1. DIABETES MEDICATION UPDATE A. Sami Wood, MS, RD/LD,CDE Center For Diabetes Education OSUMC

2. What Is Diabetes? A group of diseases characterized by inappropriate high blood sugar due to defects in the production and/or action of insulin and other hormones.

3. What is sugar doing in the blood? Sugar is the body’s main source of energy The body needs a constant supply of energy Blood sugar is tightly controlled

4. Sources of Glucose in the Blood Outside source: food and drinks Inside source: liver

5. Insulin A hormone made in the pancreas Prevents blood sugar from going too high - Allows the body to use sugar - Allows the body to store extra sugar

6. Blood glucose and insulin

7. Normal Insulin/Glucose Patterns

8. Basal Insulin Insulin required to control hepatic glucose output even when fasting. Accounts for 50% of daily insulin needs.

9. Bolus Insulin Insulin required to cover mealtime carbohydrates. Accounts for the other 50% of insulin needs.

10. EXUBERA An inhaled rapid-acting insulin for mealtime blood sugar control Used in DM1 in combination with a basal insulin Used in DM2 alone or in combination with a basal insulin and/or pills Should be taken 0-10 minutes before a meal

11. A lung function test is required before a patient is started on Exubera and every 6 months thereafter

12. EXUBERA-Contraindications Smokers Patients with Asthma and COPD Children Pregnant women

13. EXUBERA Store Inhaler and insulin blisters at room temperature in a dry place Unopened insulin blisters in their foil overlap

14. EXUBERA Side effects Hypoglycemia Mild cough

15. WHAT ABOUT THE OTHER HORMONES INVOLVED IN BLOOD SUGAR CONTROL?

16. Glucagon A hormone made in the pancreas Prevents blood sugar from going too low - Allows the use of stored sugar - Allows the production of new sugar in the liver

17. Amylin A hormone made and released with insulin Slows the flow of sugar from the stomach to the blood Keeps the liver from making too much sugar Helps us feel full

18. SYMLIN An injectable hormone replacement for Amylin Used in patients with DM1 or DM2 who are on insulin Given immediately before major meals May reduce needs for meal insulin or sulfonulureas by 50% Lasts in the body 3 hrs with peak action in 21 min

19. SYMLIN Start low and go slow Dose range 2.5 to 20 units Store opened vials in the refrigerator or at room temperature for up to 28 days

20. SYMLIN Side effects Nausea Hypoglycemia Possible weight loss

21. SYMLIN Not appropriate for patients with Hypoglycemia unawareness Gastroporesis or on meds affecting gastric motility A1C >9% Poor compliance with insulin shots

22. Incretins Hormones made in the intestine in response to sugar in the blood. Augment insulin secretion Slow the flow of sugar from the stomach to the blood Keep the liver from making too much sugar Help us feel full

23. BYETTA An analogue for one of the incretin hormones (GLP-1) An injectable medicine Used alone or in combination with metformin, TZD and/or sulfonylureas in patients with DM2. Given 0-60 minutes before breakfast and supper

24. BYETTA Available in 5 and 10 mcg pens Opened pens are only good for 30 days.

25. BYETTA Side effects Nausea Hypoglycemia especially when used with sulfonylureas Possible weight loss

26. BYETTA Not appropriate for patients with Gastroporesis or on meds affecting gastric motility A1C >9% Severe liver or kidney disease

27. Galvus and Januvia Galvus: coming soon Januvia: available Stabilize one of the incretins (GLP-1) Used alone or in combination with metformin and/or TZD in patients with DM2. A once a day pill. No weight loss or gain observed.

28. More options for better diabetes management with more freedom and flexibility