How they work and when to take them. Diabetes Medications

Transcription

1 How they work and when to take them Diabetes Medications

2 BIGUANIDES Metformin Actions Slows down the release of glucose from the liver. Helps the bodies cells become more sensitive to insulin. Pros Weight neutral Does not cause hypos Cons Gastric side effects diarrhoea/flatulence When to take with or just after food Effect on HbA1c 13mmol/mol reduction Other info Safe in pregnancy Shown to be effective at reducing cardiovascular disease

3 SULPHONYLUREAS The..rides and zides! Actions Stimulate the beta cells on the pancreas to make more insulin. They also help insulin work more effectively. Pros Good HbA1c reduction Cons Can cause hypos Weight gain of 3-4kg When to take with or just after food Effect on HbA1c 17mmol/mol reduction Other info Need regular meals

4 Thiazalodones Pioglitazone Actions Helps the body to address insulin resistance, Works on the muscle and adipose tissue Take around 6 months to become effecting Reduce liver glucose output Pros Low risk of hypo Cons Weight gain of approx 3kg Can cause fluid retention When to take with or just after food Effect on HbA1c 11mmol/mol reduction Other info Rosiglitazone removed because of heart failure stories

5 Newer therapies Incretin mimetics GLP-1 analogues DPP4 inhibitors SGLT2 inhibitors

6 Incretin mimetics-glp1 analogues Exenatide (Byetta/Bydureon), Lixisenatide (Lyxumia) and Laraglutide (Victoza). Actions Increase amount of GLP-1 hormone associated with appetite suppression Pros Low risk of hypo Weight loss of 2-3kg Cons Gastric side effects Nausea When to take Once or twice daily; once weekly Effect on HbA1c 11mmol/mol reduction Other info Non-insulin injectable

7 GLP1 analogues the..tides! Action Carbohydrate intake dependent

8 DPP-4 Inhibitors Sitagliptin, Linagliptin, Saxagliptin, Alogliptin and Vildagliptin. Actions block the action of the enzyme DPP-4 which destroys GLP-1 hormone Pros Low risk of hypo Weight neutral Cons Gastric side effects When to take Once daily Effect on HbA1c 8mmol/mol reduction Other info

9 DPP-4 Inhibitors The gliptins

10 SGLT2 Inhibitors Dapagliflozin, Empagliflozin and Canagliflozin Action Reduces the amount of glucose being absorbed in the kidneys More glucose is passed out in the urine Pros Weight loss 3-4kg Lose up to 70g glucose per day approx 280 kcals Low risk of hypo Cons UTIs When to take Once daily Some dependent and some independent of food Effect on HbA1c 9-13mmol/mol reduction Other info

11 SGLT2 Inhibitors the flozins! The only insulin independent drug

12 Still out there but not so commonly used

13 Prandial glucose regulators Repaglinide, Nateglinide Action Stimulate the beta cells in the pancreas to produce more insulin, Unlike sulphonylureas, they only last for a short time. Pros Weight Neutral If you miss a meal you don t have to take them Cons Possible risk of hypos

14 Alpha-glucosidase inhibitors Acarbose Action Reduces the absorption of carbohydrate from the intestine Pros Weight neutral No risk of hypo Cons Flatulence Diarrhoea

15 Insulin Animal insulin Bovine and Porcine insulin still available Human insulin Analogue insulin

16 Bit of insulin background?% of people with type 2 diabetes now use insulin Most people use insulin pens but some still like to use syringes and vials Only 3 companies make insulin Lilly, NovoNordisk, Sanofi

17 Most common insulins Human and Analogue

18 Basal insulin Human basal Insulatard, Humulin I, Insuman basal Analogue basal Levemir and lantus Action To keep blood glucose levels steady overnight and between meals May be injected once or twice day Can be taken independent of food but ideally similar times each day Twice daily ideally 12 hours apart Human basal has a peak action from 2-12 hours after taking Analogue basal has no peak

19 Diet and basal insulin Similar carbohydrate amounts in each meal helps avoid peaks and troughs Can t adjust to food intake People on human basal MAY need a snack at peak times Ask? Are they snacking to avoid hypos

20 Mixed Insulin Human Humulin M3, Insuman Comb 15, 25 and 50 Analogue Novomix 30, Humalog Mix 25 and 50 Action Control blood glucose between meals, overnight and for food eaten Usually twice a day but can be three times Human mixed Need to take minutes before eating Analogue mixed Can be taken just before eating

21 Diet and mixed insulin Evidence is that similar carbohydrate amounts in each meal helps with glycaemic control Difficult to adjust insulin to carbohydrate intake Increase the quick acting you increase the background Ideally eat three meals a day at regular times Not suitable for everyone MAY need a snack mid morning and/or pre bed Ideally lower the dose to try and limit the snacking! If overweight

22 Basal bolus regimes Background (basal) and quick acting/mealtime (bolus) insulin Quick acting/meal time Novorapid, Apidra or Humalog Take before food Usually just before but mins before can help post prandial rise Last for around 4 hours Peak at around 1 hour

23 Diet and basal bolus regimes Increased flexibility with carbohydrate amounts Increased flexibility of meal timings Miss or delay meals Have meals with no carbohydrate Allows you to eat what you want (?) Don t assume people eat 3 times a day! Carbohydrate counting We are the experts

24 VERY new insulin/insulin combinations Degladec/Tresiba (Novo Nordisk) Very long acting insulin Can be given Xultophy/Degladec and Victoza (Novo Nordisk) Long acting insulin and GLP Once daily Toujeo (Sanofi) Long acting insulin 300units per ml Lantus insulin Humalog U-200 (Lilly) Meal time insulin 200units per ml

25 Insulins Mix Basal (long/medium) Bolus (Short/Quick) Human insulin mins pre food Lasts hours Humalin M3 Insuman Comb 15,25/50 Human Insulin od or bd Lasts hours Insulatard Humulin I Insuman Basal Human Insulin 30 mins pre foodlast 6-8 hours Humulin S Actrapid Insuman Rapid Analogue insulin Take pre meal Lasts hours Humalog Mix 25/50 Novomix 30 Analogue insulin od or bd same time lasts hours Levemir Lantus Analogue insulin Just before food Lasts 2-4 hours Novorapid Apidra Humalog

26 Diabetes UK Meds&Kit %20download.pdf

27 Summary There s a lot to remember! Insulin and SU s ( rides and zides ) more likely to cause hypos Always check correct treatment given Insulin, SU s and pioglitazone associated with weight gain The tides (GLP) and flozins (SGLT2) associated with aiding weight loss Timing of insulin with meals is important

28 Contact me Julie Taplin Registered Dietitian Diabetes specialist dietitian BDA diabetes specialist group minutes secretary