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Diabetes 101: The Drugs
Transcript of Diabetes 101: The Drugs
Kristen Abbott, PharmD
PGY1 Pharmacy Resident
May 12, 2015
The 4 M's of Diabetes:
Present before blood sugars are elevated
Caused by genetics, obesity, and inactivity
Increases heart attack/stroke risk...
MICROvascular = small blood vessels
Often present to some extent at diagnosis
MACROvascular = large blood vessels
Heart disease is the leading cause of death in diabetes
tip of the iceberg:
high blood sugars
A gentle Balance:
how they work:
ex: glipizide, glimepiride, glyburide
-requires functioning pancreas
-lowers A1C by 2%
-many years of data to support use (been around since 1984)
-stimulates pancreas to release insulin
-reduces MICROvascular complications
Works in many ways:
reducing insulin resistance = less locks
helps organs use insulin
decreased glucose made by the liver
-lowers A1C up to 2%
-proven mortality benefits
-low risk of hypoglycemia
-may improve triglycerides
- lactic acidosis (rare)
#1 Drug of choice in Type 2 Diabetes!
Insulin sensitizer = less locks
(helps body use its own existing insulin better)
preserves pancreas cell function
low hypoglycemia risk
bladder cancer (rare)
cannot be used with heart failure
How they work:
sugars after meals by
inhibiting breakdown of incretins in stomach
- meal time coverage
- well tolerated, low risk of hypoglcemia
- once daily dosing
- weight neutral
- cold-like symptoms
The way they work:
- similar action in stomach as "gliptins"
- stops liver from making extra glucose
- decreases appetite
- enhances satiety
- weight loss
- insulin sparing
- used in type 1 and 2
- preserves pancreas cell function
- pancreatitis (rare)
- comes in pen-like device
- given as injection
- may require mixing
- variable dosing: twice daily,
once daily, or weekly
Glucose loss through urine:
a backup mechanism to control blood sugars
Diabetes vs. Non-diabetes
allows kidneys to release more glucose through urine
**smaller glass of water=
- weight loss
- insulin sparing
- low risk of hypoglycemia
- benefit in type 1 and type 2 diabetes
- newest agents, least data
- urinary tract and yeast infections
provides external supply of insulin to overcome lack of production by body
-mimics natural insulin in body
- weight gain
used to offset body's natural production of glucose
- glargine (Lantus)
- detemir (Levemir)
- NPH (Novolin N, Humulin N)
- long acting
- used once or twice daily
- covers fasting blood sugars
- can be used with oral medications
- NPH insulin is cloudy
used to offset glucose taken in through diet
- aspart (Novolog)
- lispro (Humalog)
- glulisine (Apidra)
- regular (Novolin R, Humulin R)
- fast acting
- used up to 4 times daily
- covers blood sugars after meals
- used with "basal" insulin
In the intestines:
hormones called "incretins"
When you eat:
Your body releases:
to break down food.
Incretins work by:
- helping pancreas be more reactive
- releasing insulin in response to food
- delaying stomach emptying
- enhancing satiety through brain
These actions are greatly impaired in diabetes.
Glucose = fuel
- necessary for nearly every
system in body to run properly
- body has ways to compensate
when it is not getting enough glucose
- example: liver produces glucose overnight to store fuel supply for body
Have you ever gone to bed with your blood sugar in range and then woken up with high blood sugar?
How might we
get more keys?
metformin, Actos, & exercise
glipizide, glimepiride, glyburide
gliptins: Januvia, Onglyza, Trajenta, Nesina
mimetics: Byetta, Bydureon, Victoza, Trulicity, Tanzeum
Invokana, Farxiga, Jardiance
-Lantus, Levemir, NPH
- Novolog, Humalog, Apidra, Regular
Have you ever gone low after working out?
Exercise is our MOST potent sensitizer!!
Have you ever eaten a meal only to find yourself hungry 15 minutes later?
Have you ever had to use the restroom excessively when your sugars were high?