Drugs for Diabetes Mellitus Lecture Notes PDF

## Drugs for Diabetes Mellitus ### 1- Insulin Preparations Insulin preparations are classified as short-acting, rapid-acting, intermediate-acting, and long-acting. | Type of Insulin | Onset | Peak | Duration | | -------------- | ---------- | ------------ | ----------- | | **Rapid-Ac...

## Drugs for Diabetes Mellitus ### 1- Insulin Preparations Insulin preparations are classified as short-acting, rapid-acting, intermediate-acting, and long-acting. | Type of Insulin | Onset | Peak | Duration | | -------------- | ---------- | ------------ | ----------- | | **Rapid-Acting Insulin** | | | | | Insulin aspart | 10-20 min | 40-50 min | 3-5 hr | | Insulin lispro | 15-30 min | 30-90 min | 3-5 hr | | Insulin glulisine | 20-30 min | 30-90 min | 1-2.5 hr | | **Short-Acting Insulin** | | | | | Regular insulin | 30-60 min | 2-5 hr | 5-8 hr | | **Intermediate-Acting Insulin** | | | | | Isophane (NPH) insulin | 1-2 hr | 4-12 hr | 18-24 hr | | **Long-Acting Insulin** | | | | | Insulin glargine | 1-1.5 hr | None | 20-24 hr | | Insulin detemir | 1-2 hr | 6-8 hr | Up to 24 hr | | Insulin degludec | 1-2 hr | None | >24 hr | | **Inhaled Insulin** | | | | | Human insulin liquid | 5-10 min | 1 hr | 5-10 hr | ### Routes SC - inhalation - continuous SC infusion with an insulin pump ### S/E: reactions (lipodystrophy) that affect the rate of insulin absorption ## 2- Other Antidiabetic Agents ### A) Sulfonylurea Drugs - First oral antidiabetic agents. - **The original sulfonylureas** - Chlorpropamide - Acetohexamide - Tolbutamide - **The second-generation drugs** - Glicilized glipizide - Glyburide - Glimepiride *classify as 3rd* ### B) Meglitinide Drugs - Ex: Repaglinide and Nateglinide - Useful for patients whose meal schedules vary from day to day ### S/E - Increases their risk of hypoglycemic reactions to sulfonylureas - Hypoglycemic reactions are not often serious as in sulfonylureas ### C) Biguanides: Metformin (Antihyperglycemic) - Another biguanide, phenformin, was removed from the market in the 1970s because of an unacceptable risk of fatal lactic acidosis. - Used alone or in combination with a sulfonylurea, meglitinide, alpha-glucosidase inhibitor, or incretin mimetic for patients whose diabetes is not controlled with a single drug. ### Thiazolidinediones "Insulin sensitizer" - Ex: Pioglitazone and rosiglitazone - Used as an adjunct to diet and exercise for the management of type 2 diabetes. ### Adverse Effects - a) edema, increase plasma volume - b) increase the risk of developing heart failure in individuals with diabetes - c) not be used in persons with heart failure or a high risk of developing heart failure - d) ↑ risk of myocardial infarction (MI) (Rosiglitazone > Pioglitazone) ### Rosiglitazone and pioglitazone have somewhat different effects on serum lipids ### alpha-Glucosidase Inhibitors - Acarbose and miglitol - Adverse effects: increased flatulence and abdominal bloating ### GLP-1-Based "Incretin mimetics" Therapies: #### GLP-1 Receptor Agonists (GLP-1Ra's) and DPP-4 Inhibitors - GLP-1 itself is not suited for therapeutic use because it is rapidly degraded by dipeptidyl peptidase-4 (DPP-4) and has a half-life of only 2 minutes. - **Exenatide** A sustained-release preparation is now available for once-weekly injection. - **Liraglutide** - **Sitagliptin, linagliptin, and saxagliptin** ### Amylin Analogue - **Pramlintide acetate** - Reduces caloric intake and may lead to weight loss. - Subcutaneously. ### Inhibitors of Glucose Reabsorption in the Kidney: SGLT-2 Inhibitors - Canagliflozin, empagliflozin, and dapagliflozin are now approved for treating patients with type 2 diabetes. - The main adverse effects include urinary tract infection due to the excretion of glucose in the urine.