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DH206: PharmacologyChapter 21: Diabetes MellitusLisa Mayo, RDH, BSDH
Pancreatic Hormones
Pancreatic HormonesIslets of Langerhans
1. Alpha cells: secrete glucagon 2. Beta cells: secrete insulin
Diabetes Mellitus▫Read p.233-237 for review of Type I & Type
II diabetes if needed
Pancreatic Hormones
Diabetes Mellitus▫Drugs used to manage: presented differently than
book1. Insulin2. Sulfonylureas 3. DPP-4 Inhibitors 4. Meglitinides5. Biguanides6. Alpha-Glucosidase Inhibitors7. Thiazolidinediones8. Combination drugs9. Parental Adjuncts
Pancreatic Hormones
Need to know drugs in ppt in ea category!
Drugs work on pancreas
1. InsulinoSub-QoUsed for Type I, some Type IIoDrugs vary in onset action & durationoAdverse effect = Hypoglycemia
Pancreatic Hormones
ONSET & DURATION
DRUG
Short-Acting Insulin apart(Novolog)Insulin lispro(Humalog)
Intermediate-Acting Insulin NPH(Humulin, Novolin)
Long-Acting Insulin detemir(Levemir)Insulin glargine(Lantus)
BOOK CORRECTION ON MED LIST & ONSET/DURATIONUSE THIS LIST, NOT BOOK
Pancreatic Hormones1. Insulin
Indicated for Type I & II (when cannot be controlled by other means)
AdministrationoSubcutaneous injectionoIV/IM for medical emergencies (ketoacidosis,
diabetic coma)oNOT given orally
Insulin’s differ in onset and duration of action but have similar metabolic effects
p.237
Injectable Insulin
receptor is target tissue
Pancreatic Hormones1. Insulin Adverse Reactions
1) Hypoglycemia is the most common adverse reaction to insulin (Administer glucagon: cake frosting)
2) Lipodystrophy at site of injection: disappearance of subcutaneous fat at site of injection
Diabetes Mellitus▫Drugs used to manage: presented differently
than book1. Insulin2. Sulfonylureas 3. DPP-4 Inhibitors 4. Meglitinides5. Biguanides6. Alpha-Glucosidase Inhibitors7. Thiazolidinediones8. Combination drugs9. Parental Adjuncts
Pancreatic Hormones
Drugs work on pancreas
Side Effects:Weight gain
Hypoglycemia
2. Sulfonylureas / Secretagogueo First oral agents used in diabetes managemento 1st & 2nd generation drugs (2nd most common = less side
effects, more potent so smaller doses used and less toxicity chance)
o Mechanism of action Stimulate release insulin from beta cell of pancreas
(see next slide)
Pancreatic Hormones
Sulfonylureas/Secretalgogues
Glimepiride(Amaryl)
Glipizide(Glucotrol)
Glyburide(DiaBeta, Glynase)
p.238
↑ Insulin secretion
Sulfonylureas
3. DPP-4 Inhibitors Physiology Review▫ Incretin GLP-1 (gut hormone that is glucose-
dependent)↓
▫ Cause release of insulin in response to glucose in the gut (diabetics have less secretion of GLP-1)
▫ Drugs in this category inhibit DPP-4 so GLP-1 has more time to stimulate insulin secretion
▫ Remember: insulin moves glucose out of the blood
Pancreatic Hormonesp.240
DPP-4 INHIBITOR
Sitagliptin(Januvia)
DPP-4 breaks down GLP-1
DPP-4 Inhibitors
↑ Insulin secretion
4. MeglitinidesNewest class of oral drugs Increase insulin secretion from pancreas but at a different site than sulfonylureas drugs
Taken before meals – miss meal do NOT take drugWeight gain, hypoglycemia common
Pancreatic Hormones
MeglitinidesRepaglinide(Prandin)
nateglinide(Starlix)
p.238
Meglitinides
↑ Insulin secretion
Different receptors on pancreas than sulfonylureas
Diabetes Mellitus▫Drugs used to manage
1. Insulin2. Sulfonylureas 3. DPP-4 Inhibitors 4. Meglitinides5. Biguanides6. Alpha-Glucosidase Inhibitors7. Thiazolidinediones8. Combination drugs9. Parental Adjuncts
Pancreatic Hormones
Side Effects:LDL chol.Cardiac
RespiratoryRenal
NO weight gain or hypoglycemia
5. BiguanidesAction
Decrease glucose productionStimulate glucose uptake into tissues
No weight gain, hypoglycemia like sulfonylureas & meglitinidesDOES NOT affect insulin production/secretion – why
does not cause hypoglycemia or weight gain
Pancreatic Hormones
Biguanides
Metformin(Glucophage)
p.238
Diabetes Mellitus▫Drugs used to manage: presented differently than
book1. Insulin2. Sulfonylureas 3. DPP-4 Inhibitors 4. Meglitinides5. Biguanides6. Alpha-Glucosidase Inhibitors7. Thiazolidinediones8. Combination drugs9. Parents Adjuncts
Pancreatic Hormones
NO weight gain, hypoglycemia
Side Effect: GI
6. α-Glucosidase InhibitorsACTIONInterfere with CHO digestion through enzyme blocking in stomach
↓Delays glucose absorption
↓Prevents blood glucose levels after meals
(postprandial) from immediately peaking
Pancreatic Hormones
α-Glucosidase InhibitorsAcrabose(Precose)Miglitol(Glyset)
p.240
Stomachα-Glucosidase Inhibitors
Diabetes Mellitus▫Drugs used to manage: presented differently
than book1. Insulin2. Sulfonylureas 3. DPP-4 Inhibitors 4. Meglitinides5. Biguanides6. Alpha-Glucosidase Inhibitors7. Thiazolidinediones8. Combination drugs9. Parental Adjuncts
Pancreatic Hormones
Side Effects:
Weight gainFluid retentionLiver damage
Thiazolidinediones & Combo missing from your text Very important drugs in diabetes management – in board books
6. Thiazolidinedione's ▫ Newer drugs, 2nd line therapy, usually used in
combo with other drugs▫ Referred to as “insulin sensitizers”▫ Action
Enhance insulin response in fat & liver cells = glucose utilized more efficiently
Causes the removal of glucose from blood into cells
Pancreatic Hormones
Thiazolidinediones
Rosaglitazone(Avandia)
Prolitazone(Actos)
Thiazolidinediones(fat & liver)
“Insulin sensitizer”
Diabetes Mellitus▫Drugs used to manage: presented differently
than book1. Insulin2. Sulfonylureas 3. DPP-4 Inhibitors 4. Meglitinides5. Biguanides6. Alpha-Glucosidase Inhibitors7. Thiazolidinediones8. Combination drugs9. Parental Adjuncts
Pancreatic Hormones
Thiazolidinediones & Combo missing from your text Very important drugs in diabetes management – in board books
8. Combination drugs
Pancreatic Hormones
Combination Drugs: Metformin
+
Classification
Glipizide(Metagrip) Sulfonylureas
Glyburide(Glucovance) Sulfonylureas
Rosiglitazone(Avandamet)
Thiazolidinedione
Diabetes Mellitus▫Drugs used to manage: presented differently
than book1. Insulin2. Sulfonylureas 3. DPP-4 Inhibitors 4. Meglitinides5. Biguanides6. Alpha-Glucosidase Inhibitors7. Thiazolidinediones8. Combination drugs9. Parental Adjuncts
Pancreatic Hormones
Pancreatic Hormones
DRUG NOTATIONS
Exenatide(Byretta) Injectable non-insulinGLP-1 agonist
Pramlintide(Symlin)
Injectable non-insulin used at mealtimesAmylin Analog (amylin slows gastric emptying & is deficient in diabetics)Helps increase satietyMANY BLACK BOX WARNINGS
p.240
9. Parental Adjuncts: not to be used as stand-alone tx
These agents are NOT in Mosby’s DH Board Review Book