Diabetes Drugs Overview

Introduction

• Popular Topic: Requested multiple times on the channel.
• Main Discussion: Difference between drugs for Type 1 and Type 2 Diabetes.

Conceptual Framework

• Type 1 Diabetes: Primarily treated with insulin.
• Type 2 Diabetes: Primarily treated with oral anti-hyperglycemic agents.
• Crossovers: Some overlap depending on severity.

Insulin Types for Type 1 Diabetes

1. Rapid-Acting Insulin

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

2. Short-Acting Insulin

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

3. Intermediate-Acting Insulin

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

4. Long-Acting Insulin

   • Examples: Glargine, Detemir
   • Peak Time: No definite peak
   • Duration: 24 hours
   • Mnemonic: God Damn 24 hours is a Long Time (Glargine, Detemir)

Type 2 Diabetes Drugs (Oral Anti-Hyperglycemics)

1. Metformin (Biguanide)

   • Mechanism: Inhibits hepatic gluconeogenesis, increases glycolysis, increases glucose uptake
   • Adverse Effects: Lactic acidosis (especially with renal insufficiency), B12 deficiency, GI upset
   • Mnemonic: MET (Metformin causes METabolic acidosis)

2. Sulfonylureas

   • Examples: Glimepiride, Glipizide, Glyburide
   • Mechanism: Increase insulin release by depolarizing K-channels in B-cells
   • Adverse Effects: Hypoglycemia, disulfiram reaction
   • Mnemonic: I'd take your sulfonylurea (IDE)

3. Meglitinides

   • Examples: Nateglinide, Repaglinide
   • Mechanism: Similar to sulfonylureas, different binding site
   • Adverse Effects: Hypoglycemia
   • Mnemonic: I'd take your Meglitinide (IDE)

4. DPP-4 Inhibitors

   • Examples: Linagliptin, Saxagliptin, Sitagliptin
   • Mechanism: Inhibits DPP-4 enzyme, increasing GLP-1 which promotes insulin release and inhibits glucagon release
   • Adverse Effects: Urinary and respiratory infections
   • Mnemonic: Lipton makes you pee pee four more times (Liptin)

5. GLP-1 Agonists

   • Examples: Exenatide, Liraglutide
   • Mechanism: Potentiates GLP-1
   • Adverse Effects: Pancreatitis
   • Mnemonic: Gulping down Tide Pods (TIDE)

6. SGLT-2 Inhibitors

   • Examples: Canagliflozin, Dapagliflozin, Empagliflozin
   • Mechanism: Inhibits sodium glucose co-transporter 2, decreases glucose reabsorption in kidneys
   • Adverse Effects: Glucosuria, UTI, vaginal yeast infections, hyperkalemia, dehydration
   • Mnemonic: Flows in through the urine (Flozin)

7. Alpha-Glucosidase Inhibitors

   • Examples: Acarbose, Miglitol
   • Mechanism: Inhibits alpha-glucosidase enzyme in the intestinal brush border
   • Adverse Effects: GI upset, gas, bloating
   • Mnemonic: A-carb (without carbs)

8. Thiazolidinediones (TZDs)

   • Examples: Pioglitazone, Rosiglitazone
   • Mechanism: Binds to PPAR-γ, increasing insulin sensitivity
   • Adverse Effects: Heart failure, increased risk of fractures
   • Mnemonic: Bring glitter to the party (Glitazone, Party for PPAR)

9. Amylin Analogs

   • Example: Pramlintide
   • Mechanism: Synthetic amylin, works alongside insulin
   • Adverse Effects: Hypoglycemia
   • Mnemonic: Amylin works like Insulin (both end in 'lin')

Summary

• Insulins: Know the names, categories, peak times, and durations.
• Oral Agents: Understand categories, mechanisms, adverse effects.
• Mnemonics: Use mnemonics to remember drug classes and details.

Final Notes

• Integration: Be comfortable identifying drugs by their category and understanding their mechanisms and adverse effects.
• High Yield: These drugs are essential for exams and clinical practice.
• Practice: Review and memorize mnemonics to enhance recall for exams.

Good luck!