Diabetes Drugs Lecture Notes

Overview

• Diabetes Drugs are divided into:
  • Type 1 Diabetes Drugs: Primarily Insulin-based.
  • Type 2 Diabetes Drugs: Primarily Oral Anti-hyperglycemics.
• Important distinction for exams like USMLE and COMLEX.

Type 1 Diabetes Drugs: Insulin

• Types of Insulin:
  • Rapid Acting Insulin: Lispro, Aspart, Glulisine
    • Peak: 1-1.5 hours
    • Duration: 3-4 hours
    • Mnemonic: Rapid insulins do not LAG.
  • Short Acting Insulin: Regular
    • Peak: 2.5 hours
    • Duration: 4-6 hours
    • Mnemonic: Regular and Short.
  • Intermediate Acting Insulin: NPH
    • Peak: 8 hours
    • Duration: 10-16 hours
    • Mnemonic: Not Particularly Hasty.
  • Long Acting Insulin: Glargine, Detemir
    • No peak, lasts 24 hours
    • Mnemonic: God Damn 24 hours is a long time.

Type 2 Diabetes Drugs: Oral Anti-hyperglycemics

Metformin

• Mechanism: Inhibits hepatic gluconeogenesis, increases glycolysis and peripheral glucose uptake.
• Adverse Effects: Lactic acidosis, B12 deficiency, GI upset.
• Mnemonic: Metformin -> Met -> Metabolic acidosis.

Sulfonylureas

• Mechanism: Increase insulin release by depolarizing potassium channels.
• Drugs: Glimepiride, Glipizide, Glyburide (end in -ide)
• Adverse Effects: Hypoglycemia, Disulfiram reaction.
• Mnemonic: I'd take your sulfonylurea.

Meglitinides

• Mechanism: Similar to sulfonylureas, but different binding site.
• Drugs: Nateglinide, Repaglinide (end in -ide)
• Adverse Effects: Hypoglycemia.
• Mnemonic: I'd take your meglitinide.

DPP-4 Inhibitors

• Mechanism: Inhibit DPP-4, potentiating GLP-1.
• Drugs: Linagliptin, Saxagliptin, Sitagliptin (end in -gliptin)
• Adverse Effects: Urinary and respiratory infections.
• Mnemonic: Lipton makes you pee pee four more times.

GLP-1 Agonists

• Mechanism: Potentiate GLP-1.
• Drugs: Exenatide, Liraglutide (end in -tide)
• Adverse Effects: Pancreatitis.
• Mnemonic: Gulping down Tide pods.

SGLT2 Inhibitors

• Mechanism: Inhibit sodium-glucose co-transporter II, decreasing glucose reabsorption.
• Drugs: Canagliflozin, Dapagliflozin, Empagliflozin (end in -flozin)
• Adverse Effects: Glucosuria, UTIs, yeast infections, hyperkalemia, dehydration.
• Mnemonic: Flows in through the urine.

Alpha-Glucosidase Inhibitors

• Mechanism: Inhibit intestinal brush border alpha-glucosidase.
• Drugs: Acarbose, Miglitol.
• Adverse Effects: GI upset, gas, bloating.
• Mnemonic: A carb means without carb.

Thiazolidinediones (TZDs)

• Mechanism: Bind PPAR gamma, increasing insulin sensitivity.
• Drugs: Pioglitazone, Rosiglitazone (end in -glitazone)
• Adverse Effects: Heart failure, increased fracture risk.
• Mnemonic: Bring glitta to the party.

Amylin Analogs

• Mechanism: Synthetic amylin works with insulin.
• Drug: Pramlintide.
• Adverse Effects: Hypoglycemia.

Conclusion

• Memorize drug classes, mechanisms, and adverse effects for exams and clinical practice.
• Utilize mnemonics to help recall different drug classes and their characteristics.
• Review summary chart of mnemonics for type 2 drugs.

Diabetes drugs are highly prevalent and crucial for medical knowledge and practice.