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Which drugs address glucose influx?
Alpha-Glucosidase
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Which drugs target insulin resistance?
- 1. TZDs
- 2. Metformin
- 3. Dopamine agonist
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Which drugs target glucagon secretion?
- 1. GLP 1 Mimetic
- 2. Symlin (amlyn)
- 3. DPP4 Inhibitor
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Which drugs target insulin supply (ACUTE beta cell function)?
- 1. Sulfonylureas (Glipizide, Glyburide)
- 2. Glinides (Prandin)
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Which drugs target Insulin supply (Chronic B-cell function)?
Insulin
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T or F. Glinides are short-acting and target post-prandial well.
True (Prandin)--> TID 30-45min before meal
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What is the MOA of SFU & nonSFU?
BIND to ATP-dependent K+ channel of B-cell --> stopping K efflux increasing depolarization of cell--> causing increased insulin secretion
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Why is SFU NOT considered first line therapy?
- High secondary failure rate
- -Glyburide (non-selective 1st gen) is NOT heart friendly b/c effect K+channels in heart as well and has increased risk for hypoglycemia (esp at night in older people).
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T or F. Metformin does NOT causes hypoglycemia or wt gain.
True (works on liver and targets how much glucose put out by liver)
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MOA: Metformin
- Activates 5AMPK (enhances GLP1 effects
- -Decrease glyconeogensis & increase sk-muscle glucose uptake
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T or F. Metformin has a risk of causing kidney damage.
False--> just needs functioning kidneys, doesn't actually cause damage
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What supplements should be considered for people taking metformin?
Vit B12
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MOA: TZDs
- -Involved in gene expression
- -PPAR seletive agonist--> to increase GLUT-4 transport
- -BODY MUST HAVE INSULIN TO WORK
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What are some S/E of TZD?
- -Wt gain
- -Edema
- -CHF
- -Acts on lipids
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What patients should NOT receive TZDs?
CHF (Actos/Avandia--> Black Box Warning)
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MOA: Alpha Glucosidase Inhibitors
- -Inhibits pancreatic & intestinal enzymes found in small intestine
- -Prevents breakdown of complex starch
- -Defers digestion & absorption distally
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What is a common S/E of a-glucosidase inhibitor?
- Flatulence
- -Contraindicating in IBD, cirrhosis
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T or F. Orange juice should NOT be used in hypoglycemia from AGIs.
True
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Discuss Incretins
- -Hormones in gut
- -Nutrient entry in stomach-->release incretins--> stim insulin secretion
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Glucagon is made by which cells?
Alpha cells
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What are 5 effects GLP-1?
- 1. Reduce appetite
- 2. Alpha cells: decrease postprandial glucagon secretion
- 3. Liver: Decrease glucagon reduces output of sugar
- 4. Stomach: Slows stomach emptying
- 5. Beta cells: Enhances insulin secretion
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MOA: GLP-1 Analogs
- Mimic GLP-1
- -Glucagon suppression
- -Enhances insulin/amylin secretion (only during hyperglycemia)
- -Delays gastric empything
- -Enhances satiety
- **OK to miss a meal
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What is the Black Box Warning of GLP-1 (Victoza)?
Risk of Thyroid C-Cell Tumor
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MOA: DPP-IV Inhibitors
- -DDP-IV is an enzyme that breaks down GLP-1 so inhibitors block the enzyme, increasing GLP-1
- -Tumor inhibition enzyme
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What are some SE of DPP-IV Inhibitor?
- -weight NEUTRAL
- -Rare GI
- -H/A
- -Nasopharyngitis
- -URI
- **suppressing immunity??
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What are 2 major concerns for DPP-IV Inhibitors?
- 1. Hemorrhagic/necrotizing pancreatitis (watch for abd pain w/ vomiting)
- 2. Cancer concern
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What hormone is co-secreted with insulin from Beta cell?
Amylin (in response to food)
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What are 3 effects of Amylin?
- 1. Inhibits glucagon secretion
- 2. Delays gastric emptying
- 3. Satiety agent
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T or F. Amylin should NOT be taken with insulin.
F--> Take TID before meals WITH prandial insulin
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What are 2 contraindications for Amylin Analog?
- 1. Gastroparesis
- 2. Hypoglycemia unawareness
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What is the Black Box Warning for Symlin?
Increased risk of insulin-induced severe hypoglycemia, particularly in Type 1 diabetes
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Amlin causes weigh gain or weight loss?
- -weight LOSS
- -reduces meal-time insulin dose
- -hypoglycemia
- -GI: N/V, anorexia
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MOA: dopamine agonist?
- Unknown
- -NON-insulin mediated glucose disposal
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What are S/E of Dopamine Agonists?
- -Hypotension
- -Somnolence
- -Rhinitis
- -H/A
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What are 2 precautions for dopamine agonists?
- -Liver impairment
- -Nursing mothers
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How is BAS best used?
In combo with either SFU or metformin
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What is a precaution for BAS?
Increase TG
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What are examples of Basal Insulins?
- Intermediate--> Novolin/Humulin N
- Long acting--> Lantus (glargine) & Levemir (Detemir)
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What are examples of Bolus insulin?
- -Short acting--> Humulin/Novolin R
- -Rapid acting--> Humulog (Lispro), Novolog (aspart) & Apidra (glulisine)
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Should pregnant women receive lantus?
NO
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What needs to be considered with regular insulin?
-Need to take 30min before meal, can last up to 6-8hrs so can overlap with sequential doses
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What are 2 concerns w/ Insulin?
- 1. Hypoglycemia
- 2. Hypertrophy of subQ fat (rotate sites)
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