Pharmacology- Endocrine: diabetes
- ANS-
\Alpha cells of pancreas - ANS-secretory products: glucagon, proglucagon
\Alpha-glucosidase inhibitors - ANS-MOA: block enzymes that digest starches in small
intestine= slows glucose absorption
efficacy: decrease peak after meal glucose 40-50, decrease A1C 0.5-1%
EX: Acarabose(Precose), miglitol(Glyset)l
*only drug that doesn't specifically target disease, decreased effect in pts w/ low carb diet
considerations/ADEs: flatulence, diarrhea, and discomfort, no spec effect on lipids or BP, no
wt gain, hypoglycemia w/ secretagogue,
contraindications: pts w/ IBS or cirrhosis
\Amylin Analog - ANS-an Incretin analog, synthetic analog of amylin
given subQ right before meal
MOA: binds to amylin recpetors- slows gastric emptying, similar effect to GLP1 analog
* used in DM 1 and 2- suppresses glucagon secretion, delays gastric emptying, suppresses
appetite
efficacy: 0.5-1% reduction of A1C, effective after meal glucose reduction
considerations/ADEs: ***HIGH risk of hypoglycemia!- decrease short acting insulin dose by
50% when starting this, contraindicated in ppl that don't realize their symptoms of
hypoglycemia or are frequently hypoglycemic
ex. pramlintide(symlin)
\assessment standards-glucose checks - ANS--at least q 6 months for those patients
meeting goals and in good control
-at least every three months for those not meeting goals or have had therapy changes
-Fasting lipid profiles should be obtained as part of an initial assessment and thereafter at
each follow-up visit if not at goal, annually if stable and at goal, or every 2 years if the lipid
profile suggests low risk.
\Basal-Bolus Insulin- why? - ANS-basal insulin ("baseline"):
-controls glucose production b/t meals and overnight
-near constant levels
-usually 50% of daily needs
, Bolus insulin ("mealtime or prandial"):
- limits hyperglycemia after meals
-immediate rise and sharp peak at 1 hour after meal
-10-20% of total daily insulin requirement at each meal
example: total requirement: 60 units/day= lentos 30 unitsQHS + 10 units Humalog w/ meals
(30 units divided into three for each of three meals)
considerations:
-education: need to learn carb counting, must have motivated/comptetent patient
-advantages: mimics physiologic insulin, less hypoglycemia, flexible
-disadvantages: cost, frequent injections
\beta cells of pancreas - ANS-made insulin, C-peptide, proinsulin and amylin
\Bile Acid Sequestrants - ANS-MOA: bile acid binder= lowered glucose via unknown
mechanisms
efficacy: minimally effective in lowering glucose: 0.3-0.5% A1C reduction
considerations: constipaiton, indigestion, flatulance, hypersensitivity rxns, large
pills(dysphagia), can exacerbate high tags, not systemically absporbed
\Continuous SubQ insulin for Type II DM - ANS-patient candidates: absolutely insulin
deficient, take 4+ injections/day, assess blood glucose levels 4+times/day, motivated for
tighter glucose control, COMPETENT in carb counting, insulin correction and adjustment
formulas, ability to troubleshoot pxs, stable life situation, frequent contact w/ healthcare
provider
\delta cell of pancreas - ANS-make somatostatin
\diagnosis of DM - ANS-Based on four critera:
1. Fasting plasma glucose≥126 mg/dL (≥7 mmol/L),
2. a 2-hour value from a 75-g oral glucose tolerance test ≥200 mg/dL (≥11.1 mmol/L),
3.a casual plasma glucose level of ≥200 mg/dL (≥11.1 mmol/L) with symptoms of diabetes,
4. or a hemoglobin A1c [HbA1c] ≥6.5% (≥0.065; ≥48 mmol/mol Hb).
The diagnosis should be confirmed by repeat testing if obvious hyperglycemia is not present.
HbA1c ≥6.5% (≥0.065; ≥48 mmol/mol Hb). The test should be performed in a laboratory
using a method that is National Glycohemoglobin Standardization Program (NGSP) certified
and standardized to the DCCT assaya
Fasting plasma glucose ≥126 mg/dL (7 mmol/L). Fasting is defined as no caloric intake for at
least 8 hoursa
2-hour plasma glucose ≥200 mg/dL (≥11.1 mmol/L) during an OGTT. The test should be
performed as described by the World Health Organization, using a glucose load containing
the equivalent of 75-g anhydrous glucose dissolved in watera
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random
plasma glucose concentration ≥200 mg/dL (≥11.1 mmol/L)
\Dipeptidyl Peptidase-4 inhibitors (DPP-4 Inhibitor) - ANS-MOA: inhibits breakdown of
glucagon-like peptide (GLP-1) secreted during meals which then helps increase glucose
medicated insulin release; suppresses glucagon secretions, delays gastric emptying=satiety
- ANS-
\Alpha cells of pancreas - ANS-secretory products: glucagon, proglucagon
\Alpha-glucosidase inhibitors - ANS-MOA: block enzymes that digest starches in small
intestine= slows glucose absorption
efficacy: decrease peak after meal glucose 40-50, decrease A1C 0.5-1%
EX: Acarabose(Precose), miglitol(Glyset)l
*only drug that doesn't specifically target disease, decreased effect in pts w/ low carb diet
considerations/ADEs: flatulence, diarrhea, and discomfort, no spec effect on lipids or BP, no
wt gain, hypoglycemia w/ secretagogue,
contraindications: pts w/ IBS or cirrhosis
\Amylin Analog - ANS-an Incretin analog, synthetic analog of amylin
given subQ right before meal
MOA: binds to amylin recpetors- slows gastric emptying, similar effect to GLP1 analog
* used in DM 1 and 2- suppresses glucagon secretion, delays gastric emptying, suppresses
appetite
efficacy: 0.5-1% reduction of A1C, effective after meal glucose reduction
considerations/ADEs: ***HIGH risk of hypoglycemia!- decrease short acting insulin dose by
50% when starting this, contraindicated in ppl that don't realize their symptoms of
hypoglycemia or are frequently hypoglycemic
ex. pramlintide(symlin)
\assessment standards-glucose checks - ANS--at least q 6 months for those patients
meeting goals and in good control
-at least every three months for those not meeting goals or have had therapy changes
-Fasting lipid profiles should be obtained as part of an initial assessment and thereafter at
each follow-up visit if not at goal, annually if stable and at goal, or every 2 years if the lipid
profile suggests low risk.
\Basal-Bolus Insulin- why? - ANS-basal insulin ("baseline"):
-controls glucose production b/t meals and overnight
-near constant levels
-usually 50% of daily needs
, Bolus insulin ("mealtime or prandial"):
- limits hyperglycemia after meals
-immediate rise and sharp peak at 1 hour after meal
-10-20% of total daily insulin requirement at each meal
example: total requirement: 60 units/day= lentos 30 unitsQHS + 10 units Humalog w/ meals
(30 units divided into three for each of three meals)
considerations:
-education: need to learn carb counting, must have motivated/comptetent patient
-advantages: mimics physiologic insulin, less hypoglycemia, flexible
-disadvantages: cost, frequent injections
\beta cells of pancreas - ANS-made insulin, C-peptide, proinsulin and amylin
\Bile Acid Sequestrants - ANS-MOA: bile acid binder= lowered glucose via unknown
mechanisms
efficacy: minimally effective in lowering glucose: 0.3-0.5% A1C reduction
considerations: constipaiton, indigestion, flatulance, hypersensitivity rxns, large
pills(dysphagia), can exacerbate high tags, not systemically absporbed
\Continuous SubQ insulin for Type II DM - ANS-patient candidates: absolutely insulin
deficient, take 4+ injections/day, assess blood glucose levels 4+times/day, motivated for
tighter glucose control, COMPETENT in carb counting, insulin correction and adjustment
formulas, ability to troubleshoot pxs, stable life situation, frequent contact w/ healthcare
provider
\delta cell of pancreas - ANS-make somatostatin
\diagnosis of DM - ANS-Based on four critera:
1. Fasting plasma glucose≥126 mg/dL (≥7 mmol/L),
2. a 2-hour value from a 75-g oral glucose tolerance test ≥200 mg/dL (≥11.1 mmol/L),
3.a casual plasma glucose level of ≥200 mg/dL (≥11.1 mmol/L) with symptoms of diabetes,
4. or a hemoglobin A1c [HbA1c] ≥6.5% (≥0.065; ≥48 mmol/mol Hb).
The diagnosis should be confirmed by repeat testing if obvious hyperglycemia is not present.
HbA1c ≥6.5% (≥0.065; ≥48 mmol/mol Hb). The test should be performed in a laboratory
using a method that is National Glycohemoglobin Standardization Program (NGSP) certified
and standardized to the DCCT assaya
Fasting plasma glucose ≥126 mg/dL (7 mmol/L). Fasting is defined as no caloric intake for at
least 8 hoursa
2-hour plasma glucose ≥200 mg/dL (≥11.1 mmol/L) during an OGTT. The test should be
performed as described by the World Health Organization, using a glucose load containing
the equivalent of 75-g anhydrous glucose dissolved in watera
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random
plasma glucose concentration ≥200 mg/dL (≥11.1 mmol/L)
\Dipeptidyl Peptidase-4 inhibitors (DPP-4 Inhibitor) - ANS-MOA: inhibits breakdown of
glucagon-like peptide (GLP-1) secreted during meals which then helps increase glucose
medicated insulin release; suppresses glucagon secretions, delays gastric emptying=satiety
