diabetes

• Insulin Products (Parenteral)


  MOA= promotes uptake (by muscle/fat)/storage of glucose and other ingested nutrients,, reduces glucose output from liver (stim enzymes for glycogen synthesis//inhib enzymes in glycogenolysis and gluconeogenesis)... ENHANCES STORAGE/DEC PRODUCTION
• Insulin (parenteral) Adverse Effects

  hypoglycemia, weight loss, Lipodystrophy, injection rxn, Allergic rxn/Hypersens
• Rapid Acting Insulins


  • Lispro (Humalog)
  • Aspart (Novolog)
  • Glulisine (Apidra)
  • Inhaled insulin (Afrezza)
• Short Acting Insulins


  • Regular insulin (Humulin R, Novolin R, ReliOn R)
  • U-500 (Humulin RU-500)- hypoglycemia risk
• Intermediate Acting Insulins


  • NPH (Humulin N, Novolin N, ReliOn N)- hypoglycemia risk
• Long Acting Insulins


  • Glargine (Lantus- 100units/mL, Toujeo- 300units/mL)
  • Detemir (Levemir)
  • Degludec (Tresiba)
• Pre-Mixed Insulins


  • Insulin aspart and insulin aspart protamine (Novolog Mix 70/30)
  • Insulin lispro and insulin lispro protamine (Humalog Mix 75/25, Humalog Mix 50/50)
  • Insulin isophane (NPH) and insulin regular (Recombinant) (Novolin 70/30, Humulin 70/30, Humulin 50/50, ReliOn 70/30)
• Combination Injectables (Combined Insulin/Non-insulin products)

  • Insulin glargine plus lixisenatide (Soliqua)
  • Insulin degludec plus liraglutide (Xultophy)
• Sulfonylureas


  MOA= inc secretion of insulin from functioning pancreatic beta cells by binding to sulfonylurea receptor on the beta cell, leading to closure of ATP- dependent potassium channels, depolarization of the cell membrane, and opening of Ca2+ channels; inc intracellular Ca2+leads to increased insulin secretion
• Sulfonylureas


  • lowers A1C, REDUCES FBG and POSTPRANDIAL BG, potential "secondary failure"
  • Adverse Effects= hypoglycemia, weight gain, rash, photosensitivity, dyspepsia, HA
  • Contraindications= DKA, T1DM, hypoglycemic unawareness, hypersens, severe liver/kidney disease
• Sulfonylureas


  • Glimepiride (Amaryl)
  • Glipizide (Glucotrol, Glucotrol XL)
  • Glyburide (Diabeta, Micronase)
• Meglitinides


  MOA= faster onset/shorter duration compared to sulfonylureas
• Meglitinides


  • lower A1C, REDUCE postprandial BG
  • Adverse Effects= hypoglycemia, weight gain
  • Contraindications= DKA, T1DM, hypoglycemic unawareness
• Meglitinides


  • Repaglinide (Prandin)
  • Nateglinide (Starlix)
• Biguanides


  MOA= inhib hepatic glucose production, improve periph glucose uptake/utilization/dec periph insulin resistance, dec/slow intestinal abs of glucose
• Biguanides


  • Lower A1C, reduces FBG
  • Metformin (Glucophage, Glucophage XR, Fortamet)
  • Clinical= T2DM, micro/macrovasc outcomes good, weight loss/no change, positive lipid profile effect, doesn't cause hypoglycemia
  • Adverse Effects= GI probs, Vit B12 deficiency, BBW (Lactic acidosis)
  • Monitoring= efficacy (A1C, BG), renal function (b4 starting and ongoing), Vit B12
• Thiazolidinediones


  • MOA= primary- agonists at the peroxisome proliferator-activated receptor- (PPAR-) located in the adipose tissue, skeletal muscle, and liver, results inc glucose uptake in tissues//Lead to inc insulin-sensitivity and dec insulin resistance
  • secondary- dec hepatic glucose production
• Thiazolidinediones


  • Lower A1C, modestly reduces FBG
  • Adverse Effects= weight gain, edema, worsening HF, hepatotoxicity, hand/foot fracture in post-menopausal women
  • Contraindications= hypersens, BBW (class ⅔ HF) (R), caution in pt w hepatic disease, bladder cancer (P)
• Thiazolidinediones


  • Pioglitazone (Actos) → bladder cancer
  • Rosiglitazone (Avandia) → MI
• Alpha-glucosidase Inhibitors


  MOA= Reduce blood glucose concentrations by decreasing the rate of glucose abs, Delay the digestion of starch and disaccharides thru inhib of enzyme -glucosidase, located in brush border of intestinal tract that converts oligosaccharides/disaccharides to glucose and other monosaccharides
• Alpha-glucosidase Inhibitors


  • lowers A1C, reduce postprandial BG
  • Adverse Effects= fart, abd discomfort, diarrhea, elevation of hepatic enzymes
  • Contraindications= hypersensitivity, DKA, IBD, GI obs, malabs, cirrhosis
• Alpha-glucosidase Inhibitors


  • Acarbose (Precose)
  • Miglitol (GLyset)
• SGLT-2 Inhibitors


  MOA= inhib SGLT-2→dec in abs of filtered glucose/inc glucose excretion
• SGLT-2 Inhibitors


  • lower A1C, reduce both FBG/postprandial BG, does not cause hypoglycemia, help w weight loss, RENOPROTECTIVE
  • Adverse Effects= low bp, hyperkalemia, genital mycotic infections, UTI, inc urination, weight loss
  • Contraindications= hypersensitivity, pts w CrCL <45mL/min on dialysis
• SGLT-2 Inhibitors


  • Canagliflozin (Invokana)*^- dec CV risk in T2DM pts, risk of amputation
  • Dapagliflozin (Farxiga)*+^
  • Empagliflozin (Jardiance)*+^
  • Ertugliflozin (Steglatro)
  • Bexagliflozin (Brenzavvy; TheracosBio)
• DPP-4 Inhibitors


  MOA= inhibit the enzyme DPP-4 from breaking down endogenous GLP-1 and GIP, glucose-dependent inc insulin secretion by pancreas, glucose-dependent glucagon secretion, inc uptake of glucose from blood by tissues, suppress appetite
• DPP-4 Inhibitors


  • lower A1C, reduces postprandial BG
  • Adverse Effects= pancreatitis, skin reactions, adjust in renal insuff
  • Contraindications= hx of pancreatitis, DKA, T1DM
• DPP-4 Inhibitors


  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)
  • Linagliptin (Tradjenta)
  • Alogliptin (Nesina)
• GLP-1 Agonists


  MOA= Synthetic analogues of human GLP-1 → Glucose-dependent inc insulin secretion by the pancreas, Glucose-dependent dec glucagon secretion, dec gastric emptying, inc satiety
• GLP-1 Agonists


  • lower A1C, FBG/postprandial BG varies
  • Adverse Effects= GI, injection site nodule, pancreatitis, kidney dysfunction, BLACK BOX thyroid C-cell tumor
  • Contraindications= gastroparesis, pancreatitis hx, patients with multiple endocrine neoplasia syndrome type 2 or fam hx of medullary thyroid carcinoma
• GLP-1 Agonists


  • Exenatide (Byetta, Bydureon 1x wkly)
  • Liraglutide (Victoza, Saxenda)*=
  • Lixisenatide (Adlyxin)
  • Dulaglutide (Trulicity)*
  • Semaglutide (Ozempic (parenteral) Rybelsus (oral))*=
  • Tirzepatide (Mounjaro)=
• Amylin Analog


  MOA= Synthetic analog of human amylin (pancreatic hormone) → Glucose-dependent inhib of glucagon, secretion dec rate of gastric emptying, inc satiety
• Amylin Analog


  • lower A1C, lower postprandial BG
  • Clinical= tx of T1/T2DM as adjunct therapy for pts who use mealtime insulin therapy and have failed to achieve desired glucose control
  • Adverse Effects= N/V, hypoglycemia w insulin
  • Contraindications= gastroparesis, hypoglycemic unawareness, A1C>9%, pt who don't self-monitor BG
• Amylin Analog


  • Pramlintide (Symlin) SUBQ
• Brand/Generics Exam 1


  • Lispro (Humalog)
  • Aspart (Novolog)
  • Regular insulin (Humulin R, Novolin R, ReliOn R)
  • NPH (Humulin N, Novolin N, ReliOn N)
  • Glargine (Lantus, Toujeo)
  • Novolog Mix (Novolog 70/30)
  • Sitagliptin (Januvia)
  • Empagliflozin (Jardiance) *+^
  • Canagliflozin (Invokana)*
  • Liraglutide (Victoza, Saxenda)*=
  • Semaglutide (Ozempic, Rybelsus) *=
  • Dulaglutide (Trulicity)*
  • Dapagliflozin (Farxiga) *+^
• Types of insulin


  • Rapid acting: glulisine, aspart, lispro, inhaled insulin
  • Short acting: regular, U-500
  • Intermediate acting: NPH
  • Long acting: detemir, glargine, degludec
• Rapid/Short acting insulin


  • Mimics insulin secretion by pancreas in response to meal, provides bolus coverage (decreases postprandial glucose)
• Rapid acting insulin


  Take right before/after meal
• Short acting insulin


  Take 30 mins before meal
• Long/Intermediate acting insulin


  • Mimics continuous insulin secretion by pancreas, provides basal coverage (decreases fasting glucose)