Diabetic drugs

Question 1

Insulins and non-insulins

Answer 1

Insulins: recombinant human insulins

non-insulin drugs: oral, injectables

Question 2

Rapid-acting insulin

Answer 2

Onset 10-15 min
Peak 60-90 min
Duration 3-5 hr

Insulin lispro

Taken with each meal

Question 3

Short (fast) acting insulins

Answer 3

Onset 30-60 min
Peak 2-3 hr
Duration 6-7 hr

Regular insulin

Question 4

Intermediate acting insulins

Answer 4

Onset 1-3 hr
Peak 5-8 hr
Duration 10-18 hr

NPH: Neutral Protamine Hagedorn

Cloudy appearance

Question 5

Long acting insulins

Answer 5

Onset 90 min
NO pronounced PEAK
Duration 24 hr

Insulin glargine

Clear, colorless

Question 6

Interactions with insulins

Answer 6

Increase hypoglycemic effect so will lower blood glucose levels

●B-Blockers (eg propranolol)
-Reduce glycogenolysis (glycogen to glucose). exacerbates insulin-induced hypoglycemia

Glucocorticoids
-Reduce effect of insulin: so will increase blood glucose levels

Question 7

Insulin secretagogues

Answer 7

Increase insulin production in type II diabetes

•Sulphonylureas: Glyburide

Question 8

Other diabetes drugs

Answer 8

Metformin

TZD: Rosiglitazone

Gliptin: Sitaglipin

Incretin mimetic: Excenatide

Question 9

Metformin

Answer 9

•Biguanide
•Decrease hepatic production of glucose
•Does NOT increase insulin production from the pancreas
•Does NOT cause hypoglycemia
•Taken 2-3x/day with meals to reduce GI disturbance

Question 10

Sulphonylureas: Glyburide

Answer 10

Stimulate insulin secretion from pancreatic beta cells = increasing insulin levels

** Improves sensitivity** to insulin in muscles, liver and fat

Taken with breakfast (1/day)

ADVERSE:
Hypoglycemia

Question 11

Thiazolidinediones (TZDs)

Answer 11

Decreases insulin resistance (“insulin sensitizing agents”)

Drug: rosiglitazone
Box warning: angina, MI, heart failure risk

Question 12

Incretins

Answer 12

Intestinal contents release incretins:
•GLP-1
•GIP

Incretins broken down by the enzyme DPP- 4 (reduces incretin metabolism)

Incretin mimetic: Exenatide
Subcutaneous
GLP-1 receptor agonist

DPP-4 Inhibitor: Sitagliptin
Oral

Question 13

Na-glucose transport inhibitors

Answer 13

Newest type of DM type 2 drug

Inhibit SGLT2 (glucose transporter)

DRUG: Canaglifozin

Question 14

Other drugs

Answer 14

Pramlintide
Injectable
Acts as amylin

Alpha-glucosidase inhibitors
Causes delayed glucose absorption.
Must be taken with meals to prevent excessive postprandial blood glucose elevations

Glucocorticoids
Cortisol-like drugs cause increase in blood glucose

Question 15

If hypoglycemia occur

Answer 15

Have the alert client eat 120 – 200 mL clear fruit juice, glucose tablets or gel

After the liquid snack have the client eat their meal soon or, give a small snack such as crackers or half sandwich (carbohydrates and protein)