 pharmacologic management of diabetes mellitus, insulin management of diabetes. Let's examine how insulin helps to manage diabetes mellitus. Insulin. Insulin is often used to treat diabetes mellitus. Clients with type 1 diabetes must receive insulin to live. The action of insulin. Let's look at each bulleted item to examine how insulin works. It stimulates the transportation of glucose across cell membranes. It converts glucose into glycogen for storage in the liver. It enhances storage of dietary fat in adipose tissue and inhibits the breakdown of fat into fatty acids. And it promotes protein synthesis in the muscle and inhibits protein breakdown. Remember that insulin performs the following functions. Transports glucose, stores fat, synthesizes protein, and converts glucose. Different types of insulin work at different speeds. Rapid acting. Lice pro. On set in 10 to 15 minutes. Peak in one hour with a duration of three to four hours. As part. On set in 10 to 15 minutes. Peak in 40 to 50 minutes with a duration of four to six hours. Short acting. Regular. Novelin R. And humulin R. On set in one half to one hour. Peak in two to four hours with a duration of six to eight hours. Semilant. On set in 30 to 90 minutes. Peak in five to 10 hours with a duration of 12 to 16 hours. Intermediate acting. Lent or humulin L. On set in one to four hours. Peak in seven to 15 hours with a duration of 18 to 24 hours. NPH. Humulin N. Novelin N. On set in 60 to 90 minutes. Peak in four to 12 hours with a duration of 18 to 24 hours. Long acting. Ultralent. On set in four to eight hours. Peak in 10 to 30 hours with a duration of 36 hours. Glargin. On set in one hour. Peak is continuous with a duration of 24 hours. Other injectable medications. In this activity you will examine drugs used to control glucose that are given by injection but are not insulin. These mimic hormones or synthetic forms of hormones found in your body. These hormones work with insulin to control your blood sugar. Let's look at each hormone to learn its role in glucose control. Amylen. Made by the pancreas. Slows the movement of food through the stomach and intestines. Helps keep glucose to be stored in the liver by preventing a rise in glucagon. Controls appetite in the brain. Insulin. Unlocks the numerous receptor doors on the surface of the cell. Glucose can enter the cell when the door is opened. GLP-1 molecules. Made in the intestines. Slows the movement of food from the stomach to the intestines. This means sugar will be absorbed more gradually. Stimulates the pancreas to make insulin when sugar is present. Helps the liver store and release sugar in a controlled way. Controls appetite in the brain. Bayetta. Bayetta is the first drug in the new classification of Inquitin mimetic. It mimics GLP-1. It is given by injection to type 2 diabetics with an injection pen. It is given by subcutaneous injection one hour before breakfast and supper. It can be used in conjunction with oral medications. Bayetta mimics GLP-1. When the blood sugar is elevated it promotes the pancreas to make more insulin. It can help keep the liver store and release glucose in a controlled way. It slows gastric emptying. It may reduce appetite and the amount of food eaten. Simlin. Simlin is a synthetic form of the hormone amylin. It can be used by type 1 or type 2 diabetic individuals. Given at mealtime by injection with a pre-filled pen. Actions. Food moves through stomach slower. The liver releases less glucose and the brain thinks you're full sooner at meals. Oral agents for treating diabetes. Some diabetic clients are treated with oral medications but all oral medications are not alike. Celfonylureas are the oldest type of oral agents with two generations of drugs. Celfonylureas have two actions that are beneficial when you consider the pathology of type 2 diabetes. Celfonylureas are also known as oral hypoglycemics because they can cause hypoglycemia. Celfonylureas perform the following two actions. They stimulate the release of insulin from the pancreas. They increase the sensitivity to insulin at receptor sites. This is done by increasing the degree of binding or increasing the number of receptors. Let's see their actions. There are many Celfonylureas. First generation include Thoropropamide, Tolanzamide, and Tolbutamide. Second generation includes Glimeparide, Glippazide, and Glyburide. Metformin is also known as Glucophage. It is a drug in the classification of byguanides. Metformin has three actions. Let's look at each action below to see it illustrated. It decreases hepatic production of glucose, it decreases intestinal absorption of glucose, and it increases sensitivity to insulin. Prandin. Prandin is also known as Repanglinide. It is a drug in the classification meglitinide. Remember that Prandin is taken when a person dines. Reasons Prandin should be taken with meals. It simulates the release of insulin from pancreatic beta cells. A client must have functional beta cells to take this drug. The onset of action is within 30 minutes, so hypoglycemic can occur if food is not taken after the client takes Prandin. If a meal is skipped, the dose of Prandin should also be skipped. Starlex. Starlex is also a meglitinide. It requires functioning beta cells. It is taken one to 30 minutes before the meal and not while the client is eating. Food will delay the absorption. The drug stimulates the release of insulin from the pancreas and can cause hypoglycemia. If a meal is skipped, the dose of Prandin should also be skipped. Thiozolidine diones. Two drugs that have a brand name beginning with an A belong to this class Avandia and Actos. There is another anti-diabetic agent that starts with an A that does not belong to this class, amaryll. It is a sulfonylurea. Hint. Note that both amaryll and sulfonylurea have a YL in them. The A drug with the YL does not belong in the thiozolidine diones class. Actos and Avandia enhance insulin action at the receptor sites in muscle and fat tissue without increasing insulin secretion. Because insulin secretion is not stimulated, these drugs work without causing hypoglycemia. The most significant but rare side effect of these drugs is liver damage. Liver function studies should be done regularly. Alpha glucosidases. The two alpha glucosidases are precoce and glycet. These drugs slow the digestion and absorption of carbohydrates within the intestine. They do this by inhibiting enzymes in the intestinal tract, which delays the digestion of the carbohydrates. The prolonged digestion time leads to a lower postprandial blood glucose level. DPP4 inhibitor. Junivia is the only drug in a new classification of oral anti-diabetic medication. It works by preventing the breakdown of a naturally occurring compound in the body, GLP1. Normally, GLP1 reduces blood glucose levels in the body, but is broken down very quickly, so it does not work well when injected as a drug itself. GLP1 has several actions that can lower blood sugar, including stimulating insulin production. Because Junivia interferes with the process that breaks down GLP1, it allows the GLP1 to remain active in the body longer. GLP1 is one of the post-potent stimulators of insulin release. The more available, the more insulin is available. You can learn more about GLP1 in the Injectable Medications section. DPP4 inhibitor. Basically, Junivia allows naturally occurring substances to work longer. This results in increased insulin synthesis and release, allowing for better uptake of glucose by peripheral tissues. Decreased glucagon, resulting in decreased glucose production by the liver. After food ingestion, incretin hormones are released into the intestine as a result of glucose stimulation. Junivia inhibits DPP4 enzymes, maintaining levels of active incretins. Congratulations! You have completed this activity, pharmacologic management of diabetes mellitus.