DIABETES MEDICATION UPDATE

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DIABETESMEDICATION UPDATE

• A. Sami Wood, MS, RD/LD,CDE
• Center For Diabetes Education
• OSUMC

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What Is Diabetes?

• A group of diseases characterized by
  inappropriate high blood sugar due to defects in
  the production and/or action of insulin and other
  hormones.

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What is sugar doing in the blood?

• Sugar is the bodys main source of energy
• The body needs a constant supply of energy
• Blood sugar is tightly controlled

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Sources of Glucose in the Blood

• Outside source food and drinks
• Inside source liver

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Insulin

• A hormone made in the pancreas
• Prevents blood sugar from going too high
• - Allows the body to use sugar
• - Allows the body to store extra sugar

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Blood glucose and insulin
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Normal Insulin/Glucose Patterns
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Basal Insulin

• Insulin required to control hepatic glucose
  output even when fasting.
• Accounts for 50 of daily insulin needs.

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Bolus Insulin

• Insulin required to cover mealtime carbohydrates.
• Accounts for the other 50 of insulin needs.

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EXUBERA

• An inhaled rapid-acting insulin for mealtime
  blood sugar control
• Used in DM1 in combination with a basal insulin
• Used in DM2 alone or in combination with a basal
  insulin and/or pills
• Should be taken 0-10 minutes before a meal

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• A lung function test is required before a patient
  is started on Exubera and every 6 months
  thereafter

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EXUBERA-Contraindications

• Smokers
• Patients with Asthma and COPD
• Children
• Pregnant women

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EXUBERA

• Store
• Inhaler and insulin blisters at room temperature
  in a dry place
• Unopened insulin blisters in their foil overlap

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EXUBERA

• Side effects
• Hypoglycemia
• Mild cough

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WHAT ABOUT THE OTHER HORMONES INVOLVED IN
BLOOD SUGAR CONTROL?
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Glucagon

• A hormone made in the pancreas
• Prevents blood sugar from going too low
• - Allows the use of stored sugar
• - Allows the production of new sugar in the
  liver

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Amylin

• A hormone made and released with insulin
• Slows the flow of sugar from the stomach to the
  blood
• Keeps the liver from making too much sugar
• Helps us feel full

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SYMLIN

• An injectable hormone replacement for Amylin
• Used in patients with DM1 or DM2 who are on
  insulin
• Given immediately before major meals
• May reduce needs for meal insulin or
  sulfonulureas by 50
• Lasts in the body 3 hrs with peak action in 21 min

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SYMLIN

• Start low and go slow
• Dose range 2.5 to 20 units
• Store opened vials in the refrigerator or at room
  temperature for up to 28 days

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SYMLIN

• Side effects
• Nausea
• Hypoglycemia
• Possible weight loss

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SYMLIN

• Not appropriate for patients with
• Hypoglycemia unawareness
• Gastroporesis or on meds affecting gastric
  motility
• A1C gt9
• Poor compliance with insulin shots

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Incretins

• Hormones made in the intestine in response to
  sugar in the blood.
• Augment insulin secretion
• Slow the flow of sugar from the stomach to the
  blood
• Keep the liver from making too much sugar
• Help us feel full

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BYETTA

• An analogue for one of the incretin hormones
  (GLP-1)
• An injectable medicine
• Used alone or in combination with metformin, TZD
  and/or sulfonylureas in patients with DM2.
• Given 0-60 minutes before breakfast and supper

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BYETTA

• Available in 5 and 10 mcg pens
• Opened pens are only good for 30 days.

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BYETTA

• Side effects
• Nausea
• Hypoglycemia especially when used with
  sulfonylureas
• Possible weight loss

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BYETTA

• Not appropriate for patients with
• Gastroporesis or on meds affecting gastric
  motility
• A1C gt9
• Severe liver or kidney disease

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Galvus and Januvia

• Galvus coming soon
• Januvia available
• Stabilize one of the incretins (GLP-1)
• Used alone or in combination with metformin
  and/or TZD in patients with DM2.
• A once a day pill.
• No weight loss or gain observed.

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• More options for better diabetes management with
  more freedom and flexibility