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stimulates synthesis of glycogen; released into circulation when levels of glucose around cells rise
*work on pancreas

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treatment of Type 1 diabetes
treatment of Type 2 diabetes that cannot be controlled by diet or other agents

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hypoglycemia, hypokalemia

potential issues:
Somogyi effect: rebound effect in which overdose of insulin causes hypoglycemia; usually during hours of sleep
dawn phenomenon: hyperglycemia present on awakening in the morning
hypokalemia: patient may present with cardiac dysrhythmias & muscle cramping w/ large doses

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1. rapid acting: do not administer until meal is available; onset is 15 mins; lispro (Humalog)
2. short acting: onset is 30 mins; regular (Humulin)
3. intermediate acting: onset is 2-4 hours; NPH *cloudy, opaque
4. long acting: onset is 1-2 hours & lasts for 24+ hours; glargine (Lantus)

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- drug-to-drug interactions: beta blockers will mask s/s of hypoglycemia
- check blood sugar before administering

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hormone is co-secreted with insulin
*work on pancreas

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Type 1 & Type 2 diabetes

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risk for hypoglycemia in Type 1 DM

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- do not inject in the arm; only use abdomen or thigh
- monitor for weight loss

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stimulates insulin from beta cells
suppresses glucagon secretion
slows GI absorption
stimulated satiety center to decrease appetite
*work on pancreas

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hypoglycemia
nausea
rare: acute pancreatitis, thyroid C-cell tumors for Trulicity

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- can give with metformin, do NOT give with insulin or sulfonylurea
- monitor for hypoglycemia 2 hours after dosing
- administer 1 hour before breakfast & dinner
- use a new needle each time, do not store pen with needle attached, 30 day expiration
- contraindicated in pregnancy

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bind to potassium channels on pancreatic beta cells
improve insulin binding to insulin receptors & increase number of insulin receptors
*work on pancreas

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adjunct to diet & exercise to lower blood glucose levels in Type 2 Diabetes

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1. first generation: associated with increased risk of CV disease
2. second generation: advantage over first gen drugs (do not interact with as many drugs, longer duration of action)

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hypoglycemia
GI distress
skin reactions

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- contraindicated in Type 1 DM
- drug-to-drug interactions: beta blockers, alcohol

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first generation: chlorpropamide
second generation: glyburide

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increase insulin production from pancreas
*work on pancreas

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upper respiratory cough
GI upset

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- take 30 minutes before each meal up to time of meal
- don't give if meal is skipped
- contraindicated in Type 1 DM
- monitor renal function

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reduce glucose production by the liver
improves glucose transport into cells
*works on liver

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lactic acidosis in patients with hx of liver disease
GI upset

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- safe for children > 10 y/o
- BBW for adults > 80 y/o
- discontinue 48 hrs before contrast dye (d/t risk of renal impairment)
- monitor renal function at start & annually

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biguinide (Metformin)

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improves insulin sensitivity, transport, & utilization at target tissues
*works at target tissues

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most effective in those with insulin resistance

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- risk for hepatotoxicity: check liver functions every 2 months (ALT & AST)
- do NOT use if HF present
- take with meals
- increased risk for bladder cancer if taken more than one year

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"starch blockers;" slow down absorption of carbs in the small intestine
*works in the GI tract

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GI: bloating & flatulence

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- works best with sulfonylurea medications
- potential for leukopenia, thrombocytopenia, & anemia

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slows the breakdown of GLP-1 which leads to release of insulin, decrease secretion of glucagon, & slowed GI secretion
*works in pancreas

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hypoglycemia

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- monitor for weight loss
- have patient take daily

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increased excretion of glucose in the urine & prevents reabsorption in the kidney

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increased risk for genital mycotic infections & UTI esp. in females

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contraindicated in patients with GFR < 45 or end-stage renal disease

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increase blood glucose levels by decreasing insulin release & accelerating breakdown of glycogen in the liver to release glucose

*intranasal glucagon: Baqsimi

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treatment of hypoglycemia when glucose is <40 mg/dL

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GI upset

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- assess for renal or hepatic dysfunction & CV disease
- can be administered IM, subQ, or IV
- effectiveness with elevated glucose > 70 mg/dL
- anticoagulants can increase tendency to bleed

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dulaglutide (Trulicity)

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prandiol