Treatment for Diabetes

Flashcard set is only half of lecture slides

What are the goals of therapy?

• reduce risk of micro and macro-vascular disease complications

• ameliorate symptoms

• reduce mortality

• improve quality of life

What are microvascular complications of diabetes vs macrovascular complications

Microvascular complications

• retinopathy, nephropathy, neuropathy

Macrovascular complications

• CV disease (MI, stroke)

Which target tissues have an increase in peripheral glucose uptake?

• adipose tissue

• skeletal tissue

Which target tissue has an increase in insulin secretion?

pancreas

Which target tissue has a decreased glucose reabsorption?

Kidney

Which target tissue has a decreased glucose introduction?

liver

which target tissue has a decreased glucose absorption?

Intestines

What are the rapid acting insulins?

(GAL)

• Glulisine (Apidra)

• Aspart (Novolog)

• Lispro (Humolog)

What are the short acting insulins? (8 hours)

• Humalin R

• Novolin R

R = regular

What are the intermediate acting insulins? (12 hours)

• Humalin NPH

• Novolin NPH

N = neutral

What are the long acting insulins?

• Glargine (Lantus, Basaglar, Tojueo)

• Detemir (Levemir)

L = long

Which insulin is ultra long acting up to 48 hours?

Tresiba (degludec)

____ provides the basal rate

____ covers glucose from a meal

• Long acting insulin

• rapid acting (GAL)

What are the pros and cons of using the basal/bolus regimen?

Pros

• Mimics what body does naturally

• provides ideal coverage

• easily adjusted

Con

• multiple shots

• $$$

What are the 2 modified insulin regimens?

• Intermediate acting and rapid acting (70/30)

• Sliding scale

Which insulin option regimen has:

Pros: less injections, cheaper

Cons: difficult to individualize, lunch is not covered

Intermediate acting and rapid acting (70/30)

Which insulin option regimen has:

Pros: individualized doses

Cons: requires significant pt education (best for T1D)

sliding scale

What is the sliding scale regimen for insulin?

The sliding scale regimen for insulin involves adjusting insulin doses based on blood glucose levels at specific times of day.

 Have to be able to count carbs and administer insulin

When would you expect to see a intermediate acting regimen?

inability to afford traditional basal/bolus

What is Afrezza?

Rapid acting inhaled insulin

• fixed dose cartridges and multiple are needed to provide sufficient insulin coverage

Which insulin has a BBW for acute bronchospasm in chronic lung disease pts (asthma, COPD) and hypoglycemia?

Afrezza`

What are the ADE of Insulin?

• hypoglycemia MC)

• weight gain

• injection site rnx

• lipodystrophy (at site of injection)

What are the sx of hypoglycemia?

• shaky

• fast HR

• sweaty

• dizzy

• anxious

• hungry

• blurred vision

• weak or tired

• HA

• nervous or upset

Check your BG, eat to increase sugar, check again

oral glucose normally results in a higher release of insulin than when an IV glucose load is delivered is known as the _____

incretin effect

Incretin effect occurs in response to a glucose load the _____ releases

a. liver

b. adipose tissue

c. gut

d. skeletal muscle

c. gut

_____ is responsible for 60-70% of post-prandial insulin secretion

incretin response

T/F: the incretin response is significantly lower in type 2 diabetics

true

What are examples of drugs that produce the incretin effect?

GLP-1

GIP

which drug has the MOA of:

• improving glucose dependent insulin secretion

• slow gastric emptying

• enhance satiety (reducing food intake)

• decrease postprandial glucose secretion

• promote beta cell proliferation = increase in insulin secretion from pancreas

GLP-1 analogs

How are GLP-1 Analogs administered?

SubQ

What are the GLP-1 Analog drugs and which are used FDA approved for diabetes?

• Exenatide (Byetta)

• Exendatide (Bydureon)

• Liraglutide (Victoza, Saxenda)

• Dulaglutide (Trulicity)

• Semaglutide (Ozempic, Ryblesus, Wegovy

FDA approved for diabetes: Victoza, Trulicity, Ozempic, Wegovy

Which GLP-1 Analog is FDA approved for weight loss?

Saxenda

Wha are the ADE of GLP-1 Analogs?

N/V/D

Risk of pancreatitis - discontinue immediately or when abd pain is experienced

which diabetic drug has a BBW for thyroid C-cell tumors

• not confirmed in rats

GLP-1 Analogs

Why should GLP-1 analogs be avoided in patients with diabetic gastroparesis?

They can delay gastric emptying, worsening symptoms.

Can lead to impaction

If a patient is placed on Insulin glargine + lixisenatide (Soliqua) or Insulin degludec + liraglutide (Xultophy),

What combination of diabetic drugs is this?

what would be their future regimen?

Why isn’t this regimen recommended for all patients?

1. GLP-1 and long acting insulin

2. discontinue therapy with basal and GLP-1 prior to initiation; dose once daily

3. regimen may increase risk of hypoglycemia or weight gain; not suitable for all patients.

Tirzepatide (Mounjaro and Zepbound) are examples of which combination of drugs?

GLP-1 and GIP receptor agonists (glucose dependent polypeptide)

Which drug group has an MOA of:

• increase insulin sensitivity 

• increase insulin secretion

• decrease glucagon secretion

• slows gastric emptying

GLP-1 + GIP (Tirzepatide)

What is the mechanism of Tirzepatide?

When food is consumed, it will enter the small intestine and trigger GLP-1 and GIP release leading to effects on the brain, pancreas, and fat tissue 

How does Tirzepatide impact fat tissue?

• increase in lipolysis (GLP-1)

• fatty acid synthesis

Why shouldn’t GLP-1s be used on T1D?

These patients are already underweight and don’t need to effects of the drug

What is Amylin?

• hormone co-secreted with insulin

  • delays gastric emptying

  • decreases post-prandial glucogon secretion

  • improves satiety

What is the synthetic amylin analog?

Pramlintide (Symlin)

When is Pramlintide (symlin) used?

Adjunct to mealtime insulin in patients with T1D and T2D

Administer subQ immediately before meals

Meal-time insulin should be reduced by 50% if Pramlintide is added

Which drug has the BBW when combined with meal-time insulin and/or when used in T1D leading to hypoglycemia?

Pramlintide

What are ADE of Pramlintide?

• hypoglycemia

• N/V

• Anorexia - not wanting to eat

• injection site rxn

• avoided in pts with diabetic gastroparesis

Which of the following is a basal insulin?

a. Pramlintide

b. Aspart

c. Lispro

d. Glargine

d. Glargine

Which classes can cause weight gain?

a. GLP-1/GIP

b. long-acting insulin

c. amilyn analog

d. short-acting insulin

e. NPH

b. long-acting insulin

d. short-acting insulin

e. NPH (intermediate acting - Humalin and Novolin N)