Medications for Diabetes

Transcription

1 Medications for Diabetes Sweet, but not too sweet Colette Raymond, Pharm D June 15, 2011

2 Learning Objectives At the end of this presentation you should be able to: Understand the prevalence and types of diabetes. Understand that uncontrolled diabetes can lead to serious long-term complications. Recognize the differences between medications used to treat diabetes.

3 What is Diabetes?

4 What is diabetes?

5 Risk Factors for Diabetes Canadian Diabetes Guidelines 2008

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7 Diagnosis A fasting blood glucose (no food or drink, at least 8 hours pre) test > 7.0 mmol/l suggests diabetes. Patients with a fasting blood glucose of 6.0 to 7.0 mmol/l are at high risk of developing diabetes in the future.

8 Diabetes in Manitoba Surveillance Report 2009

9 Complications of diabetes

10 Big vessels Diabetic complications Heart attacks, strokes 80% of people with DM will die of a vascular event! (Diabetes Care 2003;27(Suppl2):S58) Small vessels Kidneys Nerves (feet) Eyes 68% of people with DM do NOT think that CVD is a complication of DM! (J Am Coll Cardiol 2002;40:1877)

11 COMPLICATIO NS OF DIABETES Vision Loss Skin Problems Foot Care Kidney Disease Heart Disease and Stroke COMMENTS Diabetic retinopathy is the most common cause of blindness in people under age 65 High blood glucose lowers resistance to infections and slows healing of skin Over time, diabetes can damage sensory nerves in the hands and feet (i.e. neuropathy) leaving patients less likely to feel a foot injury Left unnoticed, these injuries can become infected and potentially lead to serious complications Risk factors: High blood glucose and blood pressure About one-third of people who have had diabetes for more than 15 years will develop kidney disease Diabetics may develop heart disease 10 to 12 years earlier than individuals w/o diabetes Up to 80% of people with diabetes will die from a heart attack or stroke

12 Complications of diabetes

13 Treatment of diabetes

14 Treatment of Diabetes Education Physical Activity Nutrition Weight Management Medication Lifestyle Management Blood Pressure Control

15 Treatment of diabetes: Non blood sugar targets Condition Target Lipids LDL <2.0mmol/L BP <130/80 Smoking Weight loss (if BMI > 30) None! 5-10% Lifestyle modification for all! Canadian Diabetes Guidelines 2008

16 Goals of therapy: glycemic control Target for most patients Recommended targets for glycemic control A1C (%) FPG (mmol/l) 2 hr postprandial (mmol/l) < Normal < Goal to obtain target A1C within 6-12 mo Manitoba Diabetes Care Recommendations 2010, Canadian Diabetes Guidelines 2008

17 Drugs for diabetes Metformin Glyburide, gliclazide Rosiglitazone (Avandia), Pioglitazone (Actos) Repaglinide (Gluconorm) Acarbose (Glucobay) Insulin 30/70, NPH, N, Toronto, Regular

18 Mechanism of oral agents Metformin X Decrease glucose production Alphaglucosidase inhibitor BETTER GLUCOSE CONTROL Slow glucose absorption Sulfonlyureas Meglitinides Increase insulin production Increase insulin sensitivity Glitazones (Metformin)

19 Oral Agents comparison JAMA 2002;287: Monotherapy only practical when A1C 8 % Decrease in A1C (%) across trials Sulfonylureas Meglitinides Metformin Glitazones Acarbose

20 Management of hyperglycemia in type 2 diabetes Add another agent best suited to the patient CDA 2008

21 Management of hyperglycemia in type 2 diabetes CDA 2008

22 Insulin Therapy Insulin preparations differ by their duration of action, time of onset and peak actions. Available in rapid, short, intermediate, and longacting preparations.

23 Category Insulin Colour Onset Peak Duration Rapid Acting Lispro (Humalog) Aspart (Novorapid) Clear hrs mins hr 3-6 h Short Acting Humulin R Novolin Toronto Clear hr 2-5 h 6-8 h Intermediate acting Humulin / N Novolin NPH Cloudy 1-2 h 4-12 h h Long acting Detemir (Levemir) Clear (Don t mix) Dose dependent 1-2 h Peakless Dose dependent hrs Glargine (Lantus) Clear (Don t mix) 1.5 h Peakless 24 h Humalog Mix 25 Mixed Humulin 20/80, 30/70 Novolin 10/90, 20/80, 30/70, 40/60, 50/50 Cloudy h 2-12 (Dual peak) h

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25 Side effects: diabetes drugs Metformin, Acarbose (Glucobay) Stomach Start low, go slow Rosiglitazone (Avandia), Pioglitazone (Actos) Puffiness, swelling Glyburide, gliclazide, Insulin, Repaglinide (Gluconorm) low blood sugar learn how to manage, decrease dose, switch from glyburide to others Weight gain importance of diet

26 Side effects of drugs for diabetes Low blood sugar

27 How to manage low blood sugar 3 glucose tablets (15 grams glucose) PO OR ¾ cup of juice * OR 3 tsp (3 packs) of sugar dissolved in water Then retest, Have snack** of 1 starch and 1 protein ** Snack Examples: 1 piece of bread/ toast with peanut butter, 8 crackers with cheese, ½ sandwich

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