2. There are two main groups of diabetes treatment
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3. The most common tablets for the treatment of Diabetes are….
•Metformin
•It’s a Biguanide – a drug that reduces the release of glucose from the
liver and enables glucose to be taken into muscles and fat cells more
efficiently.
•Metformin’s length of action is around 8 – 12 hours and it is available
in 500mg and 850mg tablets.
•Or it is available in a modified release form taken once or twice day.
available in 500mg and 750mg tablets.
•Maximum dose is total daily dose of 2g.
•It is also available in liquid or powder form.
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4. •Metformin
•It is best taken with food to avoid gastric disturbance the most
common of side effect of the medication.
•Generally it is well tolerated and produces good results on top of being
very cheap.
•Metformin itself does not usually cause hypos but it will augment the
effects of other medications to induce a hypo.
Metformin should be used with caution in patients with
Renal Failure – Creatinine >150 and eGFR <50. There
Warning is an increased risk of lactic acidosis, rare but possibly fatal
complication.
Metformin may not be suitable for those with heart failure
(a condition whereby the pumping action of the heart is
inadequate
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5. Metformin is usually withheld if a radiological dye
is required and it can be recommenced 48-72hrs
post procedure.
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6. Gliclazide
•It is part of the Sulfonylurea family (several types are available ‘Gliclazide’
is one of the more common). Others include Glibenclamide, Glipizide and
Glimepiride
•Gliclazide works by making the beta cells in the pancreas to release more
insulin.
•It is available in 80mg tablets with a maximum dose of 160mg BD.
•It is also available in modified release form (Diamicron MR) 30mg with a
maximum daily dose of 120mg.
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7. Gliclazide
•Glicazide is usually started once Metformin is no longer effective on its own
or it is no longer appropriate to the patient with.
•The most common side effect of Glicazide is gastric upset and then weight
gain.
•It is a cheap and effective treatment for diabetes.
Gliclazide commonly causes hypoglycaemia . This is usually
Warning related to a reduced dietary intake. There may be a need to
temporarily reduce the Gliclazide dose to reflect the reduce dietary
intake.
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8. Thiazolidinediones (glitazones)
•These are Pioglitazone and Rosiglitazone; you will see Pioglitazone
used as currently Rosiglitazone is unavailable.
•These work by reducing insulin resistance and improving insulin
sensitivity enabling the insulin that the body produces to work more
effectively.
•Pioglitazone is available in 15mg, 30mg and 45mg tablets as well
combined with Metformin in a preparation called Competact.
•The most common side effects are gastric disturbances and weight
gain secondary to fluid retention.
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9. Thiazolidinediones (glitazones)
•Glitazones should not be used in patients with heart
failure or with a history of heart failure.
•Glitazones will exacerbate the two conditions.
Thiazolidinediones (glitazones)
•Both forms of glitazones should be avoided in both
Pregnancy and Breastfeeding. In animal studies was
found to be toxic during pregnancy and also found in
milk.
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10. And the not so common…..
•DPP-4 inhibitors (gliptins)
•Saxagliptin, Sitagliptin and Vitagliptin
•Acarbose - Alpha glucosidase inhibitor
•Glucobay
•Prandial glucose regulator
•Repaglinide
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11. Insulin
•Insulin is a hormone made by an organ in our bodies called the pancreas.
•The pancreas lies just behind the stomach.
•The function of insulin is to help our bodies use glucose for energy.
•For all people with Type 1 diabetes and for some people with Type 2 diabetes,
insulin is essential to keep blood glucose levels under control.
12. Basal once Human
a day Analogue
Meal time Human
Insulin Analogue
Pre mixed Human
Insulin Analogue
13. Insulatard
Basal once Human
a day Analogue
Meal time Human
Insulin Analogue
Pre mixed Human
Insulin Analogue
14. Insulatard Humulin I
Basal once Human
a day Analogue
Meal time Human
Insulin Analogue
Pre mixed Human
Insulin Analogue
15. Insulatard Humulin I
Basal once Human
Levemir
a day Analogue
Determir
Meal time Human
Insulin Analogue
Pre mixed Human
Insulin Analogue
16. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Meal time Human
Insulin Analogue
Pre mixed Human
Insulin Analogue
17. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid
Meal time Human
Insulin Analogue
Pre mixed Human
Insulin Analogue
18. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Insulin Analogue
Pre mixed Human
Insulin Analogue
19. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid
Insulin Analogue
Pre mixed Human
Insulin Analogue
20. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog
Insulin Analogue
Lispro
Pre mixed Human
Insulin Analogue
21. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Pre mixed Human
Insulin Analogue
22. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Mixtard 30
Pre mixed Human
Insulin Analogue
23. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Mixtard 30 Humulin M3
Pre mixed Human
Insulin Analogue
24. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Mixtard 30 Humulin M3 Insuman
Pre mixed Human
Comb. 15
Comb 25
Insulin Analogue
25. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Mixtard 30 Humulin M3 Insuman
Pre mixed Human
Comb. 15
Comb 25
Novomix 30
Insulin Analogue
26. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Mixtard 30 Humulin M3 Insuman
Pre mixed Human
Comb. 15
Comb 25
Novomix 30 Humalog
Insulin Analogue
Mix 25
27. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Mixtard 30 Humulin M3 Insuman
Pre mixed Human
Comb. 15
Comb 25
Novomix 30 Humalog
Insulin Analogue
Mix 25
Humalog
Mix50
28. Insulatard Humulin I
Basal once Human
Levemir Lantus
a day Analogue
Determir Glargine
Actrapid Humulin S
Meal time Human
Novorapid Humalog Apidra
Insulin Analogue
Lispro
Mixtard 30 Humulin M3 Insuman
Pre mixed Human
Comb. 15
Comb 25
Novomix 30 Humalog
Insulin Analogue
Mix 25
Humalog
Mix50
29. •Hypoglycaemia
•Reduction in the amount of carbohydrate eaten by
patient
•Patients actually now taking medication
•Medications being given in the correct manner
•Prescription errors
•Incorrect timings of medications
•Inappropriate use of stat/PRN insulin
•Enteral feed stopped
•Diarrhoea and Vomiting
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30. •Hyperglycaemia
•Physical stress from infection, pain
•Anxiety or emotional
•Immobility
•Raised awareness of continued hyperglycaemia
•Prescription errors
•Addition of oral or IV steroids
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32. GLP-1: Multiple physiological
Increased
effects
glucose-dependent Promotes satiety and
insulin secretion* reduces appetite
Increased insulin
Decreased gastric
synthesis
emptying
Decreased
glucagon secretion Increased beta-cell
proliferation†
Reduced hepatic
glucose output Decreased beta-cell
apoptosis†
*GLP-1 only stimulates insulin secretion when †In
glucose is raised, thereby reducing the risk of in vitro studies
hypoglycaemia
Drucker DJ, Nauck M. Lancet 2006;368:1696–705
Baggio LL, Drucker DJ. Gastroenterol 2007;132:2131–57
33. • Prior to first use,
store in fridge (2–8°C)
• Do not freeze
• After first use, store below
25°C
• Do not store with needle
attached
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Editor's Notes
\n
There are two main groups of diabetes treatments\nTablets &#x2013; most commonly Metformin and Glicazide\nInsulin &#x2013; in its various forms and guises\n\nThere are other types of treatment that don&#x2019;t fit into either of these groups.\n\nLets look at tablets or Oral Hypoglycaemic Agents OHAs\n
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OCTOBER 2010 - SUSPENSION OF LICENCE. Avandia is being withdrawn in the UK following a recommendation by the European Medicines Agency (EMA) on 23rd September 2010 regarding rosiglitazone-containing medicines. The EMA have been reviewing safety data accumulated since the launch of rosiglitazone and have decided that the benefits of this medicine no longer outweigh its risks. New research has shown that rosiglitazone is associated with an increased risk of heart problems, including heart attacks and heart failure.\n
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DPP-4 inhibitors\nThey work by blocking the action of the enzyme, DPP-4, which destroys the hormone incretin.\nIncretins help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed. These hormones are released throughout the day and levels are increased at meal times.\nHypoglycaemia (hypo), drowsiness, diarrhoea, nausea, flatulence, constipation, upper abdominal pain, oedema, headache, dizziness, osteoarthritis, arm or leg pain, allergic skin reactions, general allergic reaction, weight loss, loss of appetite, respiratory infection. \n\nAcarbose \nworks by slowing down the absorption of starchy foods from the intestine, thereby slowing down the rise in blood glucose after meals. \nSide&#xA0;effects which may be experienced in this group\nFlatulence, diarrhoea, abdominal pain, nausea, vomiting, indigestion, liver function problems, oedema, blood disorders, allergic skin reaction, intestinal problems.\n\nPrandial Glucose Regulator\nThese work by stimulating your pancreas to produce more insulin. However, unlike the sulphonylureas they work very quickly but only last for a short time. \nNB&#xA0;- If a meal is missed the dose must be omitted. \nSide&#xA0;effects which may be experienced in this group\nHypoglycaemia (hypo), allergic skin reactions, liver function problems, abdominal pain, nausea, diarrhoea, vomiting, constipation, visual disturbances.\n
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GLP-1 has multiple physiological functions. \nInsulin and glucagon secretion: \nGLP-1 has a direct effect on pancreatic cells, one of the most important of which is to increase insulin secretion. Importantly, however, this insulin secretory effect is glucose-dependent. Thus, GLP-1 lowers blood glucose only when levels are elevated, which reduces the risk of hypoglycaemia. GLP-1 also regulates glucagon secretion, which may be via an increase in somatostatin secretion, and/or via a direct effect on the alpha-cell in the pancreas. This reduction in glucagon secretion decreases output of glucose from the liver.\nBeta-cell \nGLP-1 also appears to play an important role in maintaining beta-cells, stimulating beta-cell neogenesis, growth and proliferation (in vitro animal studies). Additionally, decreased beta-cell apoptosis has been reported in in vitro studies involving isolated human islets. \nGI\nGLP-1 delays gastric emptying. This means that glucose enters the blood more slowly after a meal, and may also promote feelings of satiety thus reducing appetite. \n\nReferences\nDrucker DJ, Nauck M. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet 2006;368:1696&#x2013;705. \nBaggio LL, Drucker DJ. GLP-1 and GIP. Gastroenterol 2007;132:2131&#x2013;57.\n
