HYPOGLYCEMIC AGENTS

1. type 1 diabetes-----pancreas unable to produce insulin type 2 diabetes----impaired insulin secretion and insulin resistance by cells insulin must be injected to avoid breakdown in gastric acid. Never shake insulin-never shake insulin—never shake insulin The protein chain is very fragile. Roll between palms to be mixed. Keep in frig until ready. Good for 30 day after puncture at room temp. Must not be frozen or heated. oral hypoglycemic agents---for use when diet, weight reduction, and exercise not effective. Type 1 diabetes insulin---novolog, humalog,novolin, lantus rapid acting—just before meal (3-4 hours) Short acting—30min before meal (6-8 hours) Intermediate acting—2x day (14-20 hours) Long acting—once or twice day (~24 hours) Some products are mix of all types. HYPOGLYCEMIC AGENTS

2. HYPOGLYCEMIC AGENTS Type 2 meds— Sulfonylureas---bind to beta cell (insulin cell) potassium channel yields depolarization yields increased release of any insulin. side effect---usual well tolerated sulfonylurea examples--- glimeperide/Amaryl glipizide/Glucotrol, Glucotrol XL glyburide/DiaBeta, Glynase PresTab, Micronase enzyme inhibitors---inhibit intestinal wall enzymes that convert saccarides into glucose, yields less hyperglycemia reactions---abdominal pain, diarrhea, flatulence examples--- acarbose/Precosemiglitol/Glyset

3. biguanides--- moa---decrease intestinal absorption of glucose and improve glucose sensitivity. reaction---metal taste, weight loss, nausea, more dose needed later examples--- metformin/Glucophage other biguanides removed from market Glitazones(thiazolidininediones)--- moa--Increases the amount of glucose taken up by muscle cells and keeps the liver from overproducing glucose reactions---elevated HDL examples-- pioglitazone/Actos rosiglitazone/Avandia HYPOGLYCEMIC AGENTS

4. HYPOGLYCEMIC AGENTS combination of oral types--- glipizide&metformin/Metaglip glyburide&metformin/Glucovance rosiglitazone&metformin/Avandamet injectable hypoglycemic agents humulin---synthetic insulin can be stored a month room temp examples-- isophane insulin&insulin/Humulin 50/50 isophane insulin&insulin/Humulin 70/30 insulin analog/Humalog insulin glargine/Lantus several others

5. Insulin types Insulin aspart---novolog, novolog penfill Insulin lispro—humalog, humalog pen Insulin regular---humulin R, novolin R Insulin zinc---humulin L Isophance insulin---humulin N novolin N Insulin detemir---levemir Iunsulin glargine---lantus