Diabetes Treatment (PDF)

## Treatment of Diabetes ### Oral hypoglycemic agents | Drug Class | MOA | When to Use | Adverse Effects | |---|---|---|---| | **Biguanides** *(Metformin)* | Biguanides prevent the production of glucose in the liver. Metformin decreases gluconeogenesis in the liver and increases glucose uptake...

## Treatment of Diabetes ### Oral hypoglycemic agents | Drug Class | MOA | When to Use | Adverse Effects | |---|---|---|---| | **Biguanides** *(Metformin)* | Biguanides prevent the production of glucose in the liver. Metformin decreases gluconeogenesis in the liver and increases glucose uptake by skeletal muscles, decreasing blood glucose levels. | Does not cause hypoglycemia, as it does not alter insulin levels. | gastrointestinal toxicities (i.e. abdominal discomfort, diarrhea) anorexia, nausea, metallic taste, and lactic acidosis* | | **Insulin secretagogues** | increase insulin secretion from pancreatic beta cells. Inhibit the potassium channels on beta cells, causing cell depolarization and an increase in calcium entry. Increase in calcium entry leads to increase in insulin. | | Hypoglycemia GI disturbances Jaundice Allergic skin reactions | | **Glucagon-like polypeptide agonists** | Synthetic analogs of GLP-1 bind to GLP-1 receptors, helping to restore GLP-1 activity. Injection of GLP-1 receptor agonists results in an increase in insulin release, a decrease in glucagon release, lowering blood glucose levels.| adjunct therapy for type 2 diabetes.| nausea, vomiting, and diarrhea. Weight loss | | **Dipeptidyl peptidase-4 (DPP-4) inhibitors** *(ex) sitagliptin* | a serine protease found throughout the body critical for the inactivation of GLP-1. | DPP-4 inhibitors are indicated as adjunct therapy for T2 diabetes and are administered orally | upper resp tract infections, headaches, hypoglycemia acute pancreatitis and severe allergic and hypersensitivity reactions also exist | | **Sodium-glucose linked transporter inhibitors** | SGLT-2 inhibitors can be administered to antagonize the transporter protein and prevent the reabsorption of glucose. | | These drugs can be used by diabetics to decrease their blood sugar levels. Common adverse effects include increased urination, low BP, weight loss | ### Insulin #### Goals: - To alleviate diabetes-associated symptoms and to prevent or reduce diabetes-associated complications - T1 diabetes is always managed with insulin - T2 may be managed through physical acidity and meal planning or also require meds | Drug Class | MOA | When to Use | Adverse Effects | |---|---|---|---| | **Insulin** | 1. Rapid acting: very fast onset of action and short duration of action <br>2. Short acting: rapid onset of action <br> 3. Intermediate acting: intermediate onset of action <br> 4. Long acting: slow onset of action and long duration of action | Necessary for all T1 patients and for diabetic ketoacidosis, may also be used for T2 diabetes. <br> Insulin pen, syringe, jet injector, insulin pump <br> Patients with type 1 diabetes have destroyed beta cells, which means their pancreas is incapable of making insulin <br> Injection of insulin via subcutaneous injection (or other methods) replace the body's natural store of insulin <br> patients with type 2 diabetes are insulin-resistant, meaning their cells are unable to respond normally to insulin | Hypoglycemia is most dangerous complication <br> Usually result of unusual physical exertion, too large of insulin dose, insulin allergy and insulin resistance <br> Treatment is glucose administration, generally a simple sugar preferably in liquid form <br> Symptoms: Tachycardia and palpitations, sweating, shaking, nausea, hunger |