Diabetes Drugs

Question 1

Sulfonylureas

Answer 1

Causes K+ channel closure&raquo_space; Ca2+ influx&raquo_space; Release of endogenous insulin

Pros:

Cons: Can’t use if have sulfa allergy
Weight gain
Hypoglycemia
Tolerance

Question 2

Biguanides (Metformin)

Answer 2

Acts on the liver to prevent gluconeogenesis. Basically “pretends” to be insulin at the liver

Pros: Inexpenstive. No hypoglycemia or weight gain

Cons: Risk of lactic acidosis in those with CHF, renal insufficiency, and liver insufficiency. Also, lots of GI issues (need to start low and slowly increase dose)

Question 3

Thiazolindinediones (TZDs)

Answer 3

Increases insulin sensitivity

Pros:

Cons: Worsening CHF
Expensive
Risk of bladder cancer
Weight gain

Question 4

GLP-1 Agonists

Answer 4

GLP-1 enhances glucose-stimulated insulin secretion. Will work ONLY if blood glucose is already elevated.

Pros: Glucose-dependent, weight loss

Cons: subQ injection, nausea, very expensive

Question 5

DPP-4 Inhibitors

Answer 5

DPP-4 normally breakdowns GLP-1 (which we really want!). This drug therefore prevents the breakdown of GLP-1

Pros: Multiple mechanisms. PO, Weight neutral

Cons: less effective than GLP-1 Agonist. Nasopharyngitis, Headache

Question 6

SGLUT2 Inhibitor

Answer 6

SGLUT 2 normally promotes glucose reuptake in the kidney. This drug prevents filtered glucose to be reabsorbed in the nephron, so you pee out the glucose

Pros: Weight loss, Lowers BP

Cons: UTIs, GU infections. Increased risk for electrolyte imbalance (hypokalemia)

Question 7

Rapid-acting Insulin

Answer 7

Use right before meals
Used in continuous infusion pumps
Onset is 5-15 minutes
Peak is 1-1.5 hours, lasts 3-5 hours

Question 8

Short-Acting Insulin

Answer 8

Usually used in hospital setting for DKA

Onset is 30-60 minutes

Question 9

Long-Acting Insulin

Answer 9

Used in basal coverage
Lasts 24 hours
No pronounced peak
Cannot be mixed in same syringe as any other insulin (acidic pH)

Question 10

Biphasic/Mixed Insulin

Answer 10

Combo of intermediate + short
Combo of intermediate + rapid

Lessons the number of injections needed

Question 11

Intermediate Acting

Answer 11

Used in basal coverage 
Onset is 2-4 hours 
Lasts 10-20 hours 
Cloudy solution 
Have to be mixed prior to administration