diabetes medications
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Diabetes Medications. An in-depth look at the medications used to treat diabetes. Type 1 Usually diagnosed in children and young adults People with type 1 diabetes do not make insulin. Type 1 Diabetes. - PowerPoint PPT PresentationTRANSCRIPT
Diabetes Medications
An in-depth look at the medications used to treat diabetes
Type 1 Diabetes
Type 1 Usually diagnosed
in children and young adults
People with type 1 diabetes do not make insulin
Diabetes: Type 1. < http://www.medicinenet.com/script/main/art.asp?articlekey=42943 > Online Image. Retrieved 20 July 2007.
Type 2 Diabetes
Most common type of diabetes
People with type 2 diabetes do not make enough insulin or the insulin they make does not work very well
Diabetes: Type 2. < http://www.medicinenet.com/script/main/art.asp?articlekey=42940 > Online Image. Retrieved 20 July 2007.
Diabetes Goals
Fasting blood sugar goal: 90-130mg/dl
Blood sugar 2 hours after starting a meal: Below 180mg/dl
Bedtime blood sugar goal: 100-140mg/dl
A1c goal: Less than 7%
Abbott Diabetes Care. < http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20:20/product/Products_By_Category.htm > Online Image. Retreived 20 July 2007.
HbA1c Goals
Importance of A1c. < http://www.apidra.com/a1c_glucose_control/Default.aspx > Online Image. Retrieved 07 July 2007.
Oral Medications
Biguanides
Biguanides work by decreasing the amount of sugar produced by the liver. They also increase the ability for sugars to be absorbed by muscle and fat cells, and decrease the body’s ability to resist insulin.
Glucophage® (metformin)
Indicated for type 2 diabetes Has been proven safe in children
Will not see any effect for a few days Can take up to 2 weeks
Take with food to decrease GI side effects Most common side effects are diarrhea, nausea/vomiting,
flatulence, and lactic acidosis
If taking the once daily Metformin, take with your evening meal
Glucophage® (metformin)
If you have kidney problems, make sure your physician is aware of them
If you are having any kind of radiologic studies (CT scan, MRI, etc) stop taking your Glucophage® 72 hours before your test
Sulfonylureas
These work by increasing insulin release from the pancreas, decreasing glucose output from the liver, and increasing the body’s sensitivity to insulin.
FreeStyle Flash®. < http://www.abbottdiabetescare.com/content/en_US/20.10.10:10/product/Product_Profile_0002.htm > Online Image.
Retrieved 23 July 2007.
glimepiride/glipizide/glyburide Indicated for type 2 diabetes
Not approved for use in children
Begins to work within 15 minutes to 3 hours
If taking more than once a day Take 30 minutes before meals
If dosed once a day Take daily with breakfast
Do not take other medications within 2 hours of taking your sulfonylurea
glimepiride/glipizide/glyburide
Sulfonylurea’s are structurally similar to sulfa medications. If you are allergic to sulfa medications, make sure your doctor or pharmacist are aware of your allergy.
Common side effects include: Sun sensitivity Dizziness Hypoglycemia Headache Nausea(Side effects such as headache and nausea will improve
within 1 to 2 weeks of starting your medication)
Thiazolidinediones
These medications work to decrease blood glucose by improving the cells response to insulin.
Recent news on Avandia®
Recent articles have focused on cardiovascular safety and Avandia®
If you have any type of heart disease speak with your doctor about the new information
Do not stop taking Avandia® without talking to your doctor first
GlaxoSmithKline (GSK) has full confidence in the safety of Avandia®, and at this time, Avandia® is not being removed from the market
The FDA is conducting further studies to ensure the safety of Avandia®
Avandia® /Actos®
Indicated for type 2 diabetes
Take once or twice daily
Take with or without food
Begins to work in 2 weeks, however, full effect may not be seen for 2 to 3 months
Avandia® /Actos®
If you have heart disease, make sure your doctor is aware
Have yearly eye exams and liver function tests
Found to decrease A1c by up to 1.4%
Avandia® /Actos®
Side effects: Increased risk of bone fractures in women
(typically hand, arm, ankle, and foot)
Increased risk of becoming pregnant if postmenopausal and still menstruating
Fluid retention
Edema
Avandia® /Actos®
Added Benefits of Actos® : Decreases triglycerides Improves HDL cholesterol
Disadvantages of Avandia® /Actos®: Possible weight gain of up 2 to 6lbs Slight increase in LDL cholesterol
Meglitinides
These work to help the body release insulin at the start of each meal to help control mealtime blood sugar spikes
Accu Chek meter systems. < http://www.accu-chek.com/us/rewrite/content/en_US/2.1:10/article/ACCM_general_article_2353.htm > Online Image. Retrieved
20 July 2007.
Indicated for type 2 diabetes
Take one tablet 30 minutes before each meal Begins to work within 20 minutes Effects last for up to 4 hours
May be taken alone or in combination with other diabetes medications
Most common side effects were hypoglycemia, joint aches, dizziness, and cold/flu symptoms
Store at room temperature
Do not take if you have liver disease
Do not take if you have type 1 diabetes
Alpha Glucosidase Inhibitors
These medications slow the breakdown of carbohydrates in the intestine.
Precose® (acarbose) / Glyset® (Miglitol )
Indicated for type 2 diabetes Not approved for use in children
Start this medication slowly. Gradually increase your dose to three times a day. Take these medications with your first bite of
your main meals
Do not take other medications within 2 hours of these medications
Precose® (acarbose) / Glyset® (Miglitol )
Have your liver enzymes checked every 3 months during your first year of treatment, then periodically
Adverse reactions include: Hypoglycemia Diarrhea Abdominal pain Flatulence
DDP-IV Inhibitors
The newest class of diabetic medications. The pancreas gives the liver messages to make less sugar, while it makes more insulin. However, because of a substance in your blood called DDP-4, those messages do not make it through. DDP-IV inhibitors work by blocking the DDP-4 so that those important messages can get through.
Januvia. < www.januvia.com > Online Image. Retrieved 07 July 2007.
Increases insulin when blood sugars are high
Reduces the amount of sugar made by your liver after you eat
Has been found to decrease A1C by up to 1.5%
Improves fasting and after meal blood glucose levels
Rarely causes hypoglycemia
Dosed once a day, with or without food
Has not been found to cause weight gain
Most common side effects: Runny nose Headache
Galvus®
Soon to be available from Novartis
Improves after meal blood glucose levels
Found to decrease A1C by 1-1.8% When combined with Actos® it has been found to decrease A1C
by up to 2.8%
Low risk of hypoglycemia
Dosed once a day
Side effects include headache, dizziness, and cold/flu symptoms
Incretin Mimetics
These drugs mimic the incretin hormonesfound in your body. These drugs work by increasing your insulin secretion, increasing your beta cell growth/replication, slowing gastric emptying, and by decreasing your food intake.
Byetta®
Byetta® is NOT an insulin
Administer 60 minutes prior to morning and evening meals
Administer injection in the upper arm, thigh or abdomen
Take any other medications 1 hour prior to Byetta® because it may alter the ability of those medications to work
Byetta. <www.byetta.com > Online image. Retrieved 07 July 2007
Byetta®
Before your pens first use, store it in the refrigerator, after you begin using your pen it may be stored at room temperature.
Discard your pen 30 days after initial use.
If your pen gets frozen, discard it.
Do not store your pen with the needles on it. This can cause air bubbles to form in the pen which can be dangerous.
Byetta®
May decrease A1c by up to 2.1%
May cause a weight loss of up to 11.2lbs
Most common side effect was nausea, which does decrease over time
Only indicated for type 2 diabetic patients
Byetta LAR
Expected to be released in 2008
Once weekly version of Byetta®
Decreases fasting blood glucose levels by up to 50mg/dL, and decreases A1c by 2%
Most common side effect is nausea
Rarely found to cause hypoglycemia
Liraglutide
Brand name has not yet been released
Drug Expected to be released in 2008/2009
Indicated for type 2 diabetics
Can be used alone or in combination with metformin or glimepiride
Once daily injection
Amylinomimetic
When used in combination with insulin this class of medications will decrease after meal blood glucose levels by prolonging gastric emptying time, reducing after meal glucagon secretion, and by decreasing your appetite.
Bayer Health Care. < http://www.bayercarediabetes.com/prodServ/products/contour/index.asp > Online Image. Retrieved 20 July 2007.
This is NOT an insulin
It does not replace your insulin, but it is used in combination with your insulin and therefore your insulin dose might be decreased
Do not use this if you have been diagnosed with gastroparesis
Monitor your blood sugar before and after meals while taking this medication
If your A1c level is above 9, this medication is not right for you
Symlin. < www.symlin.com > accessed 07 July 2007.
Store unopened vials in the refrigerator. Once opened, the vial may be stored at room temperature.
Discard your vial 28 days after initial use
Administered as a SQ injection in the thigh or abdomen (do not inject into the arm) at least 2 inches away from a site where you injected insulin
Administer immediately prior to meals containing at least 30 grams of carbohydrates
Take other oral medications 1 hour before or 2 hours after you inject Symlin®
This can cause your blood sugar to drop to low (hypoglycemia). If this is going to occur, it will occur within 3 hours following your injection.
Monitor your blood sugar frequently to prevent hypoglycemia
Never mix Symlin® in the same syringe as insulin
The most common side effect is nausea
Benefits: Fewer blood sugar “swings” throughout
the day
You will feel fuller, so you will eat less, therefore possibly losing weight
You may not need as much insulin
Insulin
Insulin is a hormone produced by the pancreas. It allows the body to use the sugar in food as a source of energy. When you have diabetes, often your body cannot produce its own insulin, so patients use man made insulin instead.
Insulin. < http://health.howstuffworks.com/insulin.htm >. Online Image. Retrieved 20 July 2007.
Insulin Myths
1. Insulin should be a last resort for treatment New guidelines suggest adding insulin earlier in
treatment. Your A1c level should be your goal in determining your treatment plan.
2. Insulin injections are painful You might be surprised at how small and thin the needle
really is. Using an insulin pen can be even less painful.
3. Insulin causes weight gain You may gain a few pounds, however, the benefits to
insulin far outweigh the risk of weight gain.
Benefits to using Pen Insulin
No need to carry insulin vials and syringes Pen contains the needle and insulin
Less painful Pen has a smaller, thinner needle
Ensures the correct dose Dial in the exact units.
Little preparation Pens are fast, easy to use, and easy to store
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
Insulin Summary
Types of Insulin
Onset Duration Examples
Rapid Acting
1 to 30 minutes
2 to 6 hours Apidra®
Humalog®
Novolog®
Exubera®
Arx iDMS®
Short Acting 30 minutes to 1 hour
6 to 8 hours Humulin® RNovolin® R
Intermediate Acting
1 to 4 hours 16 to 24 hours
Humulin® NNovolin® N
Long Acting 1 to 4 hours 12 to 24 hours
Lantus®
Levemir®
Rapid Acting Insulin
They work fast to manage mealtime blood sugar spikes. Rapid acting insulin’s act like insulin the body would make in a patient without diabetes.
Insulin. < http://www.sawstonmedicalpractice.co.uk/display.php?location=Common%20drugs&title=Insulin&home=easy&dir=drug&page=insulin > Online Image. Retrieved 20 July 2007.
Apidra®
Indicated for type 1 or type 2 diabetics
Should be used in combination with a long acting insulin
This is a rapid acting insulin. It begins to work within 1 to 2 minutes It will last for 2 to 4 hours
Apidra®
Should be given 15 minutes before a meal or within 20 minutes of starting a meal
May be given via the OptiClik® injection pen, via an insulin pump, or with a vial and syringe.
May be injected into the thigh, abdomen, or upper arm
Should be clear in color, if not clear then discard
Indicated for type 1 or 2 diabetes
In type 1 diabetes it should be used in combination with a long acting insulin
In type 2 diabetes it should be used in combination with either a long acting insulin or an oral sulfonylurea
Will begin to work within 15 to 30 minutes and will last for 3 to 6 hours
Humalog® /Novolog®
Unopened insulin should be stored in the refrigerator
Once opened insulin may be stored at room temperature for 28 days
If placed in a pump, insulin should be replaced every 48 hours and cartridges should be replaced within 7 days
Humalog® /Novolog®
Humalog® Should be injected 15 minutes before a meal, or immediately after a meal
Novlog® should be administered at the start of a meal, or within 5 to 10 minutes of the start of the meal
May be injected SQ in the upper arm, thigh or abdomen
Available in a vial or in a pen There are 3 Humalog® pens to choose from
HumaPen® MEMOIR ™ HumaPen® LUXURA™ HD Prefilled Pen
There are 4 Novolog® pens to choose from NovoPen® Jr NovoPen® 3 NovoPen® 4 Novolog® FlexPen®
Humalog® /Novolog®
This pen is designed for parents and caregivers of children
Can provide doses in ½ unit increments from 1 to 30 units
Humalog. < www.humalog.com > Online Image. Retrieved 07 July 2007.
Only insulin pen available with a memory
Records the date, time, and amount of insulin for your last 16 doses
Humalog. < www.humalog.com > Online Image. Retrieved 07 July 2007.
Prefilled pen
Pocket size
Simple to dial up
Audible clicks
No refrigeration needed after the first dose
Humalog. < www.humalog.com > Online Image. Retrieved 07 July 2007.
Novolog®
NovoPen® Jr. Designed for kids
Colorful
Able to dial ½ unit increments
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
Novolog®
NovoPen® 3 Can dial up 2 to 70
units
Can dial backwards to correct a dose
Uses cartridges for refills
Store at room temp
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
Novolog®
NovoPen® 4 For use with Novolog®,
NovoRapid®, or Levemir®
End of dose click so you’ll know your insulin has all been delivered
Available in 2 colors-silver and blue
50% less force needed to inject the insulin
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
Novolog®
Prefilled disposable pen with 300 units
Can dial backwards if a mistake is made
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
Exubera®
The first inhaled insulin
Indicated for patients with type 1 or type 2 diabetes above the age of 18
Begins to work within 10 to 20 minutes
Effects last for up to 6 hours
Decreases A1c by up to 1.9%
Exubera. < www.exubera.com > Online Image. Retreived 07 July 2007.
Exubera®
If you use any other inhalers, be sure to use those before using your Exubera®
Administer dose 10 minutes before a meal
Available in 1mg and 3mg blisters Three 1mg blisters do NOT equal 3mg
Exubera®
Do Not use if you: Smoke-you must be
smoke free for at least 6 months
Have a lung disease (asthma, COPD, etc)
Pregnant or under the age of 18
Stored at room temperature
No batteries needed
You must have a lung function test prior to beginning treatment with Exubera®
Dry powder inhaler You won’t feel the powder
as you inhale
Exubera®
Once a foil blister is opened it needs to be used within 3 months
Inhaler must be cleaned once a week Do not place any components in the dishwasher
Release unit must be replaced every 2 weeks Reminder stickers are included in the kit
Inhaler device should be replaced once a year
Exubera®
Potential Side effects
Shortness of breath
Chest pain
Hypoglycemia Monitoring your blood sugar regularly can help prevent this
Cough Tends to occur with minutes after use, but does decrease
over time
AERx® iDMS
Soon to be released from Novo Nordisk ®
Indicated for type 1 and type 2 diabetes
A liquid inhalation
Administered 30 minutes before meals
Inhaler device records the date, time, and units of insulin administered
Short Acting Insulin’s
Cover insulin needs for meals eaten within 30 to 60 minutes
Begins to work within a ½ hour
Lasts for 6 to 8 hours
Should be a clear solution Discard if solution is not clear
Injected SQ into the thigh, arm, buttock, or abdomen
Do not inject cold insulin Roll vial gently in hand first to warm and mix the insulin
Humulin® R / Novolin® R
Typically this medication is injected 30 to 60 minutes before a meal
This is usually given 2 to 4 times a day
Humulin® R / Novolin® R
If mixing with another insulin, draw regular insulin into the syringe first
Do not freeze If insulin has frozen, discard
Store unopened vials in the refrigerator Upon opening, insulin may be stored at room
temperature for 28 days
Humulin® R / Novolin® R
Novolin® R
Novolin® R Pen Can be used with the
pens featured under Novolog
Store in the refrigerator until ready to use
Store at room temperature once opened
Discard 28 days after initial use
Novolin® R Novolin® R innolet
Disposable
Large numbers
Audible clicks
Store refrigerated until ready to use
Store at room temperature once opened
Insulin Devices. < http://www.insulindevice.com/innolet/features.asp > Online Image. Retrieved 07 July 2007.
Intermediate Acting Insulin’s
Begins to work after a couple of hours, but can last for up to 24 hours.
Humulin® N, Novolin® N Indicated for type 1 or type 2 diabetes
Begin to work in 1 to 2 hours
Duration is 16 to 24 hours
Store unopened vials and pen cartridges in refrigerator If freezing occurs, discard insulin
Store opened vials at room temperature for 28 days, and opened pen cartridges at room temperature for 14 days
Humulin® N, Novolin® N Usually administered 1 to 2 times daily
Inject SQ into abdomen, buttocks, thigh, or upper arm Solution should be clear, discard if not clear
Do not inject cold insulin Roll insulin vial in palm of hands to warm and mix before injecting
May be used with a vial and syringe or in a pen
If mixing with regular insulin, draw regular insulin into the syringe first
Long Acting Insulin’s
Provide steady 24 hour blood sugar control.
One Touch Ultra 2. < http://www.lifescan.com/products/meters/ultra2/;jsessionid=OTGAYXOAK5NKGCQPCAMFRZAKB2IIWTT1 > Online Image. Retrieved 20 July 2007
Indicated for type 1 or type 2 diabetics Not indicated for children under the age of 6
Onset of action is 1 to 2 hours
Duration is 24 hours
Dosed once daily at any time of day Inject at the same time each day
Do NOT mix with any other insulin
Store unopened vials in the refrigerator If insulin freezes, discard
Opened vials and pen cartridges may be stored at room temperature for 28 days Available in vials for use with a syringe or in cartridges for
use in a pen
Injected SQ into thigh, arm, buttock, or abdomen
Clear solution, if solution is not clear then discard
OptiClik® Pen: Pen available FREE from
your physician
Insulin cartridges available from your pharmacy
Digital dose display
Audible clicks
Doses from 1 unit to 80 units
Pen may also be used with Apidra®
Added benefits of Lantus®
Decreases A1c by up to 1.7%
Once a day injection
When used in combination with Metformin or a sulfonylurea, Lantus® has been found to decrease free fatty acids which are linked to complications of diabetes such as insulin resistance
Indicated for type 1 or type 2 diabetics Not indicated for children under the age of 6
Begins to work in 3 to 4 hours
Store unopened in the refrigerator Discard if insulin freezes
Once opened vials and pens are stable at room temperature for 42 days
Long acting insulin Except at low doses-then it becomes an intermediate acting
insulin
Do not use in an insulin pump May be used in a syringe or a pen
Dosed once or twice a day Once daily dose is given with the evening meal or at
bedtime
Twice daily dosing is given in the morning and then 12 hours later
May be injected in the arm, thigh, buttock, or abdomen
Solution should be clear Discard insulin if solution is not clear
Do not inject insulin cold Roll vial in palm of hand to warm and mix
solution
FlexPen®
Disposable
Prefilled
Store at room temperature for up to 42 days
Do not store pen with needles attached
Novolog. < www.novolog.com >Online Image. Retrieved 07 July 2007.
Levemir. < www.levemir.com > Online Image. Retrieved 07 July 2007.
Hypoglycemia
If your blood sugar gets to low, your brain can run out of “fuel”, this can cause serious complications if not treated.
Hypoglycemia
Make sure your family & friends know what to do if your blood sugar gets to low.
Signs/Symptoms: Anxiety Blurred vision Feeling Cold Feeling Weak Drowsiness Weak Headache Hunger Sweating Trembling Unconscious
Hypoglycemia
Treatment of hypoglycemia: 15g of Carbs, which include things like:
Glucose tabs (3-4 or equivalent to 15g) 4oz fruit juice Frosting (equivalent to 15g) Meat & Cheese sandwich
Test your blood sugar 15 minutes later If still low repeat treatment options Recheck another 15 minutes later-if still low, contact
your health care provider
GlucaGen® Hypokit
Small, compact
Quick, easy to use
Contains everything needed to increase your bloodsugar
No medical training required for use
Glucagen. < http://www.novonordisk.com/diabetes/public/hypokit/glucagenhypokit/actualsize.asp. > Online Image. Retrieved 12 July 2007.
References• Abbott Diabetes Care. <http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20:20/product/
Products_By_Category.htm > Online Image. Retreived 20 July 2007.
• Accu Chek meter systems. < http://www.accu-chek.com/us/rewrite/content/en_US/2.1:10/article/ACCM_general_article_2353.htm > Online Image. Retrieved 20 July 2007.
Actos. < www.actos.com > Retrieved. 07 July 2007. Apidra. < www.apidra.com > Retrieved 07 July 2007. Armstrong, L. Lacy, C., Goldman, M., Lance, L. (2007). Drug Information Handbook (15th ed). Hudson, Oh: Lexi-Comp. Avandia. < www.avandia.com > Retrieved 07 July 2007. Avandia in the News: Questions and Answers. < http://www.avandia.com/pdf/Important_Information_for_Patients_2.pdf >
Retrieved 15 July 2007. Bayer Health Care. < http://www.bayercarediabetes.com/prodServ/products/contour/index.asp > Online Image. Retrieved 20
July 2007. Bellaire, S., Clauson P., Cramer J., Okikawa J. Compliance with inhaled insulin treatment using the AERx® iDMS insulin
Diabetes Management system. Diabetes Tchnology and Therapeutics. 2004: 800-807. Berkrot, Bill. Novo Nordisk’s liragulatide effective in Japan study. Reufers. 23 June 2007. <
www.aletnet.org/thenews/newsdesk/n21400781.htm >. Accessed 07 July 2007. Byetta. < www.byetta.com > Retrieved 07 July 2007. Diabetes: Type 1. < http://www.medicinenet.com/script/main/art.asp?articlekey=42943 > Online Image. Retrieved 20 July
2007. Diabetes: Type 2. < http://www.medicinenet.com/script/main/art.asp?articlekey=42940 > Online Image. Retrieved 20 July 2007. Exubera. < www.exubera.com > Retrieved 07 July 2007. FreeStyle Flash®. < http://www.abbottdiabetescare.com/content/en_US/20.10.10:10/product/Product_Profile_0002.htm >
Online Image. Retrieved 23 July 2007. Galvus. <http://www.pharma.us.novartis.com/newsroom/pressReleases/releaseDetail.jsp?PRID=2007 > Retrieved 07 July
2007. Glucagon. < http://www.novonordisk.com/diabetes/glucagenhypokit_splash.asp > Retrieved 07 July 2007.
References continued
Humalog. < www.humalog.com > Retrieved 07 July 2007. Importance of A1c. < http://www.apidra.com/a1c_glucose_control/Default.aspx > Online Image.
Retrieved 07 July 2007. Insulin. < http://www.sawstonmedicalpractice.co.uk/display.php?location=Common
%20drugs&title=Insulin&home=easy&dir=drug&page=insulin > Online Image. Retrieved 20 July 2007. Insulin. < www.virtualsciencefair.org > accessed 15 July 2007. Insulin Devices. < http://www.insulindevice.com/innolet/features.asp > Retrieved 07 July 2007. Insulin Myths and Realities. < http://www.goinsulin.com/insulin_myths_and_facts/default.aspx > accessed 15 July 2007. Januvia. < www.januvia.com > Retrieved 07 July 2007. Lantus. < www.lantus.com > Retrieved 07 July 2007. Levemir. < www.levemir.com > Retrieved 07 July 2007. Liraglutide. < www.glucagon.com >. Retrieved 10 July 2007. Novolog. < www.novolog.com > Retrieved 07 July 2007. One Touch Ultra 2. <
http://www.lifescan.com/products/meters/ultra2/;jsessionid=OTGAYXOAK5NKGCQPCAMFRZAKB2IIWTT1 > Online Image. Retrieved 20 July 2007
Prandin. < www.prandin.com > Retrieved 15 July 2007. Starlix. < www.starlix.com > Retrieved 15 July 2007. Symlin. < www.symlin.com > Retrieved 07 July 2007.