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34 Cards in this Set
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Sulfonylureas
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Primarily stimulate insulin release from Islet cells.
_due to these actions: drug blocks ATP-sensitive K+ channels in cell membrane, depolarization occurs results in big Ca++ release. This Ca++ influx leads to insulin release. Main note: pancreas stimulated to release more insulin. Use with Type 2 DM only Don't use in pregnancy, except: Glimpiride(Amaryl--taken 1x/day) SE: Hypoglycemia main issue. (Fatigue, excessive hunger, profuse sweating, palpations) Drug interactions: alcohol, NSAIDS, beta blockers. On $4 list |
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Glipizide(Glucotrol , Glucotrol XL)
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Second generation Sulfonylurea.
SE: Hypoglycemia. Can cause wt. gain as glucose is now stored instead of peed out. Use for Type 2 DM only. Reg: 10-24 hrs in body XL: 24 hrs... |
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Meglitinides
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Stimulate Pancreas to release insulin via ATP-sens. K+ channels being blocked, depolarization, Ca++ influx, Insulin released.
Rapidly absorbed. (30-60 mins.) Metabolized by P450 enzymes (CYP1, CYP2, or CYP3) in Liver. Excreted in urine. (think kidneys) Take with meal B4 eating/or within 30 mins of eating. half life 1 hour. SE: Hypoglycemia (Fatigue, excessive hunger, profuse sweating, palpations.) |
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Repaglinide(Prandin)
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Meglitinides
SE: hypoglycemia Must be taken 4x/day. Do not mix with Genfibrozil(Lopid) (for triglyceride reduction)-can limit DM drug's metabolism thus causing hypoglycemia. |
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Biguanides
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Primarily decrease hepatic production of glucose.
Also increases muscle uptake and utilization of glucose. for Type 2 DM given in evening to counter the cortisol/epinephrine glucose flushes that occur in morning (sleep responses) Doesn't make more insulin, just helps keep glycogen in storage. increases muscle sensitivity to glucose. DOES NOT cause hypoglycemia! On $4 list. SE: GI: gas, diarrhea - takes 4-6 weeks to regulate. Almost exclusively excreted by Kidneys (wear & tear). CAN cause Lactic Acidosis (depressant)--- Stop taking when admitted to hospital or when having contrast/plant based procedures, if pt. is septic, prior to surgery or where ishemic hypoxia a risk. May induce mild wt. loss second to nausea. May reduce absorption of Vit. B12 & Folic acid. Evening dose for morning BS, Morning dose for evening BS... correct fasting blood sugar first (give more drug if you wake up with high bs) Avoid: alcohol, Cimetidine(Tagamet), iodinated radiocontrast media. SE: decreased appetite, Na |
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Metformin(Glucophage)
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Biguanides
Most prescribed drug for Type 2 DM Decreased appetite, nausea, diarrhea, Lactic acidosis (rarely)- avoid alcohol use |
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Lactic Acidosis
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Decrease level of consciousness
hyperventilaton malaise can be fatal |
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Alpha glucosidase inhibitors (AGI's)
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For Type 2 DM
Decrease post meal BG by delaying CHO metabolism in small intestine, so carbs will just go out in feces instead of being absorbed and stored. only 2% of med is absorbed, minimal systemic effects. all extra drug and carbs go out through stool Converted to inactive substances by GI bacteria and enzymes. Taken with first bite of food 3x/day. Expensive. For those with okay Premeal sugars, but HIGH postprandial sugars. SE: GI Upset, gas, cramps diarrhea- increase dose slowly. (Take beano as well?) lowers Iron uptake-risk for anemia. hypoglycemia possible. DO not take SUCROSE/Table sugar in hypoglycemia as it won't be broken down...take special glucose replacer. Avoid Gemfibrozil as it will cause hypoglycemia. |
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Acarbose(Precose)--Think A-Carb: No Carbs!
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Alpha glucosidase inhibitor
Taken with food 3x/day Type 2 DM |
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Thiazolidinediones(glitazones)
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Primarily decreases peripheral insulin resistance (working inside cell) by activating PPAR-gamma receptor in cell nucleus which activates insulin responsive genes and allows for easier insulin uptake into cells.
Decreases hepatic glucose output. Take 1x/day Expensive ($300/mo.) 4-6 weeks to kick in. SE: increased risk of angina, MI, HF symptoms with wt. gain of 2-3 kgs. Hepatotoxicity risk. Check LFT's Q 3-6 mos. if >3x normal, stop taking drug. Drug interactions: gemfibrozil: bad interaction. |
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Rosiglitazone(Avandia)
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Thiazolidinediones (Glitazones)
$300/mo. For type 2 diabetes. Don't use if risk for heart disease. |
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DPP4 Inhibitors
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Work in a glucose dependent manner to block DPP4 to enhance incretins (GLP-1 & GIP) which lead to increased insulin release and decreased glucagon release.
taken 1x/day -stimulate glucose-dependent release of insulin -surpress post prandial release of glucagon. both of these helps keep blood glucose levels from climbing too high. Inhibits enzymes that inactivates incretin hormones. |
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Sitagliptin(Januvia)
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DPP4 inhibitor
May cause pancreatitis, URI, angiodema (Swelling of lips and tongue), and Stevens-Johnsons syndrom (blisters on lips and gum, reddish color) Possible cardiac problems. avoid use with alcohol. |
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Combination agents
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Type 2 meds combined, i.e.
Januvamet: Metformin & Januvia Glucovance: glyburide & metformin Metaglip: metformin and glipizide. Avandamet: rosiglitizone/metformin get affects of both meds, but no control over timing/dosing--no adjusting. |
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Insulin
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Used by Type 1 & Type 2 DM
Now synthetically made with e. coli. classified according to onset of action, peak action and duration of action |
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Onset of action
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How quick it will start working.
(ask: how close to a meal does a person have to take insulin?) This is important because a person should have some food in their system before taking insulin so they won't dip into hypoglycemia....insulin would start working and break down available glucose without any replacement...food needs time to digest as well. |
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Peak of action
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When there is the most insulin in the body
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Duration of action
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how long it lasts in the body
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Lispro(humalog)
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Rapid acting
clear insulin requires Rx Onset: 10-15 mins. pt. needs to eat right away so there will be no risk of hypoglycemia. Eating within 5-10 mins of the injection would be best-food still needs time to start digesting too. Peak: 1-2 hours. most closely matches what body would do if one didn't have DM. (insulin reg. peaks in 1-2 hrs.) Duration: 3-5 hrs. so you can dose again. Can be mixed with NPH as long as brands are the same. When mixing, give injection 15 mins. before meal. Frequently used as BOLUS (mealtime dose) part of a combination (basal/bolus) regimen with longer acting insulin. (Lantus or levemir) Used for sliding scale insulin regimens. |
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Regular Insulin: Novolin R or Humulin R
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Short-acting insulin
clear insulin, no rx req'd. ONLY type that is given IV. Onset: 30-60 mins. Take further away from meal. Peak: 1-5 hours Duration: 6-10 hours (usually less) Used to manage post-meal glucose increases. Used for sliding scale regimens where dose of insulin is determined by the CBG. May be mixed with NPH (cloudy). CBG is usually done ac and hs. generic at Walmart cheaper than Humalog. |
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sliding scale formula
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X # of units of regular for every Y mg over Z CBG.
X units * Ymg/Z CBG i.e. give 2 units regular for ever 20 mg over 160 for CBB = 232. 232-160= 72 |
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NHP insulin: Humulin N/Novolin N
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Cloudy
Intermediate acting Onset: 1-2 hours (not helpful for meals) Peak: 6-14 hrs. need to give afternoon snack! Duration: 16-24 hrs. so given 1-2x/day Roll vials to mix for minimum of 30 secs. Can be mixed with clears: clear to cloudy. no Rx needed. cheapest at Wal-mart for generic brand. |
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Insulin Glargine/Lantus
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Long acting
basal-no real peak-just steady plateau Clear. DON'T MIX Onset: 70 mins. Peak: peak less, less hypoglycemia-mimics body's basal flow Duration: up to 24 hrs. given SQ daily usually at bedtime. People who take over 80 units (BIG person) split this into two doses. Many take in morning...they forget at night. |
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Humulin 70/30
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Cloudy insulin
Mix NPH 70% with Regular 30% Get the affects of both. Onset: 30 mins. Peak 2-12 hours duration: up to 24 hours Usually given at breakfast and supper because they only want to take two injections. Biphasic peaks for both types of insulin: one will be short and the other longer lasting. |
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Storage
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store insulin in fridge unopened.
once opened leave out, use within 28 days. Cold insulin painful when injected keep between 42-86 degrees or could be altered. |
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Amylin Mimnetic
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for those not well regulated on insulin alone.
synthetic amylin analog- this is a peptide hormone excreted by pancreas along with insulin. can be used with both Type 1 & 2 DM given ac meal of 30 mg CHO to help control post meal BG elevations by delaying GI emptying. Decreases production of glucose by liver by decreasing glucagon acts in brain to promote satiety. Wt. loss typical. Person must be taking insulin to take this. SE: hypoglycemia and nausea Peak: 20 mins. Half-life 49 mins. Bad drug for person with liver troubles. |
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Pramlintide (Symlin)
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Amylin Mimetic
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Glucagon-like Peptide 1 Analogues
(GLP-1) |
Mimic action of incretin peptide hormone that is normally released in GI after meal as glucose rises.
Binds with GLP-1 receptors after meal. Delays GI emptying Decreases glucose production by liver Promotes satiety Only taken by Type 2 DM on OHAs Peak: 2.1 hrs Half life: 2.4 hrs. taken 1 hr. before meals/ usually breakfast/dinner. |
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Exenatide(Byetta)
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GLP-1 analogue
from gila monster saliva originally! |
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SQ sites
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and 2" from navel: most rapidly absorbed here
back of upper arm Top of thigh- don't give here before walking/activity. Rotate sites. |
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Insulin measures
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units not MLs
don't round. |
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pre diabetes blood sugar levels
and A1C level |
Fasting bs: 100mg/dl-125mg/dl
2hrs after eating: 140-199 mg/dl A1C 5.7%-6.4% |
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Normal blood sugar and A1C levels
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Fasting: >100mg/dl
2hrs. after eating: >140mg/dl A1C 5.6% and below |
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Indicative Diabetes blood sugar levels
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Fasting BS: 126 mg/dl or higher
2hrs. after eating: 200+mg/dl A1C; 6.5%+ |
