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