2514 Week 1: Glucose

types of insulin sensitizers

1. biguanide

2. TZDs

example of biguanide

metformin

example of TZDs

rosiGLITAZONE

types of incretin agents

1. GLP 1 receptor agonist

2. DPP 4 inhibitors

Example of GLP 1 receptor agonist

Liraglutide

Example of DPP 4 inhibitors

Gliptin

types of insulin secretagogues

1. sulfonylureas

2. meglitinides

Example of sulfonylurea

Gliclazide

Example of meglitinide

Repaglinide

types of miscellaneous meds (glucose wasters)

1. SGLT 2 inhibitors

2. alpha glucosidase inhibitors

example of SGLT 2 inhibitor

canagliflozin

example of alpha glucosidase inhibitor

acarbose

biguanide moa

lowers liver BG and increase insulin sensitivity

TZD moa

increase insulin sensitivity

GLP 1 receptor agonist moa

mimic GLP 1:

1. suppress hunger

2. slow gastric emptying

3. stim glucose-dependent insulin release

DPP 4 inhibitors

enhance incretin effects

sulfonylureas moa

stim insulin pancreatic release

meglitinides moa

quickly stim pancreatic insulin release

SGLT 2 inhibitors (piSSSSSS GLu Too)

inhibit enzyme responsible for glu reabsorption in kidneys so u pee glu out

alpha glucosidase inhibitor

delay dietary carb breakdown

rapid acting insulin example

1. lispro

2. aspart

rapid acting insulin onset

15-30 min

rapid acting insulin peak

.5 to 2.5 hr

when do we give lispro (rapid acting insulin)?

sc inj ~15 min before/after meal

when do we give aspart (rapid acting insulin)?

sc inj 5-10 min BEFORE meal

short acting insulin examples

regular insulin - humulin and novalin Rs

short acting insulin onset

30-60 min

short acting insulin peak

1-5 hrs

when do we give short acting insulin?

sc inj 30 min premeal for postprandial control

the only insulin you can inject via IV is _______ ______

regular insulin - short acting

intermediate acting insulin example

NPH - humulin and novalin N

intermediate acting insulin onset

1-2 hrs

intermediate acting insulin PEAK

6-14 hrs

when do we give intermediate acting insulin?

sc inj twice a day, same time

intermediate insulin duration

16-24 hrs

what’s special about NPH insulin?

• cloudy

• can mix w rapid/short

long acting insulin example

• lantus

• levemir

glargine (lantus) onset

1 hr

detemir (levemir) onset

1-2 hrs

do long acting insulins peak?

NO

when do you give glargine (lantus)?

sc inj once daily, same time

similarities between glargine (lantus) and detemir (levemir)

1. duration: 18-24 hrs

2. clear

3. sc inj once a daily, same time

ultra long acting insulin example

degludec - tresiba

ultra long acting insulin onset

30 to 90 min

does ultra long acting insulin peak?

no

when do we give ultra long acting insulin?

once daily same time

ultra long acting insulin duration

>24 hrs

combo insulin is 70% ____ and 30% ____

NPH, regular

combo insulin onset

30-60 min

combo insulin peak

2-12 hrs

combo insulin duration

10-16 hrs

hypoglycemia unawareness is due to:

1. autonomic neuropathy

2. beta blockers

3. chronic hypoglycemia