Which drugs address glucose influx?
Alpha-Glucosidase
Which drugs target insulin resistance?
1. TZDs 2. Metformin 3. Dopamine agonist
Which drugs target glucagon secretion?
1. GLP 1 Mimetic 2. Symlin (amlyn) 3. DPP4 Inhibitor
Which drugs target insulin supply (ACUTE beta cell function)?
1. Sulfonylureas (Glipizide, Glyburide) 2. Glinides (Prandin)
Which drugs target Insulin supply (Chronic B-cell function)?
Insulin
T or F. Glinides are short-acting and target post-prandial well.True False
True (Prandin)--> TID 30-45min before meal
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
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).
T or F. Metformin does NOT causes hypoglycemia or wt gain.True False
True (works on liver and targets how much glucose put out by liver)
MOA: Metformin
Activates 5AMPK (enhances GLP1 effects -Decrease glyconeogensis & increase sk-muscle glucose uptake
T or F. Metformin has a risk of causing kidney damage.True False
False--> just needs functioning kidneys, doesn't actually cause damage
What supplements should be considered for people taking metformin?
Vit B12
MOA: TZDs
-Involved in gene expression -PPAR seletive agonist--> to increase GLUT-4 transport -BODY MUST HAVE INSULIN TO WORK
What are some S/E of TZD?
-Wt gain -Edema -CHF -Acts on lipids
What patients should NOT receive TZDs?
CHF (Actos/Avandia--> Black Box Warning)
MOA: Alpha Glucosidase Inhibitors
-Inhibits pancreatic & intestinal enzymes found in small intestine -Prevents breakdown of complex starch -Defers digestion & absorption distally
What is a common S/E of a-glucosidase inhibitor?
Flatulence -Contraindicating in IBD, cirrhosis
T or F. Orange juice should NOT be used in hypoglycemia from AGIs.True False
True
Discuss Incretins
-Hormones in gut -Nutrient entry in stomach-->release incretins--> stim insulin secretion
Glucagon is made by which cells?
Alpha cells
What are 5 effects GLP-1?
1. Reduce appetite 2. Alpha cells : decrease postprandial glucagon secretion3. Liver : Decrease glucagon reduces output of sugar4. Stomach : Slows stomach emptying5. Beta cells : Enhances insulin secretion
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
What is the Black Box Warning of GLP-1 (Victoza)?
Risk of Thyroid C-Cell Tumor
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
What are some SE of DPP-IV Inhibitor?
-weight NEUTRAL -Rare GI -H/A -Nasopharyngitis -URI **suppressing immunity??
What are 2 major concerns for DPP-IV Inhibitors?
1. Hemorrhagic/necrotizing pancreatitis (watch for abd pain w/ vomiting) 2. Cancer concern
What hormone is co-secreted with insulin from Beta cell?
Amylin (in response to food)
What are 3 effects of Amylin?
1. Inhibits glucagon secretion 2. Delays gastric emptying 3. Satiety agent
T or F. Amylin should NOT be taken with insulin.
F--> Take TID before meals WITH prandial insulin
What are 2 contraindications for Amylin Analog?
1. Gastroparesis 2. Hypoglycemia unawareness
What is the Black Box Warning for Symlin?
Increased risk of insulin-induced severe hypoglycemia, particularly in Type 1 diabetes
Amlin causes weigh gain or weight loss?
-weight LOSS -reduces meal-time insulin dose -hypoglycemia -GI : N/V, anorexia
MOA: dopamine agonist?
Unknown -NON-insulin mediated glucose disposal
What are S/E of Dopamine Agonists?
-Hypotension -Somnolence -Rhinitis -H/A
What are 2 precautions for dopamine agonists?
-Liver impairment -Nursing mothers
How is BAS best used?
In combo with either SFU or metformin
What is a precaution for BAS?
Increase TG
What are examples of Basal Insulins?
Intermediate--> Novolin/Humulin N Long acting--> Lantus (glargine) & Levemir (Detemir)
What are examples of Bolus insulin?
-Short acting--> Humulin/Novolin R -Rapid acting--> Humulog (Lispro), Novolog (aspart) & Apidra (glulisine)
Should pregnant women receive lantus?
NO
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
What are 2 concerns w/ Insulin?
1. Hypoglycemia 2. Hypertrophy of subQ fat (rotate sites)
