DIABETES: New Insights into Therapeutic Strategies. Lisa Ellard, MSN,CRNP, CDE
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1 DIABETES: New Insights into Therapetic Strategies Lisa Ellard, MSN,CRNP, CDE
2
3 NEW, IMPROVED, ME TOO, & NOT ALONE New: Sodim-glcose co-transporter 2 Inhibitors (SGLT 2) Improved: Inslins Delivery, Dration, and Dosing Me Too: More Dipeptidyl Peptidase 4 Inhibitors (DPP4) & More Glcagon-like peptide-1 Mimetics (GLP1) Not Alone: New Combinations of Oral Diabetic Medications
4 SGLT2 INHIBITOR MEDICATIONS: A NEW CLASS OF DRUGS
5 SGLT2 INHIBITOR MECHANISM OF ACTION
6 SGLT2 INHIBITOR BENEFITS Decrease in A1c Decrease in Blood Pressre Decrease in Weight
7 SGLT2 INHIBITOR CONTRAINDICATIONS Severe Renal Impairment (egfr <30ml) [Invokana & Jardiance (egfr =/> 45ml) Farxiga (egfr =/>60)] End Stage Renal Disease Dialysis Type 1 Diabetes History of Diabetic Ketoacidosis Pregnancy and Nrsing Mothers Children < 18 years old
8 SGLT2 INHIBITOR WARNINGS AND PRECAUTIONS Hypotension Ketoacidosis Impaired Renal Fnction Urosepsis & Pyelonephritis Hypoglycemia Genital Mycotic Infections Elevated LDL-C Bladder Cancer (Farxiga) Bone Fractres (Invokana)
9 SGLT2 INHIBITOR POSSIBLE SIDE EFFECTS * Genital Mycotic Infections * Urinary Tract Infections * Increased Urination Ketoacidosis Hyperkalemia Elevated Creatinine Dehydration Impaired Renal Fnction Elevated LDL-C Hypotension Increased Risk of Bone Fractres (Invokana) Increased Risk of Bladder Cancer (Farxiga)
10 INSULIN THERAPY: IMPROVEMENTS New Delivery: Afrezza Inhaled Inslin Longer Dration: Tojeo & Tresiba New Doses: Hmalog Kwik Pen U200
11 NEW DELIVERY: INHALED INSULIN AFREZZA A rapid acting manmade inhaled inslin sed to control hyperglycemia in adlts with diabetes
12 AFREZZA BENEFITS No injections reqired Premeasred Cartridges Greater Bioavailability & Clearing Easy Portability
13 AFREZZA CONTRAINDICATIONS COPD Asthma Smoking Pregnancy & Breastfeeding Children (<18yo) DKA
14 AFREZZA WARNINGS AND PRECAUTIONS Acte Bronchospasms in patients with chronic lng disease Changes in Inslin Regimen Hypoglycemia Decreased Plmonary Fnction Hypokalemia Lng Cancer Diabetic Ketoacidosis Hypersensitivity
15 AFREZZA SIDE EFFECTS Hypoglycemia Bronchospasms Cogh Throat Irritation
16 INSULIN IMPROVEMENTS: LONGER DURATIONS
17 COMPARISONS OF LONGER DURATION Tojeo INSULINS Tresiba U300 concentration 450 nits per pen Available in boxes of 3 pens Unrefrigerated shelf life is 6 weeks Recommended to be given at same time of day Dration of action is p to 36 hors Transition to Tojeo from other long acting inslins is 1U:1U & 20% redction in Tojeo is recommended with transition from BID NPH Both U100 and U200 concentrations available U nits per pen (5/box) U nits per pen (3/box) Unrefrigerated shelf life is 8 weeks opened or nopened Recommended to be given same time of day once daily bt may delay by 16 hors if dose is missed Dration of action is p to 42 hors Transition to Tresiba from other long or immediate acting inslins is 1U:1U
18 NEW INSULIN DOSE: HUMALOG KWIK PEN U200 Available in boxes of boxes of 2 pens/600 nits per pen
19 DPP4-INHIBITORS & GLP-1 MIMETICS: ME TOO MEDICATIONS
20 DPP-4 INHIBITORS Janvia & Onglyza +PLUS+ Nesina - Available in 6.25, 12.5, & 25mg tablets Tradjenta - Available in 5mg tablets
21 GLP-1 MIMETICS Byetta and Victoza +PLUS+ Trlicity Available in.75 & 1.5mg Pens sq weekly Bydreon Available in 2mgs Pens & Syringes sq weekly Tanzem Available in 30 & 50mg Pens - sq weekly
22 COMBINATION ORAL DIABETES MEDICATIONS: NOT ALONE
23 Janmet XR Janvia+Metformin XR (100mg/1000mg, 50mg/500mg, & 50/1000mg) Jentadeto Tradjenta+Metformin (2.5mg/500mg, 2.5mg/850mg, & 2.5/1000mg) Synjardy Jardiance+Metformin (5mg/500mg, 5mg/1000mg 12.5/500mg, & 12.5/1000mg) Xigdo XR Farxiga+Metformin XR (5mg/500mg, 5mg/1000mg 10mg/500mg, & 10mg/1000mg) Kazano Nesina+Metformin (12.5mg/500mg, & 12.5mg/1000mg)
24 Detact Actos(TZD)+Amaryl(Slfonylrea) (30mg/2mg & 30mg/4mg) Oseni Nesina+Actos (25mg/15mg, 25mg/30mg 25mg/45mg, 12.5mg/15mg, 12.5mg/30mg, & 12.5mg/45mg Glyxambi Jardiance+Tradjenta (10mg/5mg & 25mg/5mg)
25 IN SUMMARY NEW CLASS OF DIABETES DRUGS SGLT2 INHIBITORS (Invokana, Farxiga, & Jardiance) IMPROVED DIABETES DRUGS Inslins (Afrezza, Tojeo, Tresiba, & Hmalog U200 Pen) ME TOO DIABETES DRUGS DPP-4 Inhibitors (Nesina & Tradjenta) GLP1 Mimetics (Trlicity, Bydreon, & Tanzem) NOT ALONE DIABETES DRUGS Combinations with Metformin (Janmet XR, Jentadeto, Synjardy, Xigdo XR, & Kazano) Combinations with Actos (Detact & Oseni) Other Combinations (Glyxambi)
26 THANK YOU
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