Pharmacology?
Since When?
Treatment Options for Diabetes
Inhaled Insulin
DPP-4
GLP-1
Detemir
Pramilintide
Exenatide
Aspart
Glargine
Glinides
Glitazones
Lispro
Metformin
Human Insulin
Sulfonylurea
Animal Insulin
1922 1950 1982-1985 1995 1996 2001 2003 2005 2006 2007
Type 1
INSULIN
Meal Planning-Physical Activity-etc
Type 2-Gestational
LIFESTYLE
Meal Planning-Physical Activity-Meds maybe-etc
What’s New In Pharmacology?
A=Hemoglobin A1c-Glucose
<6-7%
B=Blood Pressure
<130/80mm/Hg
C=Cholesterol
Diabetes-LDL
Low HDL/ HighTriglycerides-
Small Dense LDL
non-HDL <130
What’s New In Pharmacology?
How to choose-understand
What to choose-understand
What you need to know
What your patient needs to know
What’s New In Pharmacology?
Type 2 Diabetes
Orals
How they work
How to choose
What’s New In Pharmacology?
Sulfonylureas-Pancreas
• Stimulate the pancreas to put out more insulin
• Need to be making insulin!
• Can cause hypoglycemia
• Can cause weight gain
• Before meals/with meals/doesn’t matter
• Diabeta ®,Micronase ®, Glynase ® -glyburide,
Glucotrol ®, XL-glipizide, Amaryl ® -glimiperide,
• OLD-acetohexamide, tolazamide, tolbutamide,
Diabenese ® -chlopropamide
What’s New In Pharmacology?
Meglitinides-Pancreas
• Stimulate the pancreas to put out more insulin
• Shorter duration of action
• Need to be making insulin!
• Can cause hypoglycemia
• Can cause weight gain
• Take one to thirty minutes before meals-
• Working? Check post-prandials
• Prandin ® -replaglinide, Starlix ® -nateglenide
What’s New In Pharmacology?
Alpha-Glucosidase Inhibitors-Intestine
• Blocks the enzymes that absorbs starches in the small
intestine
• Does not cause hypoglycemia when taken alone-if
hypo-need to treat with pure glucose-glucose tabs/gels
• Doesn’t cause weight gain
• Take with the first bite of meal
• GI side effects-gas, bloating, diarrhea
• Do not take-IBD-Other GI-Cirrhosis
• Working? Check post-prandials-fastings
• Precose ® acarbose-Glyset ® -miglitol
What’s New In Pharmacology?
Biguinides-Liver-muscles
• Decreases excess hepatic glucose production
• Increases insulin sensitivity-muscles
• Need to be making insulin!
• May improve lipid profile
• Does not cause weight gain-some weight loss
• Does not cause hypoglycemia when taken alone
• Side effects-GI-taste, flatulence, diarrhea
• Take after largest meal or break up
• Working? Check fastings
• Check Creatinine-Hold for certain procedures/surgery
• metformin-Glucophage, Glumetza, Riomet,Fortamet
What’s New In Pharmacology?
Thiazolidindiones (TZDs)-Muscles-liver
• Improve insulin sensitivity-decreases hepatic glucose
output
• Other risks-benefits
• New black box warning for congestive heart failure
• Can improve fertility in some women-Birth Control
• Can be taken once or twice a day
• Can be taken with or without food
• Report edema, shortness of breath, other sx CHF
• LFTs -q 2 months for first year then periodically
• Avandia ® -Talk with prescriber-Don’t just stop
• Actos ® -pioglitazone, Avandia ® -rosiglitazone
What’s New In Pharmacology?
DPP4-Inhibitors-
• Enzyme DPP4 blocks the message to pancreas to
release insulin, and to decrease hgp
• DPP4 inhibitors allow the message to get through
• Work in two ways
1-Increases insulin production from pancreas
2-Decreases hepatic glucose production hgp
• Working? Check post-prandials
• Weight stable-doesn’t cause hypo alone
• Januvia ® -sitagliptin
What’s New In Pharmacology?
Combination Oral Meds
• Acto Plus Met® = Actos® & metformin
• Duetact® = Actos® & glimepiride
• Glucovance® = metformin & glyburide
• Avandamet® = Avandia® & metformin
• Avandaryl® = Avandia® & glimepiride
• Metaglip® = metformin & glipizide
• Janumet ® =Januvia ® & metformin
What’s New In Pharmacology?
Incretin Mimetics-Replacement-Gut
• Incretin hormone mimics GLP-1
• Stimulate glucose dependent insulin release
• Suppresses hepatic glucose output by inhibiting
glucagon
• Inhibits gastric emptying
• Reduces food intake and body weight
• Enhances-beta cell proliferation in animals and
isolated human islets
• Peptide, so must be taken by injection
• Twice a day, up to one hour before 2 main meals-6hrs.
• Byetta ® -exenatide
What’s New In Pharmacology?
Amylin-Replacement-Pancreas
• For type 1/type 2 who take insulin-lack amylin
• Insulin is (may be) only part of the story
• Reduces blood glucose variability and weight
• Reduces post-prandial blood glucose
• May need to take less insulin-50%, esp.at meals
• Taken within 15”before each meal (tid)
• Taken by injection-different syringe than insulin
• Main side effect is nausea-hypoglycemia
• Contraindicated-gastroparesis
• Symlin ® -pramlintide
What’s New In Pharmacology?
Insulin-Replacement-Pancreas
Insulin is a hormone made in your pancreas that allows
you to use the food you eat for energy
Everyone needs insulin
Some people make the right amount for normal blood
glucose
Some people don’t make any, or very little-type 1 diabetes
Some people make it- fight it-BG ok-insulin resistance
Some people make it, can’t use it, have high blood sugar -
type 2
Everyone needs insulin-it’s a good thing!
What’s New In Pharmacology?
Insulin-Replacement-Pancreas
Is needed for everyone who has type 1 diabetes!
Is needed for many people who have type 2 diabetes
Is needed when meal planning, physical activity, and pills
no longer get you to your blood glucose goals
Is sometimes started later than it should be
Should not be thought of as a threat
Does not mean your diabetes is worse
Does not mean you are doing anything wrong
All insulins are not the same
Can cause low blood sugar-take as much as needed for bs
What’s New In Pharmacology?
Insulin-Replacement-Pancreas
What You Need to Know
Different types of insulin
What type of insulin you use
How to take your insulin
How to store your insulin
How to prevent and treat a low
How to dispose of sharps
What’s New In Pharmacology?
Insulin-Replacement-Pancreas
• Type of Insulin-Onset, Peak, Duration
What’s New In Pharmacology?
Insulin – Administration
What’s New In Pharmacology?
Meds?
Call your rep-pharmacist-Go to the internet….
Pump?
Ask your CDE, patient or family, and/or
Check the back of the pump for the 800# and Call!
What’s New In Pharmacology?
Other
Aspirin
The American Diabetes Association recommends 75-162 mg
per day for people with diabetes >40 years old
Statins
ACE-ARB
Herbs/Supplements
Evidence Based
Unregulated system
May be effects-don’t forget the side effects
If it’s too good to be true, it’s probably isn’t true
There’s no magic pill, potion, or anything for diabetes
& weight loss
What’s New In Pharmacology?
Coagulation
Aspirin
What’s New In Pharmacology?
Amylin-Replacement-Pancreas
• For type 1/type 2 who take insulin-lack amylin
• Insulin is (may be) only part of the story
• Reduces blood glucose variability and weight
• Reduces post-prandial blood glucose
• May need to take less insulin, esp.at meals
• Can cause lows with the use of insulin
• Taken before each meal (tid)
• Taken by injection
• Main side effect is nausea
• Symlin-pramlintide