Chapter 60: Drugs for Diabetes Mellitus

Vocabulary flashcards covering key definitions, drug classes, specific medications, and acute complications from Chapter 60: Drugs for Diabetes Mellitus.

Diabetes Mellitus

A disorder of carbohydrate metabolism characterized by insulin deficiency or resistance to insulin action, leading to sustained hyperglycemia, polyuria, polydipsia, ketonuria, and weight loss.

Type 1 Diabetes

A group of endocrine disorders caused primary by insulin deficiency, requiring an integrated treatment plan of diet, physical exercise, self-monitoring of blood glucose, and insulin replacement.

Type 2 Diabetes

A disorder characterized by insulin resistance, managed through glycemic control via modified diet, physical activity, and oral or injectable drug therapy.

Hemoglobin A1c

A diagnostic test measuring average blood glucose levels over the prior $2\text{ to }3\text{ months}$, with a standard goal of below $7\%$ for most patients.

Target Pre-Meal Blood Glucose

The standard common target blood glucose value before meals, defined as $70\text{ to }130\text{ mg/dL}$.

Target Post-Meal Blood Glucose

The standard target blood glucose value $1\text{ to }2\text{ hours}$ after meals, defined as less than $180\text{ mg/dL}$.

Human Insulin Analogs

Modified forms of human insulin created via recombinant DNA technology that have the same pharmacologic actions as human insulin but different time courses.

Insulin Lispro [Humalog]

A short-duration, rapid-acting insulin analog with an onset of $15\text{ to }30\text{ minutes}$ after subcutaneous injection and a duration of $3\text{ to }6\text{ hours}$.

Insulin Aspart [NovoLog]

A short-duration, rapid-acting insulin analog with a rapid onset ($10\text{ to }20\text{ minutes}$) and short duration ($3\text{ to }5\text{ hours}$), administered immediately before or after eating.

Insulin Glulisine [Apidra]

A short-duration, rapid-acting insulin with a rapid onset ($10\text{ to }15\text{ minutes}$) and short duration ($3\text{ to }5\text{ hours}$), administered close to the time of eating.

Regular Insulin [Humulin R, Novolin R]

An unmodified short-duration, slower-acting human insulin whose effects begin in $30\text{ to }60\text{ minutes}$, peak in $1\text{ to }5\text{ hours}$, and last up to $10\text{ hours}$.

NPH Insulin [Humulin N, Novolin N]

An intermediate-duration insulin formulated as a cloudy suspension; it is the only insulin suitable for mixing with short-acting insulins and must be administered by subcutaneous injection only.

Insulin Glargine [Lantus]

A long-duration, modified human insulin provided as a clear solution with a prolonged duration of action up to $24\text{ hours}$, administered subcutaneously once daily.

Insulin Detemir [Levemir]

A long-duration human insulin analog with a slow onset and dose-dependent duration used to provide basal glycemic control; it must not be given intravenously or mixed with other insulins.

U-100 and U-500 Concentrations

Standard insulin formulations containing $100\text{ units/mL}$ ($\text{U-100}$) or $500\text{ units/mL}$ ($\text{U-500}$) of insulin.

Hypoglycemia

A major complication of insulin treatment characterized by a blood glucose level below $70\text{ mg/dL}$, requiring mandatory rapid treatment with fast-acting oral sugars, IV glucose, or parenteral glucagon.

Metformin [Glucophage]

An oral biguanide hypoglycemic drug that decreases glucose production and reduces insulin resistance; used for type 2 diabetes, prevention of type 2 diabetes, gestational diabetes, and polycystic ovary syndrome (PCOS).

Sulfonylureas

Oral hypoglycemic agents that promote insulin release from the pancreas, indicated only for type 2 diabetes, with major side effects including hypoglycemia and weight gain.

Repaglinide [Prandin]

An oral meglitinide hypoglycemic agent that stimulates insulin release, with adverse effects including hypoglycemia and drug interactions with Gemfibrozil [Lopid].

Thiazolidinediones (Glitazones)

Oral hypoglycemics, including Rosiglitazone [Avandia] and Pioglitazone [Actos], that reduce glucose levels primarily by decreasing insulin resistance in type 2 diabetes.

Alpha-Glucosidase Inhibitors

Oral hypoglycemic agents such as Acarbose [Precose] that act in the intestine to delay carbohydrate absorption, commonly causing flatulence, cramps, abdominal distention, borborygmus, and diarrhea.

DPP-4 Inhibitors (Gliptins)

Oral hypoglycemics (including Sitagliptin [Januvia], Saxagliptin [Onglyza], Linagliptin [Tradjenta], and Alogliptin [Nesina]) that promote glycemic control by enhancing incretin hormone actions to stimulate glucose-dependent insulin release and suppress glucagon.

SGLT-2 Inhibitors

Oral hypoglycemic agents that block the reabsorption of filtered glucose in the kidney to produce glucosuria; common side effects include genital fungal infections in females, urinary tract infections, and increased urination.

GLP-1 Receptor Agonists

Non-insulin injectable incretin mimetics (e.g., Exenatide [Byetta], Liraglutide [Victoza]) that slow gastric emptying, stimulate glucose-dependent insulin release, inhibit postprandial glucagon release, and suppress appetite.

Pramlintide [Symlin]

A non-insulin injectable amylin mimetic that reduces postprandial blood glucose levels by delaying gastric emptying and suppressing glucagon secretion.

Diabetic Ketoacidosis (DKA)

An acute, life-threatening hyperglycemic crisis characterized by high blood glucose levels, fluid and electrolyte loss, and prominent ketoacidosis.

Hyperosmolar Hyperglycemic State (HHS)

An acute, life-threatening hyperglycemic crisis characterized by fluid and electrolyte loss and severe hyperglycemia that is higher than in DKA, but without ketoacidosis.

Glucagon

A agent used to treat severe hypoglycemia when IV glucose is unavailable, which acts by promoting glycogen breakdown in the liver.