Glycosolated hemoglobin

Over the 120 day life-span of the red blood cells, glucose combines with hemoglobin to form the glycated form.  A uncontrolled diabetic in a prolonged state of hyperglycemia will have more glycated hemoglobin!  Target is around 6%

Biguanides Class

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Metformin (drug of choice for T2DM)

2.  MOA- Primarily acts on liver to decrease glucose output but also increases insulin sensitivity in muscle. 

3.  Advantages:  No Hypoglycemia and no Weight Gain

4.  Gastrointestinal Problems (Explosive Diarrhea)

-METALLIC-A Taste in their mouth

Thiazolidinedions (TZDs)Class

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Pioglitazone (Actos)

2.  Primarily acts in the muscle and FAT to increase insulin sensitivity but also decreases glucose production in liver.

3.  Doesn't cause hypoglycemia and favorable lipid effects (other drug could cause heart attack!)

4.  Edema and fluid retention, weight gain, heart failure, and osteopenia in old women.

Sulfonylureas Class

1.  Generic Name (brand)

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Glipizide (Glucotrol)

2.  Act on pancreas to stimulate insulin

3.  Dosed once a day

4.  Chance of hypoglycemia

Glinides Class

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Repaglinide (Prandin)

2.  Works directly on pancreas to secrete insulin

3.  Taking 3 times a day with meals (reduces chances of hypoglycemia with skipped meals)

4.  Chance of hypoglycemia

-weight gain

Alpha-Glucosidase Inhibitors

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Acarbose (precose)

2.  Alpha-glucosidase is inhibited in the small intestine causing delay of carbohydrate absorption.

3. 

4.  Gastrointestinal Issues (farts and rrhea)

-Not go-to medication...tough on patient

-Don't take oral sucrose! AGI stops sucrose to glucose hydrolysis

Incretin Mimetic Class

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Exenatide (Byetta)

2.  GLP-1 (Glucagon Like Peptide) stimulates pancreas to release insulin (only in hyperglycemic state)

3.  Weight loss!

4.  Nausea, hypoglycemia, and warning to impaired renal function.  Slows extent and rate of absorption of other meds...wait an hour before taking other drugs.

Dipeptidyl Peptidase IV (DDP-4) Inhibitor

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Sitagliptin (Januvia)

2.  Inhibits DDP-4 which normally breaks down

GLP-1, the glucagon like peptide that stimulates insulin release

3.  No hypoglycemia and limited drug interactions

4.  Hypersensitivity Reaction

Amylinomimetic Class

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Pramlintide (symlin)

2.   Mimics amylin by inhibiting carbohydrate absorption and glucose release by the GI tract

3.  Weight loss

4.  Hypoglycemia, nausea, vomiting

-same drug interactions as exenatide

Colesevelam

1.  Generic Name?

2. MOA

3.  Advantages

4.  Adverse Effects

1.  Colesevelam (Wechol)

2.  Unknown (sequesters bile acid)

3.  No Hypoglycemia, Favorable lipid action

4.  Constipation, DRUG INTERACTIONS

-have to take other drugs 4hrs beforehand

1. Lispro (Humalog)

2.  Aspart (Novolog)

3.  Inhaled (Exubera)

4.  Glulisine (Apidra)

They all peak at 30-90 minutes except aspart which is 1-3 hours

NPH (peak at 4-10 hours)

Detemir (levemir) (peak at 6-8 hours)

Glargine (lantus)

Peakless

1.  Incretin Memetic (Exenatide)

2.  Amylinomimetic (Pramlinitide)

3.  Colesvalem.

Pretty much any of the mimetics or that mess with digestion and nutrient absorption.

1.  Sulfonylureas (Glucotrol)

2.  Glinides (Repaglinide)

3.  Amylinomimetic (Pramlintide)

 4.  Incretin Mimetic

5.  Alpha glucosidase inhibitors (Acarbose)

(USE DEXTROSE TO TREAT HYPOGLYCEMIA)

TZD's (Pioglitazone)

Dipeptidyl Peptidase IV Inhibitor (Sitagliptin)

Biguanides (Metformin)

What drugs stimulate insulin release from the pancreas?

Sulfonylureas (Glipizide, Glucotrol)

Glinides (Repaglinide)

Biguanides (Metformin)

TZD's (Piaglitizone)