Rapid acting insulin (fastest)

Other Drugs: Insulin aspart (NovoLog), Insulin glulisine (Apidra)

Short-acting insulin (longer than lispro)

Use: DKA

Long-acting insulin

Crystalizes in blood and releases over time

Anti-DM Agent: Sulfonylureas

Use: Stimulate insulin release from pancreatic B cells

Mechanism: binding to and blocking ATP-sensitive K channel to cause membrane depolarization and increase Ca influx on B cells (pancreatic); 

Side effects: weight gain

Other Drugs: Glipizide (Glucotrol)

Glimepiride (Amaryl)

Tolbutamide (Orinase)

Tolazamide (Tolinase)

Chlorpropamide (Diabinese)

Anti-DM agent: Meglitinide

Use: Lower postprandial serum glucose levels, not much effect on weight

Mechanism: Receptor on the potassium channels- increase insulin release

PHK: peak effect at 1 hr; rapid, short action; Lowers HbA1c glycosylation

Side Effects; Little hypoglycemic effect

Not sulfonamides- can be used in SA allergy

Other drugs: Nateglinide (Starlix)

Anti-DM: Biguanides

Use: Reduce glucose levels in euglycemic (high) state (balance), Safe for use in children >10 y/o; initial DOC for DMII because 1. doesn't increase BW 2. Reduces macrovascular evend (UKPDS)

Mechanism: Increase glucose removal from blood, slows glucos absorption in GI, reduce plasma glucagon levels, reuced gluconeogenesis; only works when glucose is high; DOES NOT cause insulin release

Adverse effects: Diarrhea, lactic acidosis (dose dep.)

Contraindications: Lactic acidosis conditions i.e. renal dx, hepatic dx, alcoholism, dx predisposing to tissue hypoxia; pregnancy/breast feeding

Anti-DM Dx: Thiazolidinedione Derivative

Use: Lowers insulin resistance, Reduces DM II development (prophylaxis!),

 Therapeutic effects: improved glycemic control, decrease TAG long term, slight HDL increase, reduction in fasting plasma glucose, modest HBA1c glycosylation

Mechanism: Ligands of nuclear PPARy receptor which can cause post-receptor insulin mimetic action -> increase glucose transporter synth. in adipose; NOT effective in DM I

Side effects: causes edema (CHF! increase in MI in these pts!)), weight gain, hypoglycemis

Contraindications: hepatic disease, CHF, pregnancy class C

Other drugs: Rosiglitazone (Avandia) - almost pulled off market for edema and MI increases!

Anti-DM Dx: Alpha-glucosidase inhibitor

Use: Diet aid in both DM II and sometimes DM I; reduce glucose absorption

Effects: No significant weight increaselowers postprandial serum glucose, minimal effec t on fasting glucose, modest decrease in HBA1c, potential decrease in TAG

Mechanism: inhibits enzyme that breaks down complex carbs to simple carb

Side effects: Flatulence and GI effects, elevated hepatic enzymes (jaundice)

Other Dx: Miglitol (Glyset)

Anti-DM: Glucagon-like peptide 1 (GLP-1)

Use: Lowers postrprandial and fasting serum glucose; better glycemic control

Therapeutic effects: Potential increased B cell number and function, weight loss, slows gastric emptyin, modest decreast in HBA1c

Mechanism: GLP-1 agonist that are resistant to enzyme degradation by DPP-IV

Adverse effects: acute pancreatitis

Contraindications: Thyroid cancer, 

Other dx: Litralutide (Victoza)

Anti-DM: Dipeptidyl-peptidase-IV (DDP-IV) inhibitor

Therapeutic effects: Has no significant effects on weight

Mechanism: inhibits DDP-IV actions; potentiates effects of endogenous incretin hormone

PHK: ORAL 1/DAY

Adverse effects: acute pancreatitis

Other Dx: Saxagliptin (Onglyza)

Linagliptin (Tradjenta)

Alogliptin (Nesina)

Anti-DM: Amylin/like peptide

Use: DM I AND DM II!!! FDA APPROVED!!!

Therapeutic effects: weight loss

Mechanism: Works with insulin to regulate postprandial glucose by decreassing gastric emptying w/o altering overall absorption of nutrients; suppres postradndial glucagon secretion... Only an adjunct to insulin in DMI and DM II; Synthetic analog of amylin (cosecreted hormone w/ insulin)

PHK: subq injection 3x/day

Anti-DM: Dopamine agonist

Therapeutic effects: reduces the CV end point problems; 

Mecahnism: enhanced suppression of hepatic glucose production; augments low hypothalamic DA levels -> inhibits excessive SNS tone within the CNS 0> decreasing postmeal plasma glucose levels

Anti-DM: Bile acid binding resin

Indications/therapeutic effects: further decreases fasting plasma glucose and HBA1c in combo with other anti-DM agents; beneficial effects for hyperlipidemia

Mechanism unknown

Adverse effects: constipation and bloating

 PROB NOT HIGH YEILD

NEW DRUGS - 'flo" = kidney

Anti-DM: SGLT2 inhibitor

Indications: Modest decrease in HBA1c

Mechanism: Inhibits Na-Glu transporter 2 (SGLT2) in kidney (reabsorption transporter)

PHK: ORAL

Adverse effects: UTI! (glucose in urine) female genital mycotic infections, and increased urinary frequency; hyperkalemia, Increased LDL-C

Contraindications: severe renal impairment or dialysis; pts prone to UTIs or other GI infections

Other drugs: Dapagliflozin (Farxiga) - approved this month!

WONT' see these on boards

Hyperglycemic Dx

Therapeutic effects: Potent inotropic and chronotropic effects on heart; profound relaxation of intestines (used in radiology); not effective in pt c reduced glycogen stores

PHK: Parenterally (SC, IV, IM)

Anti-DM Dx: Non-diuretic thiazide, vasodilator and hyperglycemic

Mechanism: Hyperglycemia = directly inhibits insulin secretion/

Adverse effects: Possible OD -> hyperglycemia/ketoacidosis; non-ketotic hyperosmolar coma;