Antidiabetic Drugs

I. Injectable hypoglycemics Insulin Preparations MOA > increase uptake of glucose, amino acids & free fatty acids for storage > synthesize glycogen, fats & Proteins onset 5 min peak O.5 – 1 h Indication Type 1 & type2 DM SE HypoglycemiaReaction :Insulin shock HA, lightheadedness nervousness, tremors, tachycardia sweating, slurred speech memory lapse, seizure excessive hunger blood sugar= < 60 mg/dl

A. Short acting/ rapid acting 1. Lispro (Insulin analog) • Humalog 2. Crystalline Zinc Insulin (Regular) • Humulin R, Novolin R 3. Semilente B. Intermediate/ short acting 1. NPH insulin • Humulin N, Novolin N 2. Lente insulin • Humulin L, Novolin L C. Long-acting 1. Ultralente insulin a. Humulin U 2. Protamine Zinc Insulin (PZI) D. Combination 1. NPH + Regular insulin • Humulin 70/30 • Humulin 50/ 50

duration 2–4h Hyperglycemic Reaction:DiabeticKetoacidosis polyuria , extreme thirst dry mucous membranes, poor turgor fruity breath, kussmaul rapid, thready pulse blood sugar = > 250 mg/dl Hypersensitivity reactions Local sensitivity reactions to site of injection

0.5 – 1 h

2–4h

6–8h

1 – 1.5 h 1–2h 1–2h

1–4h 6 -12 h 8 – 12 h

12 – 16 h 18 – 24 h 18 – 24 h

5–8h 4 – 8 h 14 – 24 h

14 – 20 h 24 – 36 h

> 36 h

0.5 h 0.5 h

4–8h 4–8h

22 – 24 h 24 h

• Humulin 75/25

15 min

0.5 – 6 h

20 – 24 h Indication Type 2 DM unresponsive to diet SE Hypoglycemia GI effects; n & v hematologic effects: leucopenia, thrombocytopenia disulfiram- like or antabuse –like effect

II. Oral Hypoglycemics MOA A. Sulfonylurea >stimulates pancreas to secrete insulin 1. 1st generation Short acting • Tolbutamide 1st generation Intermediate acting • Acetohexamide • Tolazamide 1st generation long acting • Chlorpropamide

2. 2nd generation
• Glypizide • Glyburide • Glimepiride

B. Nonsulfonylureas
1. Biguanides > improve insulin sensitivity • Metformin (Glucophage) > decrease glucose absorption in SI > decrease hepatic glucose production 2. Alpha glucosidase inhibitor >delay absorption of glucose in SI • Acarbose • Miglitol 3. Thiazolidinediones • Rosiglitazone (Avandia) • Pioglitazone (Actos) 4. Meglitinides • Repaglinide • nateglinide > decrease insulin resistance (Insulin enhancing agent)

type 2 DM unresponsive to diet

GI effects: anorexia, diarrhea, vomiting, flatulence Lactic acidosis GI effects

weight gain, hepatotoxic

> increase pancreatic release of insulin

 Glucose elevating agents
 Diazoxide (oral)

indication > counteract hypoglycemia in hyperinsulinism

Glucagons (IV)

> counteract insulin-induced hypoglycemic attacks GOOD LUCK and GOD BLESS!!!!