Rapid: aspart(novolog), Lispro(Humalog), Glulisine(Apidra). Short: Recombinant human insulin (Humulin R). Intermediate: NPH(Humulin N, Novolin N). Slow: detemir(Levemir), Glargine (Lantus). Rapid & short insulins are used to respond to blood glucose increases from a meal. Intermediate & slow insulins are used to provide basal levels of insulin for glucose produced by the liver b/w meals. Rapid insuling can be used on a continuaouds low level infusion for insulin pumps. There are also Combination products of different types of insulin which can be used as a bolus.
Aspart, Lispro, Glulisine. Have a mutation of 1-2 amino acids to inhibit aggregation of insulin. This means the mutation prevents a hexamer formation instead they form monomers or dimers that are absorbed more rapidly.
glargine: has a mutation of 3 amino acids to decrease solubility at neutral pH (instead they are only soluble in a pH of 4 and become insoluble and so they microparcipitate in the blood which causes them to be absorbed slowly & so insulin is slowly added to the blood. detemir: attachment of a fatty acid to the inslulin slows the absorption.
NPH: complexation of insulin with protamines (a protein)… this slows absorption of insulin but not as much as the slow insulins.
hypoglycemia, weight gain, lipoatrophy at injection site, lipohypertrophy at injection site, allergy/sensitivity to non human insulin.
Sulfonylureas: glipizide (glucotrol), glimepiride (amaryl), Glyburide (Micronase, diabeta, glynase). Meglitanides: repaglinide (prandin), Nateglinide (Starlix). MoA: Sulfonylureas bind to ATP-Sensetive potassium-channel receptors and close it which causes depolarization & insulin secretion. Meglitanide interacts w/ the ATP-sensitive potassium channel and ultimately causes depolarization & insulin secretion.
Insulin secretagogues ADR's
hypoglycemia, weight gain, tachyphylaxis (accquire a gradual resistance to the drug resulting in less insulin secretion).
a substance that opposes High blood glucose (improves insulin sensitiviity)
a subsance that promotes normal blood glucose (improves insulin sensitiviity)
a substance that promotes normal blood glucose (improves insulin sensitiviity)
a substance that promotes a decrease in blood glucose (hypoglycemic is a major ADR of these agents).
metformin(Glucophage). MoA: decrease hepatic gluconeogenesis, decrease intestinal absorption of glucose, improve insulin sensitivity by increase uptane & utilization. ADR's: lactic acidosis, diarrhea, contraindicated for patients w/ renal dysfunction b/c it is eliminated renally, & for those that may become hypoxic (COPD).
Acarbose (Precose), Miglitol (Glyset). MoA: delay digestion and absorption of carbs by competitively inhibiting alpha-glucosidase enzymes of the small intestine, causes a slower rise in blood glucose which requires a reduced insulin response. ADR's: farts, diarrhea, abd pain. (these do NOT cause hypoglycemia but can increase possibility when taken w/ insulin. should treat w/ monosaccharides).
incretins are hormones that affect insulin, glucagon and blood glucose. More insulin is secreted in response to oral glucose than IV glucose, due to incretins from the small intestines. Drugs: Linagliptin (Tradjenta), Sitagliptin (Januvia), Saxagliptin (Onglyza). MoA: reduce glucagon secreation, increase insulin secreation, and slow gastric emptying. (DPP-IV is the enzyme that breaks down incetins). ARD's: they are NOT hypoglycemic agents, NO MAJOR ADR'S but some incidents of acute pancreatitis and hypersensitivity reactions.
Drugs: Exenatide (Byetta), Liraglutide (Victoza). Both of these drugs are similar to incretins but are poorly degraded by DPP-IV. MoA: increase insulin, decrease glucagon, slow gastric emptying, decrease appetite. ARD's: nausea, weight loss, ris of ok thyroid C-cell tumors (liraglutide). Drugs: Pramlintide (Symlin) Similar to the hormone amylin (normally secreted w/ insulin from beta-cells but is deficient in diabetes. MoA: slows gastric emptying, decrease glucagon levels, decrease appetite. ADR's: nausea, hypoglycemia b/c it is administered w/ insulin in separate injections.
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