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Treatments in diabetes for torquay

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  • There are two main groups of diabetes treatments\nTablets – most commonly Metformin and Glicazide\nInsulin – in its various forms and guises\n\nThere are other types of treatment that don’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 Avandia is being withdrawn in the UK following a recommendation by the European Medicines Agency (EMA) on 23rd September 2010 regarding rosiglitazone-containing medicines.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 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 - If a meal is missed the dose must be omitted. \nSide 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;368:1696–705. \nBaggio LL, Drucker DJ. GLP-1 and GIP. Gastroenterol 2007;132:2131–57.\n
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  • Transcript

    • 1. Treatments in Diabetes Pete Kelly Diabetes Specialist Nurse Diabetes Education Services
    • 2. There are two main groups of diabetes treatment Diabetes Education Services
    • 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. Diabetes Education Services
    • 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. ThereWarning 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 Diabetes Education Services
    • 5. Metformin is usually withheld if a radiological dyeis required and it can be recommenced 48-72hrspost procedure. Diabetes Education Services
    • 6. Gliclazide•It is part of the Sulfonylurea family (several types are available ‘Gliclazide’is one of the more common). Others include Glibenclamide, Glipizide andGlimepiride•Gliclazide works by making the beta cells in the pancreas to release moreinsulin.•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 amaximum daily dose of 120mg. Diabetes Education Services
    • 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 usuallyWarning related to a reduced dietary intake. There may be a need to temporarily reduce the Gliclazide dose to reflect the reduce dietary intake. Diabetes Education Services
    • 8. Thiazolidinediones (glitazones)•These are Pioglitazone and Rosiglitazone; you will see Pioglitazoneused as currently Rosiglitazone is unavailable.•These work by reducing insulin resistance and improving insulinsensitivity enabling the insulin that the body produces to work moreeffectively.•Pioglitazone is available in 15mg, 30mg and 45mg tablets as wellcombined with Metformin in a preparation called Competact.•The most common side effects are gastric disturbances and weightgain secondary to fluid retention. Diabetes Education Services
    • 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 bothPregnancy and Breastfeeding. In animal studies wasfound to be toxic during pregnancy and also found inmilk. Diabetes Education Services
    • 10. And the not so common…..•DPP-4 inhibitors (gliptins) •Saxagliptin, Sitagliptin and Vitagliptin•Acarbose - Alpha glucosidase inhibitor •Glucobay•Prandial glucose regulator •Repaglinide Diabetes Education Services
    • 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 Humana day AnalogueMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
    • 13. InsulatardBasal once Humana day AnalogueMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
    • 14. Insulatard Humulin IBasal once Humana day AnalogueMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
    • 15. Insulatard Humulin IBasal once Human Levemira day Analogue DetermirMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
    • 16. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir GlargineMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
    • 17. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine ActrapidMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
    • 18. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time HumanInsulin AnaloguePre mixed HumanInsulin Analogue
    • 19. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human NovorapidInsulin AnaloguePre mixed HumanInsulin Analogue
    • 20. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid HumalogInsulin Analogue LisproPre mixed HumanInsulin Analogue
    • 21. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue LisproPre mixed HumanInsulin Analogue
    • 22. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30Pre mixed HumanInsulin Analogue
    • 23. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3Pre mixed HumanInsulin Analogue
    • 24. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25Insulin Analogue
    • 25. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30Insulin Analogue
    • 26. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30 HumalogInsulin Analogue Mix 25
    • 27. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30 HumalogInsulin Analogue Mix 25 Humalog Mix50
    • 28. Insulatard Humulin IBasal once Human Levemir Lantusa day Analogue Determir Glargine Actrapid Humulin SMeal time Human Novorapid Humalog ApidraInsulin Analogue Lispro Mixtard 30 Humulin M3 InsumanPre mixed Human Comb. 15 Comb 25 Novomix 30 HumalogInsulin 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 Diabetes Education Services
    • 30. •Hyperglycaemia •Physical stress from infection, pain •Anxiety or emotional •Immobility •Raised awareness of continued hyperglycaemia •Prescription errors •Addition of oral or IV steroids Diabetes Education Services
    • 31. And finallyVictoza and Exenatide Diabetes Education Services
    • 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 †Inglucose 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 Diabetes Education Services

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