DIABETES AND LIPID LOWERING DRUGS

DIABETES

DIABETES AND LIPID LOWERING DRUGS

STANDARD TREATMENT VS INTENSIVE TREATMENT

DIABETES

INSULIN

RAPID
Aspart
SHORT
Soluble insulin
INTERMEDIATE
Isophane insulin
(NPH)

MECHANISM OF ACTION
To mimic prandial (mealtime) insulin.
Aspart must be consumed right before meal or up to 15mins
after meal whereas soluble insulin 15mins prior meal or
immediately after.
Subcutaneously
Delayed absorption from its conjugation with protamine,
forming less soluble complex. SubC

Standard treatment involves injection of insulin twice daily. In

contrast intensive treatment involves more frequent
injections.
ADA recommend target mean blood glucose levels of Hba1c
of 7% or less or 154mg/dL

INDICATION

In emergency e.g. DKA given IV

subC in regular basis usually given with
LA

All type of diabetes except DKA

Use for basal control and usually given
with rapid or short acting insulin for
mealtime control

ADVERSE EFFECTS

Headache
Anxiety
Tachycardia
Confusion
Vertigo
Diaphoresis
Lipodystrophy
Hypersensitivity

DIABETES AND LIPID LOWERING DRUGS

LONG
Glargine

Isoelectric point of insulin glargine is lower than that of human

insulin, leading to precipitation at the injection site and
extending its action.

Stimulate insulin release from -cells by blocking the ATP

+
sensitive K channel
Reduce hepatic glucose production
Increase peripheral insulin sensitivity
Pharmacokinetics
Extensively metabolised by CYP 450 enzymes in the liver
Excreted via liver and kidney
To be used with caution in patients with renal or hepatic
insufficiency
1. Reduction of hepatic glucose output (inhibits gluconeogenesis)
2. Slows intestinal absorption of sugars
3. Improves peripheral glucose uptake and utilisation (especially
in muscle cells)
4. Reduces hyperlipidemia
Pharmacokinetics
Not metabolised, cleared from the body by active tubular
secretion, excreted unchanged in the urine
To be used with caution in patients with renal insufficiency or
those predisposed to metabolic acidosis

Given subC
Slower onset than NPH, and has flat,
prolonged hypoglycaemic effect with no
peak

TZDS/GLI
TAZONE

BIGUANIDES

SULPHONYLUREAS

GLICLAZIDE

METFORMIN

PIOGLITAZONE

Suitable for pt with DM2 that cannot be

controlled with only diet

Activate the transcription factor PPAR, which affects adipose

cell differentiation and lipid metabolism
Metabolised in the liver by CYP 450 enzymes, metabolites are
eliminated mainly in bile

useful in overweight people with

diabetes

HYPOGLYCAEMIA
6.

Clinical Features
1.
2.
3.
4.
5.

AUTONOMIC
Anxiety
Sweating
Hunger
Tremor
Palpitations

1.
2.
3.
4.
5.

NEUROGLYCOPENIC
Confusion
Vertigo
Drowsy
Visual trouble seizures
Coma

Can suppress appetite

and causes less weight
gain than sulphonylureas
Largely gastrointestinal
including anorexia,
diarrhoea, nausea and
abdominal discomfort
May cause lactic acidosis

Weight gain
Fluid retention
Heart failure
Bladder cancer?

Dizziness

Hypoglycaemia
Weight gain (as insulin
preferentially deposits
calories in adipose tissue
in Type 2 diabetics)
Hyperinsulinemia

DIABETES AND LIPID LOWERING DRUGS

Initial Management
if x swallow - 2550ml 50% glucose IV
(via larger vein with
0.9% saline flush to
prevent phlebitis)
OR

oral sugar or LA
starch (toast)

glucagon 1mg IM if
no IV access (SA so
repeat after 20min
and follow with oral
carbs)

DIABETIC KETOACIDOSIS
Clinical Features

Ketonaemia 3 mmol/L or significant ketonuria (++ on urine dipstick)

Blood glucose >11 mmol/L or known diabetes mellitus
Bicarbonate (HCO3-) <15 mmol/L and/or venous pH < 7.3

Intial Management
Fluid replacement

commence 0.9%
NaCl via infusion
pump + K+
replacement

STATIN

LIPID DIS.

SIMVASTATIN

IV insulin infusion
(0.1u/kg/hr)

MOA
Inhibit enzyme HMG
Co A reductase in
cholesterol synthesis

INDICATION

systolic <90mmHg 500ml NaCl/10-15min

systolic >90mmHg 1000ml/60mins

50u soluble insulin

(SA) made up to
50ml with 0.9%
NaCl solution

Primary Hyperlipidaemia
(Reduce LDL by 30% &
Raise HDL by 20%)
2 Hypercholesterolemia

CONTRAINDICATION

during pregnancy
and lactation

ADVERSE EFFECTS

Headache, nausea, rashes

Sleep disturbances
Rise in serum transaminase
Myositis & Rhabdomyolysis

Potassium
>5.5 - NIL
3.5 - 5.5 - 40mmol/L
<3.5 - senior review

INTERACTION
increased statin concentrations
e.g ciclosporin, clarithromycin,
calcium channel blockers,
antifungals