Staff Update Winter 2006
Diabetes Medications Review
Currently there are five classes of oral diabetes medications, all of which help in lowering blood glucose levels. These different classes of diabetes medications can be used in combination or with insulin to achieve control the blood sugar.Classes and actions of medications:
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Newer Diabetes on the Market or Coming to Market
Pramlintide (brand name Symlin) is a synthetic form of the hormone amylin, which is produced along with insulin by the beta cells in the pancreas. Amylin, insulin, and another hormone, glucagon, work in an interrelated fashion to maintain normal blood glucose levels.
Pramlintide injections taken with meals have been shown to modestly improve A1C levels without causing increased hypoglycemia or weight gain and even promoting modest weight loss. The primary side effect is nausea, which tends to improve over time and as an individual patient determines his or her optimal dose.
Because of differences in chemistry, pramlintide cannot be combined in the same vial or syringe with insulin and must be injected separately. Pramlintide has been approved for people with type 1 diabetes who are not achieving their goal A1C levels and for people with type 2 diabetes who are using insulin and are not achieving their A1C goals.
Exenatide (brand name Byetta) is the first in a new class of drugs for the treatment of type 2 diabetes called incretin mimetics. Exenatide is a synthetic version of exendin-4, a naturally-occurring hormone that was first isolated from the saliva of the lizard known as a Gila monster. Exenatide works to lower blood glucose levels primarily by increasing insulin secretion. Because it only has this effect in the presence of elevated blood glucose levels, it does not tend to increase the risk of hypoglycemia on its own, although hypoglycemia can occur if taken in conjunction with a sulfonylurea. The primary side effect is nausea, which tends to improve over time.
Like pramlintide, exenatide is injected with meals and, as with pramlintide, patients using exenatide have generally experienced modest weight loss as well as improved glycemic control. Exenatide has been approved for use by people with type 2 diabetes who have not achieved their target A1C levels using metformin, a sulfonylurea, or a combination of metformin and a sulfonylurea.
Januvia prolongs the activity of proteins that increase the release of insulin after blood sugar rises, such as after a meal. Januvia does this by blocking an enzyme (dipeptidyl peptidase IV or DPP-IV) that breaks down these proteins, leading to better blood sugar control.
Januvia was examined in a total of 2,719 patients with type 2 diabetes, in studies lasting from 12 weeks to more than a year. These studies demonstrated improved blood sugar control when Januvia was used alone or in patients not satisfactorily managed with metformin or a PPAR agonist.
The most common side effects in clinical studies were upper respiratory tract infection, sore throat, and diarrhea.Januvia is manufactured by Merck
INSULINS
There are different types of insulin used for different purposes. . Humolog and Novolog are fast acting insulins and begin working in about 10 minutes, peaks at 1-1.5 hrs and is gone in 3.5-4 hours. Regular insulin is used to cover meals and snacks. Once injected, Regular insulin takes 30 minutes to begin working, peaks between 2-4 hrs and hangs on for 6-8 hrs. Longer acting insulins such as NPH, lente and ultralente last for a longer period of time. Basal insulins, such as lantus and detemir are new once a day background insulins. They offer flat insulin levels through the entire day for most users.
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Action Times for Insulins |
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Insulin |
Starts |
Peaks |
Ends |
Low most likely at: |
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Fast Acting Insulins Humolog Novolog |
10-20 m |
Hum:1.5-2.5 h Nov:45-75 min |
4-5 h |
2-5 h |
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Regular Regular |
30-45 m |
2-4 h |
5-7 h |
3-7 h |
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Longer Acting NPH |
1-3 h |
4-9 h |
14-20 h |
4-16 h |
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Lente |
2-4 h |
8-14 h |
16-24 h |
6-16 h |
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Ultralente |
2-4 h |
8-14 h |
18-24 h |
8-18 h |
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Basal Insulins |
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Lantus |
1-2 h |
6 hr |
18-26 h |
5-10 h |
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Detemir* |
1-3 h |
8-10 |
18-24 h |
8-16 h |
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* Lantus and Detemir (available soon) have little peak, so lows are less likely unless dose is excessive. |
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Alternative Insulin Delivery Methods
Many advances have been made to make injecting insulin with needles less uncomfortable by using different techniques and devices such as pumps and pens. Companies have been working on a number of more advanced ways to deliver insulin. Take a look at the pages below to find out about more of these interesting ideas.
Insulin Pump
An insulin pump is a small mechanical device that is worn outside the body, often on a belt or in a pocket. It delivers fast-acting insulin into the body via an infusion set. All insulin is delivered through the infusion set.
Inhaled Insulin
Inhaled insulin involves bringing insulin directly into the lungs. It has been a popular topic since the first inhaled version of insulin, Exubera, was approved by the FDA in January of 2006. Learn more about the concept of inhaled insulin delivery.
Insulin Pills
Oral insulin has been a possibility for a long time but dealing with the breakdown caused by digestive juices has been a problem. Learn more about the latest advances with oral insulin delivery.
Transdermal Insulin
One way of avoiding the problems of oral delivery is to put the insulin directly into the bloodstream. A possible alternative to using injections to do this is to use transdermal technology, allowing the product to be absorbed through the skin. Learn more about transdermal insulin delivery.
HIC# 11143