diabetes medications

amylin analogs 

slows gastric emptying (helps with rise of blood glucose, suppresses glucagon secretion) 

increases sense of satiety, possibly reducing food intake and promoting weight loss 

pramlintide acetate prototype 

released at same time as insulin to help regulate glucose 

pramlintide acetate (amylin analogs)

used w insulin w type 1 or 2

adjunct

sub q, admin at same time as insulin but separate injections at least 2 inches apart, do not mix

admin immediately before meals

bbw- severe hypoglycemia

type 2- oral meds taken 1 hr before or 2 hrs after

sulfonylureas

lowers blood sugar increasing secretion of insulin from the pancreas and increases the sensitivity to insulin at receptor sites 

glyburide prototype 

glyburide use (sulfonylureas)

lower bs in type 2 diabetes 

give lowest dose that achieves normal fasting and postprandial blood sugar levels 

glyburide contraindications

sulfa allergy 

glyburide key points

older adults more sensitive

inform healthcare provider of any newly prescribed meds 

take before breakfast or in divided doses if pt experiences gastric distress 

risk for hypoglycemia

alpha clucosidadse inhibitors

target postprandial hyperglycemia

inhibit enzymes in GI tract

acarbose prototype

“carb”- starchy food, slowing down digestion of starchy foods such as carbs in the small intestines, then absorption of sugar in the blood is delayed which help sudden surges of glucose after a meal

acarbose (alpha clucosidadse inhibitors)

PO

may need to combine w insulin or another oral agent

does not alter insulin secretion or cause hypoglycemia *

can cause a decreased digoxin level- can have anemia, leukopenia, thrombocytopenia

admin w first bite of meal 3 times a day

start on low dose and gradually increase to decrease GI upset

biguanide

reduce production of glucose by the liver 

decreases intestinal absorption of glucose- increases insulin sensitivity 

increases the uptake of glucose- enhancing utilization to produce energy 

metformin prototype 

metformin (also called glucophage) (biguanide)

anti hyperglycemic drug- does not cause hypoglycemia ***

metformin side effects 

lactic acidosis 

very unpleasant GI upset- very common

metformin key points

take w meals bc of GI upset

bbw- pts 80 and older should not take bc of risk for lactic acidosis

do not give contrast w this drug bc of renal failure and lactic acidosis- avoid 48 hrs before and after

thiazolidinediones

reducing blood glucose by decreasing production of new glucose from non carbohydrate molecules 

referred to “insulin sensitizers” 

blood glucose lowered in 3-4 months of use 

rosiglitazone maleate (thiazolidinedione) use

can be used w metformin or sulfonyureas

rosiglitazone maleate key points 

major side effects- stroke, HF, liver injury

can be admin w or w/o meals 

meglitinides

stimulate release of insulin from the pancreatic islet cells

“mega amounts of insulin”

repaglinide prototype

repaglinide (meglitinide) key points 

can cause hypoglycemia

admin 30 mins before meals 

can cause angina

don’t give a DKA

dipeptidyl peptidase 4 inhibitors (DPP-4)

increasing/maintaining its ability to produce more insulin and decrease the amount of glucose being produced by the liver

sitagliptin prototype

sitagliptin (DDP-4 inhibitor)

can be given w metformin or thiazolidinediones

take once daily w or w/o food

caution in renal failure pts

pt cannot have insulin w sitagliptin- risk for hypoglycemia “sit down you can’t have insulin”

Incretin mimetics or GLP-1 mimetic 

act like incretin hormones like glucagon (help body produce more insulin and decrease the amount of glucose being produced by liver)

slows gastric emptying 

stimulates feeling of fullness when eating 

act as an anti hyperglycemic *

exenatide prototype 

exenatide (incretin mimetic) 

prescribe when oral meds/diet/exercise together have not been effective in reaching the target hemoglobin A1c level 

exenatide side effects

hypoglycemia

GI distress 

nausea 

acute pancreatitis 

exenatide key points

bbw- C-cell thyroid cancer has developed in animal studies (monitor pt thyroid nodules) 

admin SQ trice a day an hour before morning and evening meal (at least 6 hrs before previous admin) *

sodium glucose cotransporter 2 (SGLT2) inhibitors 

SGLT2- responsible for about 90% of reabsorption of glucose back into the bloodstream through kidney filtration

SGLT2 inhibitors- inhibiting the reabsorption of glucose, promoting excretion of excess glucose in the urine, provide renal protection

canagliflozin prototype

canagliflozin (SGLT2 inhibitor)

give in combo w other anti diabetic agents

canagliflozin side effects 

risk of dehydration- monitor electrolytes

bc of glucose excretion- risk of genital mycotic infections, vulvovaginal candidiasis, inflammation of glans penis

risk of acute kidney injury

canagliflozin key points 

should be well hydrated “can”agliflozin

take w first meal of the day

if taken w ace inhibitors, ARBs, and loop diuretics- syncope, hypotension, and hyperkalemia can be worse

monitor for s/s of UTI

urine has glucose- risk for infection

adjuvant meds to treat diabetes (know all of these)***

ACE inhibitors (enalapril maleate)- provides kidney protective effects in both type 1 and 2

angiotensin 2 receptor blockers (losartan)- reduces rate of progression to ESRD (does not prevent) 

HMG-CoA reducatase inhibitors (simvastatin)- reduce serum cholesterol to reduce risk of CAD 

which med slows gastric emptying and increases sense of fullness

pramlintide acetate

(gastric emptying)

Which med do we start on a low dose to prevent GI upset to increase compliance 

Acarbose

(low dose)

which med are older adults more sensitive to 

glyburide

(older adults)

which drug is used when oral meds/diet/exercise together have not been effective

exenatide

(effective)

what drug do we have cautions with contrast studies 

metformin 

(contrast)

which med is used in type 1 and type 2

pramlintide acetate

(used in both)

which of these meds are substitute for diet and exercise

none

which med, if taken w ace inhibitors, ARBs, and loop diuretics- syncope, hypotension, and hyperkalemia can be worse

canagliflozin

(ace inhibitors, angiotensin 2 receptor blockers, loop diuretics)

which med reduces serum cholesterol to reduce risk of CAD

HMG-CoA reducatase inhibitors

simvastatin

what drug has a bbw for pts over 80

metformin

(bbw over 80)

which drug has a risk of major side effects (stroke, HF)

rosiglitazone maleate 

(major side effects)

which drug has a risk for UTI and infection 

canagliflozin

(uti risk)

which drug reduces rate of progression to ESRD

angiotensin 2 receptor blockers  

losartan

which drug can cause anemia, leukopenia, and thrombocytopenia

acarbose

(anemia)

which drug do we need to monitor thyroid glands bc of bbw w C-cell cancer in animals

exenatide 

(c-cell cancer)

which med has a risk of genital mycotic infections, vulvovaginal candidiasis, inflammation of glans penis

canagliflozin

(infections)

which med provides kidney protective effects in both type 1 and 2

ACE inhibitors

enalapril maleate

which drug can cause angina and we don’t give with DKA

repaglinide

(no dka)

which med takes 3-4 months to work 

rosiglitazone maleate

(3-4 months)

what med do we admin w meals bc of severe GI upset 

metformin 

(GI upset)

which med targets postprandial hyperglycemia 

acarbose 

(postprandial)