How Medicine Works to Control Blood Sugar Levels Stacie Petersen, RN, CDE Objectives Define Diabetes List how medications work (ominous octet) Identify side effects of medications for diabetes What is diabetes? Diabetes is a group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin What Happens When We Eat? Normal Blood Glucose Control High Blood Glucose (Hyperglycemia) 1
Types of diabetes Type 1-Beta cells in pancreas that produce insulin are destroyed Requires insulin to survive 5-10% of population Type 2-Pancreas not utilizing insulin properly Lack of insulin production Insufficient insulin action (resistant cells) 90-95% of population *Beta Cells eventually wear out What is the best medicine to manage your diabetes? LIFESTYLE CHANGES Lifestyle Changes Weight loss Decrease weight by 5-7% (if overweight) Exercise 30 minutes 5 days a week Ominous Octet Diabetes Prevention Program (DPP) results: Lifestyle changes can reduce chance of diabetes by 58% Biguanides Metformin Glucophage, Fortamet, Riomet, Glucophage XR Decreases release of sugar from the liver Increases absorption of sugar into the muscle Take with food to help side effects Side Effects: Diarrhea, upset stomach Sulfonylureas Glynase, Diabeta, Glucotrol, Amaryl, Diabinese Glyburide, Micronase, Glipizide, Glimepiride, Chlorpropamide Tells pancreas to make more insulin Take before meals Side Effects: Low blood sugar 2
Meglitinides Alpha Glucosidase Inhibitors Prandin (Repaglinide) Starlix (Nateglinide) Tells pancreas to make insulin quickly Take with each meal Short acting Side Effects: Low blood sugar Precose (Acarbise) Glyset (Miglitol) Slows down absorption of carbohydrates in the gut Take with meals Side Effects: Gas Thiazolidinediones (TZD s) Actos (Pioglitazone) Avandia (Rosiglitazone) Makes cells more sensitive to insulin Decreases release of sugar from the liver Side effects: Swelling, Weight Gain Dipeptidyl Peptidase-4 Inhibitor (DPP-4 Inhibitor) Januvia, Tradjenta, Onglyza, Galvus, Nesina Sitagliptin, Linagliptin, Saxagliptin, Vildagliptin, Alogliptin Blocks DPP-4 enzyme which breaks down incretins As a result keeps higher levels of incretins which Tells pancreas to make more insulin Decreases release of sugar from the liver Slows down absorption of carbohydrates in the gut Side Effects: Upper respiratory infections, stomach upset, diarrhea Sodium Glucose Cotransporter-2 (SGLT-2 Inhibitor) Invokana, Farxiga, Jardiance Canagliflozin, Dapagliflozin, Empagliflozin Kidneys normally reabsorb sugar SGLT-2 blocks reabsorption of sugar and increases excretion through urine Side Effects: Yeast infections, Urinary tract infections, Weight loss, Decrease blood pressure 3
Combination Medications Glucovance (Glyburide/Metformin) Metaglip (Glipizide/Metformin) Advandamet (Avandia/Metformin) Actoplusmet (Actos/Metformin) Avandaryl (Avandia/Amaryl) Duetact (Actos/Glimepiride) Prandimet (Prandin/Metformin) Janumet (Januvia/Metformin) Janumet XR (Januvia/Metformin XR) Jentadueto (Tradjenta/Metformin) Kombiglyze XR (Onglyza/Metformin XR) **Combination medications have same side effects as medications taken alone but they are added together. Combination Medications Kazano (Nesina/Metformin) Oseni (Nesina/Actos) Glyxambi (Tradjenta/Jardiance) Invokamet (Invokana/Metformin) Synjardy (Jardiance/Metformin) XigduoXR (Farxiga/Metformin) **Combination medications have same side effects as medications taken alone but they are added together. Glucagon-like peptide-1 (GLP-1) Byetta, Victoza, Bydureon, Trulicity, Tanzeum Exenatide, Liraglutide, Exenatide, Dulaglutide, Albiglutide **Coming 2017 Adlyxin (Lixisenatide) Body naturally produces this hormone People with diabetes do not make enough of it Replaces GLP-1 not being made by the body Enhances use of GLP-1 which helps body use insulin GLP-1 continued Tells pancreas to make more insulin Decreases release of sugar from the liver Slows down absorption of carbohydrates in the gut Tells brain you are full Side Effects: Nausea, Decrease appetite, Weight loss When do I need insulin? Diabetes medications only work as long as the body produces some of its own insulin Every person is different with regards to medication/insulin plan Insulin Hormone has to be injected or inhaled Six classes of insulin Ultra Long Acting Toujeo, Tresiba Long Acting Lantus, Levemir Intermediate Acting NPH Short Acting Regular Rapid Acting Humalog, Novolog, Apidra Very Rapid Acting-Afrezza (Inhaled version) Side Effect: Low Blood Sugar, Bruising at site 4
Ultra-Long Acting Insulin Tresiba U-100 or U-200 (Degludec), Toujeo U-300 (glargine) Background insulin Meets needs of body/organs when not eating Provides coverage well beyond 24 hours Tresiba U-200/and Toujeo less volume Take once a day/option if high doses of insulin Do not mix with other insulins Long Acting Insulin Levemir U-100 (Detemir), Lantus U-100 (Glargine) **Coming December 2016 Basaglar U-100 (Glargine) Background insulin Meets needs of body/organs when not eating Designed to last 24 hours Take once a day at same time Not compatible with other insulins Intermediate Acting NPH (Humulin N, Novolin N) Background and mealtime coverage Works 12-16 hours Usually taken twice a day Cloudy Need to mix thoroughly Can mix with Regular insulin Short Acting Regular (Humulin R, Novolin R) Mealtime insulin Lasts 5 to 6 hours Take 30 minutes before meals Rapid Acting Humalog U-100 (Lispro), Novolog U-100 (Aspart), Apidra U-100 (Glulisine) Mealtime insulin Works 2-4 hours Take 5-15 minutes before a meal Can use these in insulin pumps Rapid Acting (continued) Humalog U-200 Less Volume Delivers same dose in half the liquid Only comes in a pen which contains 600 units Designed for people on high doses of mealtime insulin (more than 25 units a meal) 5
Combination Insulins 70/30 70% NPH (intermediate acting) and 30% Regular (short acting) 75/25 MIX with Lispro Humalog Mix 75% longer acting and 25% rapid acting 50/50 MIX with Lispro Humalog Mix 50% longer acting and 50% rapid acting 70/30 with Aspart Novolog Mix 70% longer acting and 30% rapid acting Ryzodeg 70/30 (70% Tresiba and 30% Novolog) Very Rapid Acting Afrezza-only inhaled insulin available Mealtime insulin Works 2 ½-3 hours Take no more than 15 minutes before a meal Comes in cartridges Requires lung testing annually Avoid if chronic lung conditions, smoker, lung cancer Insulin tips Majority insulin pens stable 28 days in use Mixed insulin pens stable 14 days/vials 28 days in use **Check insert/ask pharmacist/health-care provider Insulin in use can be at room temperature Insulin not in use must be refrigerated Available in vials or pens Low blood sugar biggest side effect of taking insulin QUESTIONS??? 6