PANCREATIC HORMONES

Sulfonylureas, Miglitinides

Insulin Secretagogues

Insulin Sentisizers

Biguanie, Thiazolidinediones

Glucagon, mobilizes glycogen stores

Produced hormone and fx of alpha

Insulin, Amylin, Storage and anabolic effects

Beta 75%

Beta 75%

Most common islet of langherhans cell

Somatostain, universal inhibitor of secretory cells

Delta (3-5%)

Ghrelin, (+) appetite

Epsilon (<1%)

Insulin

Catabolic is inhibited by what

Raised function in blood

Glucagon function

GLUT 1 → glycolysis → krebs → ETC → ATP

In the pancreatic beta cell, glucose enters through

Glucose

Most potent insulin stimulator

Glucagon

Increases blood sugar, gluconeogenesis, glycogenolysis

Heart force

Inotropic

Chronotropic

Heart rate

Type 1 DM

Complete absence of insulin

Type 1 DM

Destruction of pancreatic beta cell → severe or absolute insulin deficiency

Common in younger patients

200mg/dL

RBS

>126 mg/dL

FBS

6.5%

HBA1C

>200mg/dL

OGTT

Polyphagia, polydipsia, polyuria ( 4th is unintentional weight loss)

Common signs and symptoms of diabetes

gestational pregnancy

placenta and placental hormones creates insulin resistance

(Lispro, Aspart, Glusine)

Rapid Acting

5-15mins

Rapid Acting Onset of action

Short Acting

(Regular)

30-60 mins

Immediate Acting (NPH)

2-4Hrs OOA

Long acting

Gladgins, detemer, degludec

Rapid acting

Usually given sa ICI due to early peak of activity

True

T/F Rapid acting is given before meals

Rapid acting

Prepared for continuous SQ infusion devices

Short acting

Administered 1hr before meals

Short acting

Used in IV emergencies (DKA), SQ for ordinary maintenance therapy

Neutral Protamine Hagedorn

Intermediate acting

Intermediate acting (NPH)

Combination of regular insulin + protamine (hastens the absorption of insulin) +Zinc

Protamine

Hastens the absorption of insulin

Intermediate acting

It is rapidly combined with short and rapid acting

Peak less insulin

Long acting are

Glargine, deteme, degludec

Long acting insulins are

Chlorpropamide, Tolbutamide, Tolazamide

1st Gen sulfonyureas

Glimepiride, glipizide, glibenclamide, glaclazide (GLI and zide)

2nd gen sulfonyureas

2nd Gen

■ MOA: (+) Insulin release by (-) ATP dependent K+ channels in the pancreatic Beta cells (blocks ATP sensitive K+ channel)

■ USES: Type 2 DM

Hypoglycemia

Commin toxicity in 1st and 2nd gen

chocolate/ candy

rub coke

Rescue agent for hypoglycemia is _____ (if unconscious: ____ in the buccal area of the patient)

Disulfiram like effect

1st gen toxicity is like

Glibenclamide

Colestatic jaundice is a toxicity of what drug

Meglitinides (-nide)

MOA: (+) Insulin release by (-) ATP dependent K+ channels in the pancreatic Beta cells

■ USES: Type 2 DM

■ TOX:

● Hypoglycemia

● Headache

● Upper respiratory tract infection

Biguanide (Metformin)

MOA: (+) AMP-stimulated protein kinase →

inhibition of renal and hepatic gluconeogenesis; slows down glucose absorption in the GIT, reduces risk of DM in high-risk patients

T2DM, DM prevention, Polycystic Ovarian Syndrome, DOC for obese DM

Metformin is used for?

Ptx with hepatic and renal failure

Metformin

Thiazolidinediones (-tazone) Pioglitazone, Rosiglitazone, Troglitazone

○ MOA: (+) PPAR (Peroxisome proliferator-Activated receptor) γ → increase insulin sensitivity by regulating the transcription of genes encoding for protein involved in carbohydrate and lipid metabolism

Thiazolidinediones (tazones)

Used for T2DM, DM PREVENTION

○ TOX:

■ Weight gain

■ Fluid retention → CHF

■ ↑ risk for fractures

■ ↑ risk of MI and cardiovascular events

(Rosiglitazone)

■ Hepatotoxicity (Troglitazone)

■ ↑ risk of bladder CA (Pioglitazone)

Toxicity of thiazolidinediones

Rosiglitazone

↑ risk of MI and cardiovascular events

Troglitazone

Hepatotoxicity

Pioglitazone

↑ risk of bladder CA

GLP1 analogs (-Tide)

MOA: (+) GLP1 receptors → mimics incretin which (+) insulin release, (-) glucagon release, produce a feeling of satiety

○ USES: T2DM

○ TOX:

■ Hypoglycemia

■ Acute pancreatitis (inflamed pancreas)

■ Weight loss → however once stopped, will

result in rebound weight gain

DPP4 Inhibitors (-gliptin) Sitagliptin, Linagliptin, Vildagliptin

MOA: Prevents GLP1 degradation

○ USES: T2DM

○ TOX:

■ Headache

■ Nasopharyngitis

■ URTI

Alpha-Glucosidase (Acarbose, Voglibose, Miglitol)

● MOA: (-) Intestinal α glucosidase → ↓ conversion of

starch and disaccharides to monosaccharides

● USES: T2DM

● TOX:

○ GI disturbances (Flatulence, Abdominal Pain, Diarrhea)

Amylin (Pramlintide)

● MOA: (+) Amylin receptors → ↓ glucagon release,

slows gastric emptying time, reduces appetite

● USES: T2DM

● TOX:

○ Hypoglycemia

○ Nausea

SGLT2 Inhibitors (-flozin) Dapaglifozin, Empaglifozin, Canaglifozin

● MOA: (-) Sodium-Glucose co-Trasnporter 2 (SGLT2) → (-) renal glucose reabsorption

● USES: T2DM

● TOX:

○ Glucosuria (UTI, vulvovaginitis, vaginal candidiasis)