Collaborative Health Advocate Team CHAT

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Collaborative Health Advocate Team(CHAT)

• Midwestern University
• Colleges of
• Medicine, Physician Assistants Pharmacy

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Medications in Type 2 Diabetes
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How diabetes medicines work

• Some medicines help insulin release from the
  pancreas
• Some medicines help glucose move from the blood
  into the body tissue or cell
• Some medicines control or regulate the movement
  of food through the stomach intestine

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6 Classes of Oral Medicines for Diabetes

• Sulfonylureas
• Glitinides
• Biguanides
• Alpha Glucosidase Inhibitors (AGIs)
• Glitazones
• DPP-4 inhibitors

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Sulfonylureas

• Micronase
• (glyburide)
• Diabeta
• (glyburide)
• Glucotrol
• (Glipizide)
• Amaryl
• (Glimepiride)

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Sulfonylureas

• Works to help insulin release from the pancreas
• Long acting (gt6 hours)
• Lowers fasting glucose and after meal glucose
• Most common side effect(s)
• Hypoglycemia (low sugar)
• Weight gain

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Meglitinides

• Prandin
• (Repaglinide)
• Starlix
• (Nateglinide)

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Glitinides

• Works to help insulin release from the pancreas
• Short acting (30min to lt4 hours)
• Lowers after meal glucose
• Most common side effect(s)
• Hypoglycemia (low blood sugar)

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Biguanides

• Glucophage
• (Metformin)

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Biguanides

• Works indirectly to help glucose move from the
  blood into the body tissue or cell
• Specifically stops the liver from making excess
  glucose (sugar)
• Lowers fasting glucose
• Most common side effect(s)
• Stomach and intestine distress
• Weight loss

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Alpha Glucosidase Inhibitors

• Precose
• (Acarbose)
• Glyset
• (Miglitol)

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Alpha Glucosidase Inhibitors

• Slows the breakdown (or metabolism) of
  carbohydrates and helps regulate the movement of
  food through the stomach
• Short acting
• Lowers after meal glucose
• Most common side effect(s)
• Stomach and intestinal discomfort
• Flatulence (gas)

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Glitazones

• Actos
• (Pioglitazone)
• Avandia
• (Rosiglitazone)

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Glitazones

• Works to help glucose move from the blood into
  the body tissue or cell
• Allow 4 weeks for medicine to start working
• Lowers fasting glucose and after meal glucose
• Most common side effect(s)
• Weight gain
• Edema (swelling) usually in the legs

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DiPeptidyl Peptidase 4 (DPP-4) Inhibitors(Increti
n Hormone)

• Januvia
• (Sitagliptin)
• Galvus
• (Vildagliptin)

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DPP-4 Inhibitors

• Regulates the movement of food through the
  stomach intestine and decreases the amount of
  sugar made by the liver
• Lowers after meal glucose
• Most common side effect(s)
• Stuffy, runny nose
• Headache

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Combination Medications

• Target different organs that are involved in
  diabetes
• Liver
• Tissue
• Pancreas
• Stomach/Intestine

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Some Combination Medications

• Avandamet
• Avandia (rosiglitazone)
• Glucophage (metformin)
• Glucovance
• Glucophage (metformin)
• Micronase/Diabeta (glyburide)
• Metaglip
• Glucophage (metformin)
• Glucotrol (glipizide)

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Glucagon Like Peptide -1 (GLP-1) (Incretin
Hormone)

• Byetta
• (Exenatide)
• Injection (before meals)

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GLP-1

• Regulate the movement of food through the stomach
  intestine and decreases the amount of sugar
  made by the liver
• Lowers after meal glucose
• Most common side effect(s)
• Weight loss
• Stomach upset

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What About Insulin??

• Insulin - either alone or in combination is used
  in over 40 of persons with type 2 diabetes

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Insulin Therapy

• Basal InsulinIntermediate-Acting- NPHLong
  Acting- Lantus- Levemir

• Bolus InsulinShort Acting- Humulin R- Novolin
  RRapid Acting- Humalog- NovoLog- Apidra-
  Exubera

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Bolus Insulin Response to Meals
Adopted Eli Lilly Co
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Bolus Insulin

• Short Acting- Humulin R- Novolin R
• Rapid Acting- Humalog- NovoLog- Apidra-
  Exubera

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Basal Insulin Release
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Basal Insulin

• Intermediate-Acting- NPH
• Long Acting- Lantus- Levemir

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Amylinomimetic Agents

• Pramlintide (Symlin )
• injection
• In addition to insulin
• Inject before major meals
• Slows food movement through stomach intestine
• Gives a feeling of full
• Decreases sugar made in liver

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American Association of Clinical Endocrinologists

• Fasting
• lt 100mg/dl
• 2 hour post-prandial
• lt 140mg/dl
• Bedtime
• 100-140mg/dl
• A1c
• lt 6.5

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ADA Standards of Care

• Aspirin
• Blood Pressure
• Foot Care
• Eye Exam
• Lipid (Cholesterol) Profile
• Flu Pneumo shot
• Education

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What Questions Can We Answer For You?

• Thank you
• scorne_at_midwestern.edu