Antidiabetic Drugs

I. Injectable hypoglycemics MOA Indication SE

Insulin Preparations > increase uptake of glucose, Type 1 & type2 DM HypoglycemiaReaction :Insulin shock
amino acids & free fatty acids HA, lightheadedness
for storage nervousness, tremors, tachycardia
> synthesize glycogen, fats & sweating, slurred speech
Proteins memory lapse, seizure
excessive hunger
blood sugar= < 60 mg/dl
A. Short acting/ rapid acting onset peak duration
1. Lispro (Insulin analog) 5 min O.5 – 1 h 2–4h
• Humalog
Hyperglycemic Reaction:DiabeticKetoacidosis
2. Crystalline Zinc Insulin (Regular) 0.5 – 1 h 2–4h 6–8h polyuria , extreme thirst
• Humulin R, Novolin R dry mucous membranes, poor turgor
fruity breath, kussmaul
rapid, thready pulse
3. Semilente 1 – 1.5 h 1–4h 12 – 16 h blood sugar = > 250 mg/dl

B. Intermediate/ short acting

1. NPH insulin 1–2h 6 -12 h 18 – 24 h Hypersensitivity reactions
• Humulin N, Novolin N
Local sensitivity reactions to site of injection
2. Lente insulin 1–2h 8 – 12 h 18 – 24 h
• Humulin L, Novolin L

C. Long-acting
1. Ultralente insulin 5–8h 14 – 20 h > 36 h
a. Humulin U

2. Protamine Zinc Insulin (PZI) 4 – 8 h 14 – 24 h 24 – 36 h

D. Combination
1. NPH + Regular insulin
• Humulin 70/30 0.5 h 4–8h 22 – 24 h
• Humulin 50/ 50 0.5 h 4–8h 24 h
 • Humulin 75/25 15 min 0.5 – 6 h 20 – 24 h

II. Oral Hypoglycemics MOA Indication SE

A. Sulfonylurea >stimulates pancreas to secrete insulin Type 2 DM Hypoglycemia
1. 1st generation Short acting unresponsive to diet
• Tolbutamide GI effects; n & v

1st generation Intermediate acting hematologic effects: leucopenia,

• Acetohexamide thrombocytopenia
• Tolazamide disulfiram- like or antabuse –like effect

1st generation long acting

• Chlorpropamide

2. 2nd generation
• Glypizide
• Glyburide
• Glimepiride

B. Nonsulfonylureas type 2 DM GI effects:

1. Biguanides > improve insulin sensitivity unresponsive to diet anorexia, diarrhea, vomiting, flatulence
• Metformin (Glucophage) > decrease glucose absorption in SI Lactic acidosis
> decrease hepatic glucose production

2. Alpha glucosidase inhibitor >delay absorption of glucose in SI GI effects

• Acarbose
• Miglitol

3. Thiazolidinediones > decrease insulin resistance weight gain, hepatotoxic

• Rosiglitazone (Avandia) (Insulin enhancing agent)
• Pioglitazone (Actos)

4. Meglitinides > increase pancreatic release of insulin

• Repaglinide
• nateglinide

 Glucose elevating agents indication

 Diazoxide (oral) > counteract hypoglycemia in hyperinsulinism
 Glucagons (IV) > counteract insulin-induced hypoglycemic attacks

GOOD LUCK and GOD BLESS!!!!