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Diabetes 101: The Drugs

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Kristen Abbott

on 13 May 2015

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Transcript of Diabetes 101: The Drugs

Diabetes 101:
The Drugs

Kristen Abbott, PharmD
PGY1 Pharmacy Resident
Mission Hospital
May 12, 2015

The 4 M's of Diabetes:
Meal Planning
Monitoring
Movement
Medication
Diabetes
Iceberg Effect
Insulin Resistance
Present before blood sugars are elevated
Caused by genetics, obesity, and inactivity
Increases heart attack/stroke risk...
MICROvascular Complications
MICROvascular = small blood vessels
kidneys
eyes
nerves
Often present to some extent at diagnosis
MACROvascular Complications
MACROvascular = large blood vessels
Heart attack
Stroke
Heart disease is the leading cause of death in diabetes

tip of the iceberg:
high blood sugars
More on
Insulin Resistance:
A gentle Balance:
food/sugar
insulin
The Secretagogues:

the
how they work:
ex: glipizide, glimepiride, glyburide
P
R
O
S
the
-hypoglycemia!!!
-weight gain
-sun sensitivity
-metallic taste
-requires functioning pancreas
-lowers A1C by 2%
-inexpensive
-many years of data to support use (been around since 1984)
-stimulates pancreas to release insulin
-reduces MICROvascular complications
Metformin
Works in many ways:
reducing insulin resistance = less locks
helps organs use insulin
decreased glucose made by the liver
Pros:
Cons:
-lowers A1C up to 2%
-proven mortality benefits
-low risk of hypoglycemia
-weight neutral
-may improve triglycerides
-inexpensive
- diarrhea
- gas
- lactic acidosis (rare)
#1 Drug of choice in Type 2 Diabetes!
"TZDs"
Pioglitazone (Actos)
Insulin sensitizer = less locks
(helps body use its own existing insulin better)
Advantages:
preserves pancreas cell function
low hypoglycemia risk
inexpensive
Disadvantages:
weight gain
swelling
bladder cancer (rare)
cannot be used with heart failure
"Gliptins"
Incretin Mimetics
SGLT-2
Inhibitors
Insulin
Januvia
Onglyza
Tradjenta
Nesina
How they work:
decreasing blood
sugars after meals by
inhibiting breakdown of incretins in stomach
The PROs:
- meal time coverage
- well tolerated, low risk of hypoglcemia
- once daily dosing
- weight neutral
The CONs:
- expensive
- cold-like symptoms
The way they work:
- similar action in stomach as "gliptins"
- stops liver from making extra glucose
- decreases appetite
- enhances satiety
Byetta
Bydureon
Victoza
Tanzeum
Trulicity
Benefits:
Risks:
- weight loss
- insulin sparing
- used in type 1 and 2
- preserves pancreas cell function

- nausea
- pancreatitis (rare)
- expensive

FYI:
- 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
Normally....
Diabetes vs. Non-diabetes
Invokana
Farxiga
Jardiance
allows kidneys to release more glucose through urine
**smaller glass of water=
more overflow!**
ACTION:
Advantages:
- weight loss
- insulin sparing
- low risk of hypoglycemia
- benefit in type 1 and type 2 diabetes
disadvantages
- newest agents, least data
- urinary tract and yeast infections
- expensive
provides external supply of insulin to overcome lack of production by body
the PROs:
the CONs:
-most effective!
-direct action
-mimics natural insulin in body
- weight gain
- swelling
- hypoglycemia
- expensive
"Basal" insulin:
used to offset body's natural production of glucose
- glargine (Lantus)
- detemir (Levemir)
- NPH (Novolin N, Humulin N)
FYI:
- long acting
- used once or twice daily
- covers fasting blood sugars
- can be used with oral medications
- NPH insulin is cloudy
"Bolus" insulin:
used to offset glucose taken in through diet
- aspart (Novolog)
- lispro (Humalog)
- glulisine (Apidra)
- regular (Novolin R, Humulin R)
FYI:
- 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:
- incretins
- insulin
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?
with diabetes:
insulin
food/sugar
How might we
get more keys?
More keys!
C
O
N
S
A summary:
Insulin sensitizers:
metformin, Actos, & exercise
Secretagogues:
glipizide, glimepiride, glyburide
Incretin agents:
gliptins: Januvia, Onglyza, Trajenta, Nesina
mimetics: Byetta, Bydureon, Victoza, Trulicity, Tanzeum
SGLT-2 inhibitors:
Invokana, Farxiga, Jardiance
insulin:
BASAL:
-Lantus, Levemir, NPH
BOLUS:
- 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?
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