blood glucose

SMBG meaning

15 grams of carbs to corret, after a few minutes check againInsu

How to correct diabetic hypoglycemia

hypoglycemia

insulin adverse effects related to MOA

1. lipodystrophies (buildup of scar tissue)

2. allergic reaction

3. immune response to foreign material

4. hypersensitivity

Insulin adverse efects NOT related to MOA [4]

acts like normal steroids in body, increases blood glucose

Steroid effect on blood glucose (prednisone)

increases gluconeogenesis, increases blood glucose

How do sympathomimetics (dopamine, dobutamine, epinephrine) affect blood glucose

they get rid of gluid, might have more glucose related to fluid and increases blood glucose

diuretic affect on blood glucose

extra hormones will increase glucose.

Birth control effect on blood sugar

can mask the S+S of hypoglycemia, can appear drunk

Alcohol affects on blood glucose

These cardiac meds will slow HR. Might not be able to tell you have low blood sugar, AND decreases glycogenolysis (decreases blood sugar)

how do beta-andrenergic blocking agents affect bloog glucose?

some of them will increase the use of insulin in the body and decrease blood glucose

affect of oral hypoglycemics on blood glucose

1. lispro (humalog)

2. Insulin aspart (Novolog, FIasp)

3. Insulin Glulisine (Apidra)

Fast acting insulins [3]

Neutral protamine Hagedorn (NPH)

1. humulin N

2. Novolin N

Intermediate acting insulins [2]

1. humulin R

2. Novolon GE toronto

Regular acting insulins

Fiasp

Insulin that has vitamin B3 added. It is more concentrated, and a little bit faster than Novolog and Novorapid

give when the tray is in front of the patient. Quickest onset

important nursing implication of Fiasp

Insulin glulisine (Apidra)

Synthetic human analogue insulin. Rapid acting

10-15 minutes

Onset of rapid acting insulins

0.5-2.5 h

Peak of rapid acting insulins

3-6 hurs

Duration of rapid acting insulins

peak: 1-1.5 h

Duration : 3-5 h

Insulin glulisine (Apidra) peak and duration

30-60 mins

Onset of regular insulins

Regular insulin

Short acting insulins that are not Rapid

1-5 h

Peak of regular insulin

6-10 hours

duration of regular insulin

The dose. The higher the dose, the longer the effect. (12024 hours)

Duration of insulin Detemir (Levemir) is dependant on what?

60-120 minutes

Onset of insulin detemir

12-24 hours

Peak of insulin detemir

1. HUmulin N

2. Novolin N

NPH insulin [2]

ixed with regular. Is a cloudy suspension that needs to be mixed

NPH can be mixed with what?

peak: 6-14 hours

Duration: 16-24+ h

NPH insulin peak and duration

1. insulin Detemir (Levemir)

2. NPH insulin

Intermediate duration insuilns [2]

1. Lantus

2. Tajeo

Insulin glargine [2]

Tajeo

Insulin glargine that is more concentrated (300units/ml) and has less risk of hypoglycemia

do not mix with anything

Lantus is clear, meaning

Insulin

Tresiba

Insulin degludec prototype

1 hours

tresiba insulin onset

1. humulin 30-70

2. Novolin ge 30/70, 40/60, 50/50

„Premixed regular insulin – NPH (cloudy) [2]

Premixed insulin analogues (cloudy) [2]

first: regular acting

second: NPHWh

with premixed insulins, the first number is always what and the second number is always what?

During growth spurts (impacts of hormones,s tress, etc.)

When do teenagers need more insulin?

Basal metabolic insulin (endogenous)

Long acting insulin mimics:

2-5 days of glucose values

Insulin doses are adjusted based on:

Minimal requirement for adequate control (cannot mimic endogenous insulin-basal and stimulated secretion)Wh

BID insulin therapy

1. daily for long acting

2. with each meal and snack

When are injections gievn in mulitple daily insulin injections

1. cognitive

2. cost

3. manual dexterity

4. memory

Factors involved in using an insulin pump [4]

1. patch pump (bluetooth)

2. pump with tubing

Types of insulin pumps

30 days

how long can insulin stay out of the fridge?

1. insuli requirements may change

2. NPO or vomiting: still needs basal

when peope with diabetes are ill:

go higher

impact of infection on blood glucose

1. Tolbutamide (Orinase®)- 1st generation

2. SuGlyburide (DiaBeta®, Micronase®)- 2nd generation

Sulfonylureas [2]

Binds to ATPase-sensitive K⁺ channels in pancreatic cell membranes

Enhance insulin secretion in response to high blood glucose levels (when you eat, etc.)

Increase sensitivity of insulin receptors.

Does not make more, secretes what is already made

Sulfonylureas MOA

1. lac of endogenous insulin

2. pregnancy

3. stressful conditions

4. allergy to selpha

Sulfonylureas contraindications

Crosses the placenta.

Why shouldnt pregnant people take sulfonylureas?

they will be put on sliding scale insulin and checked regularly

Before surgery, what happens to patients on sulfonylureas?

1. water retention (ADH effects increased, can get edema)

2. severe hypoglycemia

side effects of sulfonylureas: [2]

drives up blood sugar because they can mask the symptoms of hypo

Sulfonylureas and beta blockers interaction:

Disuphiram-like reaction. Can make you really sick

Sulfonylureas and alcohol interaction

1. NSAIDs

2. Supla dugs

3. Ranitine

4. Cimetidine

What drugs enhance the effects of sulfonylureas and decreases blood sugars? [4]

1. S+S of hypoglycemia

2. what to do if ill

Patient teaching for sulfonylureas

Metformin (Glucophage)

Oral hypoglycemic biguanide prototype

Glumetza

Long-acting metformin

binds in the liver, decreases the production of glucose in the liver

Enhances glucose uptake and use in muscles

Metformin MOA

lactic acidosis just by itself, no other diabetes meds

Rare side effect of metformin

contrast dye is excreted through the kidneys, as is metformin. THis combo can cause severe crystals in the kidneys. can get acute kidney failure.

Contrast dye and metformin interaction

If patient’s blod sugar is a little bit high, and not high enough to be diagnosed. Can give them metformin to prevent type 2 diabets.

how is metformin used to preent diabetes?

Sulfonylureas

metformin is sometimes given with:

1. Rosiglitazone (Avandia)

2. pioglitazone (Actos)

Thiazolidinediones: [2]

decreases insulin resistance and increases the ability of target cells to respond to insulin.

Thiazolidinediones MOA

1. improve beta cell function (prevents complications)

2. Decreases lipids, BP, and prevent artherosclerosis

Thiazolidinediones may… [2]

Decreased reabsorption of glucose in the kidney, more is lost in urine.

Need good kidney function (no kidney disease at ALL)

SGLT-2 inhibitor MOA

Can starts on a low dose to lower sugars if having trouble controlling sugars

How can SGLT-2 inhibitors be used in type 1?

Inkovana (canaglifloxin)

Empaglilozin (Jardiance)

SGT-2 inhibitors [2]

Sitagliptin (Januvia)

Dipeptidyl peptidase-4 (DPP-4) inhibitor prototype

inhibits DPP-4, enzyme that inactivates incretin hormone

enhancing the actions of incretin hormones — which lead to release of insulin

DPP-4 inhibitor MOA

Metformin

DPP-4 inhibitors can be used as a secondline therapy with

Glucagon-like Peptide 1 (GLP-1) agonists

injectable mediation that increases the release of insulin

1. victossa (liraglutide)

2. ozempic and Rybelsus

3. Byetta

GLP-1 agonists [3]

acivates GLP-1 receptor

increases IC cyclic AMP

increases RELEASE OF INSULIN in response to high blood glucose

GLP-1 agonist MOA