Drugs for Diabetes

   I. Physiology
      A. Pancreas
         1. islets of Langerhans
            a. alpha cells - produce glucagon
            b. beta cells - produce insulin
      B. Insulin

  II. Disease = Diabetes mellitus
         1.  hyperglycemia
      A. Clinical classifications
         1. type 1
         2. type 2
         3. gestational diabetes
         4. other
      B. Effects
      C. Treatment goal

 III. Type 1 Diabetes Treatment
      A. Regular insulin
         1. Humunin R
         2. Novolin R
      B. Analogs
         1. rapid & short
            a. insulin lispro (Humalog)
            b. insulin aspart (Novolog)
            c. insulin glulisine (Apidra)
         2. intermediate
            a. NPH
            b. Humulin N
            c. Novolin N
         3. long acting
            a. insulin glargine (Lantus & Basaglar)
            b. insulin detemir (Levemir)
         4. combinations
            a. Huminlin R
      C. Synthetic amylin analog
         1. pramlintide (Symlin)

  IV. Type 2 Diabetes Medications
      A. Strategies
      B. increase insulin production
         1. sulfonlyureas
            a. glyburide (Diabeta & Glynase)
            b. glipizide (Glucotrol)
            c. glimepiride (Amaryl)
         2. glinides
            a. repaglinide (Prandin)
            b. nateglinide (Starlix)
         3. GLP-1 & GIP receptor agonists
               1) incretins
                  a) GLP-1
                  b) GIP
                  c) dipeptidyl peptidase-4
               2) HbA1c
            a. exenatide (Byetta)
            b. liraglutide (Victoza)
            c. dulaglutide (Trulicity)
            d. semaglutide (Ozempic)
                1) (Rybelsus)
                    a) SNAC
            e. weight loss
                1) (Saxenda)
                2) (Wegovy)
         4. block incretin breakdown
             a. DPP-4 inhibitors
                 1) alogliptin (Nesina)
                 2) linagliptin (Tradjenta)
                 3) saxagliptin (Onglyza)
                 4) sitagliptin (Januvia)
      C.  insulin sensitivity
           1. metformin (Fortamet & Glucophage)
           2. TZDs
               a. pioglitazone (Actos)
               b. rosiglitazone (Avandia)
      D.  glucose excretion
           1. SGLT2 Inhibitors
               a. canagliflozin (Invokana)
               b. dapagliflozin (Farxiga)
               c. empagliflozin (Jardince)
      E. Other
           1. alpha-Glucosidase inhibitors
           2. acarbose (Precose)
           3. miglitol (Glyset)