Pharmacology Session 12

Session 12




DM 1 – autoimmune disorder of carb, fat, and protein metabolism

DM 2 – late onset disorder of carb, fat, and protein metabolism

  • resistance to insulin, and can have decreased insulin
  • liver is breaking down glycogen into glucose because the sugar cannot get into the cells and signals are sent saying that the cells need more sugar.


glucagon increases blood sugar by breaking down glycogen

amylin decreases blood sugar, helps with seisity telling the brain that you are full


  • Proinsulin is produced by the pancreas, and medications are just in the insulin form
  • if a person does not have any c peptides that are attached to the proinsulin, then their pancreas is not creating any insulin.


  • Ghrelin – produced in the stomach, low levels in of this increases insulin resistance,
  • Incretins – inhibit glycogen and increase insulin
  • IFG – impaired fasting glucose
  • IGT – impaired glucose tolerance


criteria for DM diagnosis

  • HgA1C > or equal to 6.5%
  • FBG > 126 mg/dl (7mmol/l)


DM 1 has a risk of ketoacidosis

DM 2 has a risk of Hyperosmolar hyperglycemic nonketotic state


Any body stressor will increase blood sugar


long term complications

  • macrovascular DX: HTN, stroke, Heart DX
  • microvascular DX: neph, neur, retin, Gastroparesis


Know the patho of each class and the adverse effects.


  • Metformin (glucophage)
  • Sulfon
  • Glitazones
  • Alpha Glucosidase inhibitors
  • Gliptins


  • Incretin mimetics
  • Amylin mimetics
  • Insulins shortest to longest
    • lispro (humalog) 5-10 min onset
    • aspart (nocolog) 15-20 min onset
    • glulisine (apidra) 15 min onset
    • Regular (humulin) 30 min onset peak in 2-4 hr and duration of 6-8 hr
    • NPH neutral protamine 60, 6-8hr, 15 hr
    • Detemir, Glargine


Insulin admin

  • rotate injection sites to prevent lipodystrophy
    • upper arm, thigh, abdomen
  • mixing
    • draw up clear first (clear before cloudy)
      • clear is often fast acting and cloudy is often long acting)
    • don’t mix often
    • NPH can mix with anything
  • can store for 1 month at room temp and 3 months at a cooler temp


  • regular insulin
  • onset 60
  • peak 2-4 hr
  • duration 6-8 hr


  • Lispro
    • 5-10
  • NPH insulin
    • 60-120 min
    • 6-14 hr
    • 16-24 hr
    • cloudy
  • Glargine (lantus)
    • 24hr duration of action
    • given SQ
      • clear liquid
    • very stable
  • Combo insulin
    • roll the vial gently to mix the short acting insulin and the NPH.


ORAL drugs



  • Biguanide
  • Metformin, often 1st drug prescribed


        • inhibits glu production in liver
        • decreases insulin resistance


  • does not cause hypoGLU
  • can cause lactic acidosis (don’t take with alcohol or contrast dye)


          • stops metabolism of lactic acid resulting in metabolic acidosis
          • can be fatal in half of people
          • happens more often in pts with renal insufficiency


  • Sulfonamides
  • sulfonylureas (-ide)


        • one of the first meds
        • increase insulin release


  • can cause hypoGLU
  • don’t take with alcohol, NSAID, Sulfonamides, Cimetidine, Beta blockers
  • all cause hypoGLU
  • thiazolidinediones (glitazones)
  • Avandia (rosiglitazone)
  • Actos (pioglitazone)
  • can cause hypoGLU


  • Glinides
    • increase insulin production
    • can cause hypoGLU
  • A-glucosidase inhibitors
    • Acarbose (precose) Miglitol (Glyset)
      • works in the small intestine to delay glu absorption
      • only 2% of the drug is absorbed orally
      • S/E are all GI issues ie. flatulence, upset stomach
  • Incretin Enhancers DPP-4 inhibitors
    • sitagliptin (januvia)
      • stops breakdown of incretins, stimulates release of insulin from pancreas, decreases liver glu production
      • well tolerated
      • no DD interactions


Other injectables non insulin


  • GLP-1 agonist is an incretin mimetic
    • correction of insulin amount
    • stops liver from unneeded glu production
    • decreases absorption of glu at intestinal level


  • exenatide (byetta)
    • increased fullness
    • decrease glucagon
    • decrease glu production
    • increase insulin
    • decrease gi emptying
    • from gila monster spit


DKA happens in type 1

HHNS happens in type 2 higher glu levels than DKA.

  • no ketones in urine


somogyi effect – hypoGLU at night

Dawn effect – hyper GLU at night



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