Lecture Notes: Diabetes Drugs

Introduction

• Topic: Diabetes drugs, a frequently requested subject.
• Aim: Divide into Type 1 and Type 2 diabetes drugs.
• Focus: Insulin for Type 1, oral agents for Type 2.

Diabetes Drugs Overview

• Type 1 Diabetes Drugs: Insulin
• Type 2 Diabetes Drugs: Oral anti-hyperglycemics

Insulin Types

Rapid Acting Insulins

• Examples: Lispro, Aspart, Glulisine
• Peak Time: 1 - 1.5 hours
• Duration: 3 - 4 hours
• Mnemonic: Rapid insulins do not LAG (Lispro, Aspart, Glulisine)

Short Acting Insulins

• Example: Regular insulin
• Peak Time: 2.5 hours
• Duration: 4 - 6 hours
• Mnemonic: Regular and short

Intermediate Acting Insulins

• Example: NPH
• Peak Time: 8 hours
• Duration: 10 - 16 hours
• Mnemonic: Not Particularly Hasty (NPH)

Long Acting Insulins

• Examples: Glargine, Detemir
• Peak Time: None
• Duration: 24 hours
• Mnemonic: God Damn 24 hours is a long time (Glargine, Detemir)

Type 2 Diabetes Oral Agents

Metformin

• Category: Biguanide
• Mechanism: Inhibits hepatic gluconeogenesis, increases glycolysis, peripheral glucose uptake
• Adverse Effects: Lactic acidosis in renal insufficiency, B12 deficiency, GI upset
• Mnemonic: Metformin causes metabolic acidosis

Sulfonylureas

• Examples: Glimepiride, Glipizide, Glyburide
• Mechanism: Increase insulin release via potassium channel depolarization
• Adverse Effects: Hypoglycemia, Disulfiram-like reaction
• Mnemonic: I'd take your sulfonylurea

Meglitinides

• Examples: Nateglinide, Repaglinide
• Mechanism: Similar to sulfonylureas but different binding site
• Adverse Effects: Hypoglycemia
• Mnemonic: I'd take your meglitinides

DPP-4 Inhibitors

• Examples: Linagliptin, Saxagliptin, Sitagliptin
• Mechanism: Inhibit DPP-4, potentiate GLP-1
• Adverse Effects: Urinary and respiratory infections
• Mnemonic: Lipton makes you pee pee four more times

GLP-1 Agonists

• Examples: Exenatide, Liraglutide
• Mechanism: Potentiate GLP-1
• Adverse Effects: Pancreatitis
• Mnemonic: Gulping down tide pods

SGLT2 Inhibitors

• Examples: Canagliflozin, Dapagliflozin, Empagliflozin
• Mechanism: Inhibit sodium-glucose co-transporter 2
• Adverse Effects: Glucosuria, UTIs, vaginal yeast infections, hyperkalemia, dehydration
• Mnemonic: Flows in through the urine

Alpha Glucosidase Inhibitors

• Examples: Acarbose, Miglitol
• Mechanism: Inhibit intestinal brush border alpha-glucosidases
• Adverse Effects: GI upset, gas, bloating
• Mnemonic: Acarb means without carbs

Thiazolidinediones (TZDs)

• Examples: Pioglitazone, Rosiglitazone
• Mechanism: Bind to PPAR-gamma, increase insulin sensitivity
• Adverse Effects: Heart failure, increased risk of fractures
• Mnemonic: Bring glitter to the party

Amylin Analogs

• Example: Pramlintide
• Mechanism: Synthetic amylin, works with insulin
• Adverse Effects: Hypoglycemia

Conclusion

• Review mnemonics for drug categories and their mechanisms.
• Focus on insulins for Type 1 and oral agents for Type 2 diabetes.