diabetes medications an in-depth look at the medications used to treat diabetes

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

Injectable Medications

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®

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® 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®


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


Prefilled pen

Pocket size

Simple to dial up

Audible clicks

No refrigeration needed after the first dose


Novolog®

NovoPen® Jr. Designed for kids

Colorful

Able to dial ½ unit increments


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®

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®

Prefilled disposable pen with 300 units

Can dial backwards if a mistake is made


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®

Exubera. < www.exubera.com > Online Image. Retrieved 07 July 2007.

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


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


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.

diabetes medications an in-depth look at the medications used to treat diabetes

Documents

diabetes slide

diabetes type

diabetes medications

insulin diabetes

diabetes goals

test slide

medication slide

sulfonylurea slide