Diabetes Medications

1
Diabetes Medications

• An in-depth look at the medications used to treat
  diabetes

2
Type 1 Diabetes

• Type 1
• Usually diagnosed in children and young adults
• People with type 1 diabetes do not make insulin

Diabetes Type 1. lt http//www.medicinenet.com/scr
ipt/main/art.asp?articlekey42943 gt Online Image.
Retrieved 20 July 2007.
3
Type 2 Diabetes

• Most common type of diabetes
• People with type 2 diabetes do not make enough
  insulin or the insulin they make does not work
  very well

Diabetes Type 2. lt http//www.medicinenet.com/scr
ipt/main/art.asp?articlekey42940 gt Online Image.
Retrieved 20 July 2007.
4
Diabetes Goals

• Fasting blood sugar goal 90-130mg/dl
• Blood sugar 2 hours after starting a meal Below
  180mg/dl
• Bedtime blood sugar goal 100-140mg/dl
• A1c goal Less than 7

Abbott Diabetes Care. lt http//www.abbottdiabetesc
are.com/adc_dotcom/url/content/en_US/2020/product
/Products_By_Category.htm gt Online Image.
Retreived 20 July 2007.
5
HbA1c Goals
Importance of A1c. lt http//www.apidra.com/a1c_glu
cose_control/Default.aspx gt Online Image.
Retrieved 07 July 2007.
6
Oral Medications
7
Biguanides

• Biguanides work by decreasing the amount of sugar
  produced by the liver. They also increase the
  ability for sugars to be absorbed by muscle and
  fat cells, and decrease the bodys ability to
  resist insulin.

8
Glucophage (metformin)

• Indicated for type 2 diabetes
• Has been proven safe in children
• Will not see any effect for a few days
• Can take up to 2 weeks
• Take with food to decrease GI side effects
• Most common side effects are diarrhea,
  nausea/vomiting, flatulence, and lactic acidosis
• If taking the once daily Metformin, take with
  your evening meal

9
Glucophage (metformin)

• If you have kidney problems, make sure your
  physician is aware of them
• If you are having any kind of radiologic studies
  (CT scan, MRI, etc) stop taking your Glucophage
  72 hours before your test

10
Sulfonylureas

• These work by increasing insulin release from the
  pancreas, decreasing glucose output from the
  liver, and increasing the bodys sensitivity to
  insulin.

FreeStyle Flash. lt http//www.abbottdiabetescare.
com/content/en_US/20.10.1010/product/Product_Prof
ile_0002.htm gt Online Image. Retrieved 23 July
2007.
11
glimepiride/glipizide/glyburide

• Indicated for type 2 diabetes
• Not approved for use in children
• Begins to work within 15 minutes to 3 hours
• If taking more than once a day
• Take 30 minutes before meals
• If dosed once a day
• Take daily with breakfast
• Do not take other medications within 2 hours of
  taking your sulfonylurea

12
glimepiride/glipizide/glyburide

• Sulfonylureas are structurally similar to sulfa
  medications. If you are allergic to sulfa
  medications, make sure your doctor or pharmacist
  are aware of your allergy.
• Common side effects include
• Sun sensitivity
• Dizziness
• Hypoglycemia
• Headache
• Nausea
• (Side effects such as headache and nausea will
  improve within 1 to 2 weeks of starting your
  medication)

13
Thiazolidinediones

• These medications work to decrease blood glucose
  by improving the cells response to insulin.

14
Recent news on Avandia

• Recent articles have focused on cardiovascular
  safety and Avandia
• If you have any type of heart disease speak with
  your doctor about the new information
• Do not stop taking Avandia without talking to
  your doctor first
• GlaxoSmithKline (GSK) has full confidence in the
  safety of Avandia, and at this time, Avandia is
  not being removed from the market
• The FDA is conducting further studies to ensure
  the safety of Avandia

15
Avandia /Actos

• Indicated for type 2 diabetes
• Take once or twice daily
• Take with or without food
• Begins to work in 2 weeks, however, full effect
  may not be seen for 2 to 3 months

16
Avandia /Actos

• If you have heart disease, make sure your doctor
  is aware
• Have yearly eye exams and liver function tests
• Found to decrease A1c by up to 1.4

17
Avandia /Actos

• Side effects
• Increased risk of bone fractures in women
  (typically hand, arm, ankle, and foot)
• Increased risk of becoming pregnant if
  postmenopausal and still menstruating
• Fluid retention
• Edema

18
Avandia /Actos

• Added Benefits of Actos
• Decreases triglycerides
• Improves HDL cholesterol
• Disadvantages of Avandia /Actos
• Possible weight gain of up 2 to 6lbs
• Slight increase in LDL cholesterol

19
Meglitinides

• These work to help the body release insulin at
  the start of each meal to help control mealtime
  blood sugar spikes

Accu Chek meter systems. lt http//www.accu-chek.co
m/us/rewrite/content/en_US/2.110/article/ACCM_gen
eral_article_2353.htm gt Online Image. Retrieved
20 July 2007.
20

• Indicated for type 2 diabetes
• Take one tablet 30 minutes before each meal
• Begins to work within 20 minutes
• Effects last for up to 4 hours
• May be taken alone or in combination with other
  diabetes medications
• Most common side effects were hypoglycemia, joint
  aches, dizziness, and cold/flu symptoms

21

• Store at room temperature
• Do not take if you have liver disease
• Do not take if you have type 1 diabetes

22
Alpha Glucosidase Inhibitors

• These medications slow the breakdown of
  carbohydrates in the intestine.

23
Precose (acarbose) / Glyset (Miglitol )

• Indicated for type 2 diabetes
• Not approved for use in children
• Start this medication slowly. Gradually increase
  your dose to three times a day.
• Take these medications with your first bite of
  your main meals
• Do not take other medications within 2 hours of
  these medications

24
Precose (acarbose) / Glyset (Miglitol )

• Have your liver enzymes checked every 3 months
  during your first year of treatment, then
  periodically
• Adverse reactions include
• Hypoglycemia
• Diarrhea
• Abdominal pain
• Flatulence

25
DDP-IV Inhibitors

• The newest class of diabetic medications. The
  pancreas gives the liver messages to make less
  sugar, while it makes more insulin. However,
  because of a substance in your blood called
  DDP-4, those messages do not make it through.
  DDP-IV inhibitors work by blocking the DDP-4 so
  that those important messages can get through.

Januvia. lt www.januvia.com gt Online Image.
Retrieved 07 July 2007.
26

• Increases insulin when blood sugars are high
• Reduces the amount of sugar made by your liver
  after you eat
• Has been found to decrease A1C by up to 1.5
• Improves fasting and after meal blood glucose
  levels

27

• Rarely causes hypoglycemia
• Dosed once a day, with or without food
• Has not been found to cause weight gain
• Most common side effects
• Runny nose
• Headache

28
Galvus

• Soon to be available from Novartis
• Improves after meal blood glucose levels
• Found to decrease A1C by 1-1.8
• When combined with Actos it has been found to
  decrease A1C by up to 2.8
• Low risk of hypoglycemia
• Dosed once a day
• Side effects include headache, dizziness, and
  cold/flu symptoms

29
Injectable Medications
30
Incretin Mimetics

• These drugs mimic the incretin hormones
• found in your body. These drugs work by
• increasing your insulin secretion,
• increasing your beta cell
• growth/replication, slowing gastric
• emptying, and by decreasing your food
• intake.

31
Byetta

• Byetta is NOT an insulin
• Administer 60 minutes prior to morning and
  evening meals
• Administer injection in the upper arm, thigh or
  abdomen
• Take any other medications 1 hour prior to
  Byetta because it may alter the ability of those
  medications to work

Byetta. ltwww.byetta.com gt Online image.
Retrieved 07 July 2007
32
Byetta
Byetta. lt www.byetta.com gt Online Image.
Retrieved 07 July 2007.
33
Byetta

• Before your pens first use, store it in the
  refrigerator, after you begin using your pen it
  may be stored at room temperature.
• Discard your pen 30 days after initial use.
• If your pen gets frozen, discard it.
• Do not store your pen with the needles on it.
  This can cause air bubbles to form in the pen
  which can be dangerous.

34
Byetta

• May decrease A1c by up to 2.1
• May cause a weight loss of up to 11.2lbs
• Most common side effect was nausea, which does
  decrease over time
• Only indicated for type 2 diabetic patients

35
Byetta LAR

• Expected to be released in 2008
• Once weekly version of Byetta
• Decreases fasting blood glucose levels by up to
  50mg/dL, and decreases A1c by 2
• Most common side effect is nausea
• Rarely found to cause hypoglycemia

36
Liraglutide

• Brand name has not yet been released
• Drug Expected to be released in 2008/2009
• Indicated for type 2 diabetics
• Can be used alone or in combination with
  metformin or glimepiride
• Once daily injection

37
Amylinomimetic

• When used in combination with insulin this class
  of medications will decrease after meal blood
  glucose levels by prolonging gastric emptying
  time, reducing after meal glucagon secretion, and
  by decreasing your appetite.

Bayer Health Care. lt http//www.bayercarediabetes.
com/prodServ/products/contour/index.asp gt Online
Image. Retrieved 20 July 2007.
38

• This is NOT an insulin
• It does not replace your insulin, but it is used
  in combination with your insulin and therefore
  your insulin dose might be decreased
• Do not use this if you have been diagnosed with
  gastroparesis
• Monitor your blood sugar before and after meals
  while taking this medication
• If your A1c level is above 9, this medication is
  not right for you

Symlin. lt www.symlin.com gt accessed 07 July 2007.
39

• Store unopened vials in the refrigerator. Once
  opened, the vial may be stored at room
  temperature.
• Discard your vial 28 days after initial use
• Administered as a SQ injection in the thigh or
  abdomen (do not inject into the arm) at least 2
  inches away from a site where you injected
  insulin
• Administer immediately prior to meals containing
  at least 30 grams of carbohydrates
• Take other oral medications 1 hour before or 2
  hours after you inject Symlin

40

• This can cause your blood sugar to drop to low
  (hypoglycemia). If this is going to occur, it
  will occur within 3 hours following your
  injection.
• Monitor your blood sugar frequently to prevent
  hypoglycemia
• Never mix Symlin in the same syringe as insulin
• The most common side effect is nausea

41

• Benefits
• Fewer blood sugar swings throughout the day
• You will feel fuller, so you will eat less,
  therefore possibly losing weight
• You may not need as much insulin

42
Insulin

• Insulin is a hormone produced by the pancreas. It
  allows the body to use the sugar in food as a
  source of energy. When you have diabetes, often
  your body cannot produce its own insulin, so
  patients use man made insulin instead.

Insulin. lt http//health.howstuffworks.com/insulin
.htm gt. Online Image. Retrieved 20 July 2007.
43
Insulin Myths

• Insulin should be a last resort for treatment
• New guidelines suggest adding insulin earlier in
  treatment. Your A1c level should be your goal in
  determining your treatment plan.
• Insulin injections are painful
• You might be surprised at how small and thin the
  needle really is. Using an insulin pen can be
  even less painful.
• Insulin causes weight gain
• You may gain a few pounds, however, the benefits
  to insulin far outweigh the risk of weight gain.

44
Benefits to using Pen Insulin

• No need to carry insulin vials and syringes
• Pen contains the needle and insulin
• Less painful
• Pen has a smaller, thinner needle
• Ensures the correct dose
• Dial in the exact units.
• Little preparation
• Pens are fast, easy to use, and easy to store

Novolog. lt www.novolog.com gt Online Image.
Retrieved 07 July 2007.
45
Insulin Summary
Types of Insulin Onset Duration Examples
Rapid Acting 1 to 30 minutes 2 to 6 hours Apidra Humalog Novolog Exubera Arx iDMS
Short Acting 30 minutes to 1 hour 6 to 8 hours Humulin R Novolin R
Intermediate Acting 1 to 4 hours 16 to 24 hours Humulin N Novolin N
Long Acting 1 to 4 hours 12 to 24 hours Lantus Levemir
46
Rapid Acting Insulin

• They work fast to manage mealtime blood sugar
  spikes. Rapid acting insulins act like insulin
  the body would make in a patient without
  diabetes.

Insulin. lt http//www.sawstonmedicalpractice.co.uk
/display.php?locationCommon20drugstitleInsulin
homeeasydirdrugpageinsulin gt Online Image.
Retrieved 20 July 2007.
47
Apidra

• Indicated for type 1 or type 2 diabetics
• Should be used in combination with a long acting
  insulin
• This is a rapid acting insulin.
• It begins to work within 1 to 2 minutes
• It will last for 2 to 4 hours

48
Apidra

• Should be given 15 minutes before a meal or
  within 20 minutes of starting a meal
• May be given via the OptiClik injection pen, via
  an insulin pump, or with a vial and syringe.
• May be injected into the thigh, abdomen, or upper
  arm
• Should be clear in color, if not clear then
  discard

49
Humalog /Novolog

• Indicated for type 1 or 2 diabetes
• In type 1 diabetes it should be used in
  combination with a long acting insulin
• In type 2 diabetes it should be used in
  combination with either a long acting insulin or
  an oral sulfonylurea
• Will begin to work within 15 to 30
• minutes and will last for
• 3 to 6 hours

50
Humalog /Novolog

• Unopened insulin should be stored in the
  refrigerator
• Once opened insulin may be stored at room
  temperature for 28 days
• If placed in a pump, insulin should be replaced
  every 48 hours and cartridges should be replaced
  within 7 days

51
Humalog /Novolog

• Humalog Should be injected 15 minutes before a
  meal, or immediately after a meal
• Novlog should be administered at the start of a
  meal, or within 5 to 10 minutes of the start of
  the meal
• May be injected SQ in the upper arm, thigh or
  abdomen
• Available in a vial or in a pen
• There are 3 Humalog pens to choose from
• HumaPen MEMOIR
• HumaPen LUXURA HD
• Prefilled Pen
• There are 4 Novolog pens to choose from
• NovoPen Jr
• NovoPen 3
• NovoPen 4
• Novolog FlexPen

52

• This pen is designed for parents and caregivers
  of children
• Can provide doses in ½ unit increments from 1 to
  30 units

Humalog. lt www.humalog.com gt Online Image.
Retrieved 07 July 2007.
53

• Only insulin pen available with a memory
• Records the date, time, and amount of insulin for
  your last 16 doses

Humalog. lt www.humalog.com gt Online Image.
Retrieved 07 July 2007.
54

• Prefilled pen
• Pocket size
• Simple to dial up
• Audible clicks
• No refrigeration needed after the first dose

Humalog. lt www.humalog.com gt Online Image.
Retrieved 07 July 2007.
55
Novolog

• NovoPen Jr.
• Designed for kids
• Colorful
• Able to dial ½ unit increments

Novolog. lt www.novolog.com gt Online Image.
Retrieved 07 July 2007.
56
Novolog

• NovoPen 3
• Can dial up 2 to 70 units
• Can dial backwards to correct a dose
• Uses cartridges for refills
• Store at room temp

Novolog. lt www.novolog.com gt Online Image.
Retrieved 07 July 2007.
57
Novolog
                                                                                                                 

• NovoPen 4
• For use with Novolog, NovoRapid, or Levemir
• End of dose click so youll know your insulin has
  all been delivered
• Available in 2 colors-silver and blue
• 50 less force needed to inject the insulin

Novolog. lt www.novolog.com gt Online Image.
Retrieved 07 July 2007.
58
Novolog

• Prefilled disposable pen with 300 units
• Can dial backwards if a mistake is made

Novolog. lt www.novolog.com gt Online Image.
Retrieved 07 July 2007.
59
Exubera

• The first inhaled insulin
• Indicated for patients with type 1 or type 2
  diabetes above the age of 18
• Begins to work within 10 to 20 minutes
• Effects last for up to 6 hours
• Decreases A1c by up to 1.9

Exubera. lt www.exubera.com gt Online Image.
Retreived 07 July 2007.
60
Exubera

• If you use any other inhalers, be sure to use
  those before using your Exubera
• Administer dose 10 minutes before a meal
• Available in 1mg and 3mg blisters
• Three 1mg blisters do NOT equal 3mg

61
Exubera

• Do Not use if you
• Smoke-you must be smoke free for at least 6
  months
• Have a lung disease (asthma, COPD, etc)
• Pregnant or under the age of 18

• Stored at room temperature
• No batteries needed
• You must have a lung function test prior to
  beginning treatment with Exubera
• Dry powder inhaler
• You wont feel the powder as you inhale

62
Exubera
Exubera. lt www.exubera.com gt Online Image.
Retrieved 07 July 2007.
63
Exubera
Exubera. lt www.exubera.com gt Online Image.
Retrieved 07 July 2007.
64
Exubera

• Once a foil blister is opened it needs to be used
  within 3 months
• Inhaler must be cleaned once a week
• Do not place any components in the dishwasher
• Release unit must be replaced every 2 weeks
• Reminder stickers are included in the kit
• Inhaler device should be replaced once a year

65
Exubera

• Potential Side effects
• Shortness of breath
• Chest pain
• Hypoglycemia
• Monitoring your blood sugar regularly can help
  prevent this
• Cough
• Tends to occur with minutes after use, but does
  decrease over time

66
AERx iDMS

• Soon to be released from Novo Nordisk
• Indicated for type 1 and type 2 diabetes
• A liquid inhalation
• Administered 30 minutes before meals
• Inhaler device records the date, time, and units
  of insulin administered

67
Short Acting Insulins

• Cover insulin needs for meals eaten within 30 to
  60 minutes

68


                                                              


Humulin R / Novolin R

• Begins to work within a ½ hour
• Lasts for 6 to 8 hours
• Should be a clear solution
• Discard if solution is not clear
• Injected SQ into the thigh, arm, buttock, or
  abdomen
• Do not inject cold insulin
• Roll vial gently in hand first to warm and mix
  the insulin

69
Humulin R / Novolin R

• Typically this medication is injected 30 to 60
  minutes before a meal
• This is usually given 2 to 4 times a day

70
Humulin R / Novolin R

• If mixing with another insulin, draw regular
  insulin into the syringe first
• Do not freeze
• If insulin has frozen, discard
• Store unopened vials in the refrigerator
• Upon opening, insulin may be stored at room
  temperature for 28 days

71
Novolin R

• Novolin R Pen
• Can be used with the pens featured under Novolog
• Store in the refrigerator until ready to use
• Store at room temperature once opened
• Discard 28 days after initial use

72
Novolin R

• Novolin R innolet
• Disposable
• Large numbers
• Audible clicks
• Store refrigerated until ready to use
• Store at room temperature once opened

Insulin Devices. lt http//www.insulindevice.com/in
nolet/features.asp gt Online Image. Retrieved 07
July 2007.
73
Intermediate Acting Insulins

• Begins to work after a couple of hours, but can
  last for up to 24 hours.

74
Humulin N, Novolin N

• Indicated for type 1 or type 2 diabetes
• Begin to work in 1 to 2 hours
• Duration is 16 to 24 hours
• Store unopened vials and pen cartridges in
  refrigerator
• If freezing occurs, discard insulin
• Store opened vials at room temperature for 28
  days, and opened pen cartridges at room
  temperature for 14 days

75
Humulin N, Novolin N

• Usually administered 1 to 2 times daily
• Inject SQ into abdomen, buttocks, thigh, or upper
  arm
• Solution should be clear, discard if not clear
• Do not inject cold insulin
• Roll insulin vial in palm of hands to warm and
  mix before injecting
• May be used with a vial and syringe or in a pen
• If mixing with regular insulin, draw regular
  insulin into the syringe first

76
Long Acting Insulins

• Provide steady 24 hour blood sugar control.

One Touch Ultra 2. lt http//www.lifescan.com/produ
cts/meters/ultra2/jsessionidOTGAYXOAK5NKGCQPCAMF
RZAKB2IIWTT1 gt Online Image. Retrieved 20 July
2007
77

• Indicated for type 1 or type 2 diabetics
• Not indicated for children under the age of 6
• Onset of action is 1 to 2 hours
• Duration is 24 hours
• Dosed once daily at any time of day
• Inject at the same time each day
• Do NOT mix with any other insulin

78

• Store unopened vials in the refrigerator
• If insulin freezes, discard
• Opened vials and pen cartridges may be stored at
  room temperature for 28 days
• Available in vials for use with a syringe or in
  cartridges for use in a pen
• Injected SQ into thigh, arm, buttock, or abdomen
• Clear solution, if solution is not clear then
  discard

79

• OptiClik Pen
• Pen available FREE from your physician
• Insulin cartridges available from your pharmacy
• Digital dose display
• Audible clicks
• Doses from 1 unit to 80 units
• Pen may also be used with Apidra

80

• Added benefits of Lantus
• Decreases A1c by up to 1.7
• Once a day injection
• When used in combination with Metformin or a
  sulfonylurea, Lantus has been found to decrease
  free fatty acids which are linked to
  complications of diabetes such as insulin
  resistance

81

• Indicated for type 1 or type 2 diabetics
• Not indicated for children under the age of 6
• Begins to work in 3 to 4 hours
• Store unopened in the refrigerator
• Discard if insulin freezes
• Once opened vials and pens are stable at room
  temperature for 42 days

                                                    
82

• Long acting insulin
• Except at low doses-then it becomes an
  intermediate acting insulin
• Do not use in an insulin pump
• May be used in a syringe or a pen
• Dosed once or twice a day
• Once daily dose is given with the evening meal or
  at bedtime
• Twice daily dosing is given in the morning and
  then 12 hours later

                                                    
83

• May be injected in the arm, thigh, buttock, or
  abdomen
• Solution should be clear
• Discard insulin if solution is not clear
• Do not inject insulin cold
• Roll vial in palm of hand to warm and mix
  solution

84

• FlexPen
• Disposable
• Prefilled
• Store at room temperature for up to 42 days
• Do not store pen with needles attached

Novolog. lt www.novolog.com gtOnline Image.
Retrieved 07 July 2007. Levemir. lt
www.levemir.com gt Online Image. Retrieved 07
July 2007.
85
Hypoglycemia

• If your blood sugar gets to low, your brain can
  run out of fuel, this can cause serious
  complications if not treated.

86
Hypoglycemia

• Make sure your family friends know what to do
  if your blood sugar gets to low.

• Signs/Symptoms
• Anxiety
• Blurred vision
• Feeling Cold
• Feeling Weak
• Drowsiness
• Weak
• Headache
• Hunger
• Sweating
• Trembling
• Unconscious

87
Hypoglycemia

• Treatment of hypoglycemia
• 15g of Carbs, which include things like
• Glucose tabs (3-4 or equivalent to 15g)
• 4oz fruit juice
• Frosting (equivalent to 15g)
• Meat Cheese sandwich
• Test your blood sugar 15 minutes later
• If still low repeat treatment options
• Recheck another 15 minutes later-if still low,
  contact your health care provider

88
GlucaGen Hypokit

• Small, compact
• Quick, easy to use
• Contains everything needed to increase your
  bloodsugar
• No medical training required for use

                                                                                                                 
Glucagen. lt http//www.novonordisk.com/diabetes/pu
blic/hypokit/glucagenhypokit/actualsize.asp. gt
Online Image. Retrieved 12 July 2007.
89
References

• Abbott Diabetes Care. lthttp//www.abbottdiabetesca
  re.com/adc_dotcom/url/content/en_US/2020/product/
  Products_By_Category.htm gt Online Image.
  Retreived 20 July 2007.
• Accu Chek meter systems. lt http//www.accu-chek.co
  m/us/rewrite/content/en_US/2.110/article/ACCM_gen
  eral_article_2353.htm gt Online Image. Retrieved
  20 July 2007.
• Actos. lt www.actos.com gt Retrieved. 07 July 2007.
  
• Apidra. lt www.apidra.com gt Retrieved 07 July
  2007.
• Armstrong, L. Lacy, C., Goldman, M., Lance, L.
  (2007). Drug Information Handbook (15th ed).
  Hudson, Oh Lexi-Comp.
• Avandia. lt www.avandia.com gt Retrieved 07 July
  2007.
• Avandia in the News Questions and Answers. lt
  http//www.avandia.com/pdf/Important_Information_f
  or_Patients_2.pdf gt Retrieved 15 July 2007.
• Bayer Health Care. lt http//www.bayercarediabetes.
  com/prodServ/products/contour/index.asp gt Online
  Image. Retrieved 20 July 2007.
• Bellaire, S., Clauson P., Cramer J., Okikawa J.
  Compliance with inhaled insulin treatment using
  the AERx iDMS insulin Diabetes Management
  system. Diabetes Tchnology and Therapeutics.
  2004 800-807.
• Berkrot, Bill. Novo Nordisks liragulatide
  effective in Japan study. Reufers. 23 June 2007.
  lt www.aletnet.org/thenews/newsdesk/n21400781.htm
  gt. Accessed 07 July 2007.
• Byetta. lt www.byetta.com gt Retrieved 07 July
  2007.
• Diabetes Type 1. lt http//www.medicinenet.com/scr
  ipt/main/art.asp?articlekey42943 gt Online Image.
  Retrieved 20 July 2007.
• Diabetes Type 2. lt http//www.medicinenet.com/scr
  ipt/main/art.asp?articlekey42940 gt Online Image.
  Retrieved 20 July 2007.
• Exubera. lt www.exubera.com gt Retrieved 07 July
  2007.
• FreeStyle Flash. lt http//www.abbottdiabetescare.
  com/content/en_US/20.10.1010/product/Product_Prof
  ile_0002.htm gt Online Image. Retrieved 23 July
  2007.
• Galvus. lthttp//www.pharma.us.novartis.com/newsroo
  m/pressReleases/releaseDetail.jsp?PRID2007 gt
  Retrieved 07 July 2007.
• Glucagon. lt http//www.novonordisk.com/diabetes/gl
  ucagenhypokit_splash.asp gt Retrieved 07 July
  2007.

90
References continued

• Humalog. lt www.humalog.com gt Retrieved 07 July
  2007.
• Importance of A1c. lt http//www.apidra.com/a1c_glu
  cose_control/Default.aspx gt Online Image.
  Retrieved 07 July 2007.
• Insulin. lt http//www.sawstonmedicalpractice.co.uk
  /display.php?locationCommon20drugstitleInsulin
  homeeasydirdrugpageinsulin gt Online Image.
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