Chapter 32: Diabetic Drugs

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary hormonal function of insulin in fat metabolism?

Stimulates lipolysis

Inhibits lipogenesis

Stimulates lipogenesis (correct)

Promotes gluconeogenesis

Which type of diabetes is characterized by insulin deficiency and resistance?

Type 1 Diabetes Mellitus

Latent Autoimmune Diabetes in Adults (LADA)

Type 2 Diabetes Mellitus (correct)

Gestational Diabetes

Which of the following is a long-term complication of diabetes?

Elevated fasting blood glucose

Polyphagia

Polydipsia

Retinopathy (correct)

What is a common risk associated with Type 2 Diabetes Mellitus?

Atherosclerosis plaque buildup Signup and view all the answers

What is the main treatment strategy for gestational diabetes?

Insulin treatment Signup and view all the answers

Which of the following statements about Type 1 Diabetes Mellitus is true?

It requires exogenous insulin for management Signup and view all the answers

Incretin mimetics are clinically indicated for which of the following?

Enhancing insulin secretion post-meal Signup and view all the answers

Which of the following best describes the difference between oral and injectable diabetes treatments?

Injectable treatments typically require refrigeration Signup and view all the answers

What is the primary mechanism of action for insulin in regulating blood sugar?

It promotes cellular uptake of glucose. Signup and view all the answers

Which of the following is classified as an injectable antidiabetic drug?

Glucagon-like peptide-1 (GLP-1) agonists Signup and view all the answers

What is a common adverse effect associated with insulin therapy?

Hypoglycemia Signup and view all the answers

What is the clinical indication for using incretin mimetics in diabetes treatment?

To improve gastric emptying and promote feelings of fullness Signup and view all the answers

Which of the following is a key difference between oral hypoglycemic drugs and injectable antidiabetic drugs?

Oral medications are ineffective for type 1 diabetes. Signup and view all the answers

Which drug category is known for regulating blood sugar by increasing insulin secretion from the pancreas?

Sulfonylureas Signup and view all the answers

Which of the following rapid-acting insulins is administered through inhalation?

Afrezza Signup and view all the answers

What is the average duration of action for intermediate-acting insulin like Insulin Isophane?

10 to 18 hours Signup and view all the answers

What is the primary action of long-acting insulins such as Insulin Glargine?

Provides a constant level of insulin in the body. Signup and view all the answers

Which of the following non-insulin antidiabetic drugs is recommended as the first-line treatment for type 2 diabetes mellitus?

Metformin Signup and view all the answers

What is a common adverse effect associated with the use of metformin?

Lactic acidosis Signup and view all the answers

Which class of medications is typically used along with lifestyle modifications for new-onset type 2 diabetes treatment?

Non-insulin antidiabetic drugs Signup and view all the answers

How do injectable drugs compare to oral diabetes treatments in terms of administration frequency and onset of action?

Injectables may have a quicker onset and could be given less frequently. Signup and view all the answers

Which insulin is considered an ultra long-acting insulin?

Insulin Degludec Signup and view all the answers

For hospitalized patients requiring rapid adjustments to blood glucose levels, what type of insulin is typically used?

Rapid-acting or short-acting insulin Signup and view all the answers

What is a characteristic of Insulin Detemir's duration of action?

It is dose-dependent. Signup and view all the answers

Study Notes

Diabetes Drugs

Diabetes mellitus (DM) is a group of progressive diseases, often considered a syndrome rather than a single disease.
The pancreas, located behind the stomach, is both an exocrine and endocrine gland.
The pancreas produces hormones like insulin and glucagon.
Insulin directly affects fat metabolism, stimulates protein synthesis, and promotes an intracellular shift of potassium and magnesium.
Insulin stimulates lipogenesis and inhibits lipolysis.
Excess glucose is stored in the liver and skeletal muscles.
Symptoms of diabetes mellitus include elevated fasting blood glucose, increased urination (polyuria), excessive thirst (polydipsia), and increased hunger (polyphagia).
Type 1 diabetes is characterized by a lack of insulin production or defective insulin production. Affected patients often need exogenous insulin. Fewer than 10% of all DM cases are Type 1.
Type 2 diabetes is the most common type, representing 90% of all diabetes cases. It's often characterized by insulin resistance in many tissues, leading to deficiency and resistance. It also features decreased insulin receptors or reduced responsiveness.
Type 2 diabetes can include several comorbid conditions, like coronary heart disease and increased risk for thrombotic events, collectively categorized as metabolic syndrome.
Long-term complications of diabetes include macrovascular problems (atherosclerosis plaque buildup in coronary arteries, cerebral arteries, and peripheral vessels) and microvascular problems (capillary damage leading to retinopathy, neuropathy, and nephropathy).
Gestational diabetes is a pregnancy-related condition characterized by hyperglycemia that usually subsides after delivery. About 30% of patients with gestational diabetes go on to develop Type 2 diabetes within 10-15 years.
Glycemic goals for most patients are an HbA1C of 7%. Normal HbA1C is 5.7%. Prediabetes is 6.4% HbA1C, and 6.5% is considered diabetes.
Antidiabetic drugs include insulins, oral hypoglycemics, and injectable hypoglycemics.
Human insulin is derived using recombinant DNA technologies and produced by bacteria and yeast. The goal is tight glucose control to reduce long-term complications.
Insulins have different durations and onset times (Rapid-acting, Short-acting, Intermediate-acting, and Long-acting).
Afrezza is a rapid-acting inhaled insulin with a short duration of action.
Regular insulin, in IV bolus, IV infusion, IM, and SUBQ forms, is a short-acting insulin with an immediate onset.
Isophane suspension (NPH) is an intermediate-acting insulin Often combined with regular insulin.
Glargine (Lantus) or Basaglar (biosimilar) is a clear, colorless, long-acting insulin with a constant level of insulin in the body. Toujeo (more concentrated U-300 form) is also a long-acting insulin. Levemir (Detemir) and Tresiba (Degludec) are also long-acting insulins, but their duration varies by dose.
Fixed-combination insulins contain two different types of insulin.
Sliding-scale insulin dosing adjusts rapid- or short-acting insulin based on blood glucose tests, typically used in hospitalized patients.
Non-insulin antidiabetic drugs are used for type 2 diabetes mellitus, often for those with poor glycemic control with diet and exercise alone.
Biguanides (metformin) is typically the first-line oral drug for type 2 diabetes.
Biguanides decrease glucose production, decrease intestinal absorption, and increase glucose uptake. Biguanides do not increase insulin secretion.
Adverse effects of biguanides can include gastrointestinal problems (bloating, nausea, cramping, diarrhea) metallic taste, and reduced vitamin B12. Lactic acidosis is a rare but lethal effect. Biguanides are contraindicated in renal or hepatic disease.
Sulfonylureas stimulate insulin secretion from beta cells and improve insulin sensitivity. Adverse effects can include hypoglycemia, hematologic issues, nausea, heartburn, and other problems.
Glinides (repaglinide and nateglinide) stimulate insulin secretion from the pancreas. Use is typically for type 2 DM.
Thiazolidinediones can cause or worsen heart failure; thus, use is often contraindicated when heart failure is present. Adverse effects include peripheral edema, weight gain, and decreased bone marrow density.
Alpha-glucosidase inhibitors (acarbose and miglitol) inhibit alpha-glucosidase in the small intestine. This results in delayed glucose absorption. They are primarily used to control postprandial blood glucose elevations. Adverse effects are usually gastrointestinal (flatulence, diarrhea, abdominal pain) and no hypoglycemia.
Incretin mimetics and dipeptidyl peptidase-IV (DPP-IV) inhibitors mimic naturally secreted incretin hormones, which affect insulin secretion, gastric emptying, and glucagon secretion. Examples include Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), and Alogliptin (Nesina). DPP-IV inhibits the breakdown of these hormones. This results in delayed breakdown of incretins, which helps reduce fasting and postprandial glucose levels.
GLP-1 agonists (e.g., Soliqua and Xultophy) activate GLP-1 receptors to increase first and second phase insulin secretion, slow gastric emptying, and suppress glucagon secretion. For use with type 2 diabetes. Adverse effects can include nausea, vomiting, diarrhea, pancreatitis, and weight loss. Combinations with insulin glargine or insulin degludec can be used as combination products.
Amylin agonists (pramlintide) mimic the effects of amylin, a hormone that regulates glucose. It's used when other diabetic medications haven't controlled glucose; can be used with type 1 or 2 DM. Adverse effects include nausea, anorexia, vomiting, and headache. Contraindications include gastroparesis. Insulin dosage might need to be lowered.
SGLT2 inhibitors (e.g., canagliflozin, dapagliflozin) decrease blood glucose by preventing glucose reabsorption from the glomerular filtrate. They increase insulin sensitivity and uptake. Adverse effects are genital yeast infections, urinary tract infections, hypotension, and hyperkalemia.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.