Diabetes Mellitus Class PDF

Drugs for Diabetes Mellitus Chapter 60 Oral and Other Injectable Drugs for Diabetes Drugs for Diabetes: Indications Lower blood glucose levels in patients with type 2 diabetes used alone or in combination with other agents in addition to diet and lifestyle changes Diabetes Drug...

Drugs for Diabetes Mellitus Chapter 60 Oral and Other Injectable Drugs for Diabetes Drugs for Diabetes: Indications Lower blood glucose levels in patients with type 2 diabetes used alone or in combination with other agents in addition to diet and lifestyle changes Diabetes Drugs – Target Pancreas Insulin secretagogues increase insulin production in Type 2 DM act on Beta cells of pancreas Diabetes Drugs – Target Pancreas Insulin secretagogues 2 classes 1. Sulphonylureas glyburide chlorpropamide, tolbutamide glimepiride, glipizide (Glucotrol) 2. Non-sulphonylureas (meal-time drugs) repaglinide, nateglinide short half-life Same drug target but different duration of action Diabetes Drugs Biguanides metformin Thiazolidinediones (TZDs) rosiglitazone pioglitazone = glitazones or TZDs Diabetes Drugs – Incretin Pathway and Others Gliptins (DPP-4 inhibitors) and incretin mimetics sitagliptin (Januvia) – DPP-4 inhibitor excenatide - Incretin mimetic SGLT-2 inhibitors Other Drugs Other Drugs (not covered) amylin mimetic alpha-glucosidase inhibitors Medication sites of action Oral Drugs Biguanides: metformin 1. Decrease hepatic production of glucose 2. Increase tissue sensitivity to insulin = increase uptake of glucose does not increase insulin secretion from the pancreas does not cause hypoglycemia net weight loss Oral Drugs Biguanides: metformin GI disturbances (nausea, diarrhea, decreased appetite) taken 2-3/day with meals to reduce GI disturbances Lactic acidosis Rare but 50% mortality concern in renal insufficiency Medication sites of action Oral Drugs – Target Pancreas Sulphonylureas: glyburide 1. Stimulate insulin secretion from pancreatic beta cells = increasing insulin levels Beta cell function must be present 2. Improves sensitivity to insulin in muscles, liver and fat tissues take up and store glucose more easily 3. liver by decreasing the rate of insulin metabolism and breakdown Oral Drugs – Target Pancreas Sulphonylureas: glyburide Hypoglycemia is most common adverse effect usually mild but can be severe Taken with breakfast (usually one/day) Incretins and Glucose Control Incretins DPP-4 Incretins Intestinal contents release incretins GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic peptide) stimulates insulin release Incretins broken down by the enzyme DPP- 4 dipeptidyl-peptidase 4 Medication sites of action Incretins Exenatide (GLP-1 mimetic) X DPP-4 Sitagliptin (DPP- 4 inhibitor) Incretins Incretin mimetic Exenatide (Byetta) synthetic form of a saliva protein of the Gila monster synthetic GLP-1 mimetic SC administration liraglutide, semaglutide, dulaglutide daily or weekly administration Incretins Decreases appetite useful in obesity-linked diabetes weight loss drug (without diabetes) Major adverse effect GI upset New Incretin mimetic (Nov 2023) tirzepatide (GIP & GLP-1 agonist) Incretin Preparations - FYI SC Injection Dulaglutide: Once a week Exenatide: Twice a day Exenatide extended-release: Once a week Liraglutide: Once a day Lixisenatide: Once a day Semaglutide: Once a week Tirzepatide: Once a week Semaglutide po tablets: daily Incretins DPP-4 enzyme inhibitors reduce incretin metabolism result in higher plasma incretin level reduced glucose “gliptins” Sitagliptin, saxagliptin, linagliptin DPP-4 enzyme inhibitors used alone or in combination with metformin For type 2 diabetes only Oral once daily with or without food Na-Glucose Transporter Inhibitors Newest group of Type 2 DM drugs Inhibit glucose transporter in nephron (PT) sodium-glucose transporter subtype 2 (SGLT2) loss of glucose in urine (plus water) Canagliflozin, dapagliflozin, and empagliflozin Approved in Canada May 2014 Canagliflozin X SGLT2 Inhibitors – Adverse Effect Increased urination possible hypotension/dizziness UTIs not surprising Medication sites of action Oral Drugs Thiazolidinediones (TZDs) rosiglitazone (Avandia), other glitazones Decrease insulin resistance “Insulin sensitizing agents” Increase glucose uptake and use in skeletal muscle Inhibit glucose and triglyceride production in the liver Oral Drugs Thiazolidinediones (TZDs) rosiglitazone Boxed Warning for rosiglitazone (Avandia) Increased risk of angina, MI and heart failure (plasma volume) Other Injectable Drugs Amylin Mimetic Amylin co-released with insulin delays gastric emptying and inhibits glucagon secretion reduce postparandial glucose Pramlintide acts as amylin supplement to insulins (DM Type I & II) SC injection Oral Drugs Alpha-glucosidase inhibitors Reversibly inhibit the enzyme alpha-glucosidase in the brush border of the small intestine acarbose miglitol Inhibits digestion of oligo- and disaccharides Result: delayed absorption of glucose Must be taken with meals to prevent excessive postprandial blood glucose elevations Medication Interactions with oral/non- insulin agents Glucocorticoids decrease the effect of hypoglycemic medication Cortisol-like drugs cause increase blood glucose  Antihyperglycemic Agents: Client Care Implications Assess for signs of hypoglycemia If hypoglycemia occurs: Give glucagon if required Have the alert client eat 120 – 200 mL clear fruit juice, glucose tablets or gel, teaspoon of corn syrup or honey, or non-diet soft drink After the liquid snack have the client eat their meal soon or, give a small snack such as crackers or half sandwich (carbohydrates and protein) Monitor blood glucose levels