Insulin

- Synthesis occurs in the Beta cells
- MOA: Activates recptors that lead to phosphorylation and activation of GTP (basically makes proteins to put the glucose into the cell.

-Crystalline zinc or Lispro
- Humulin or Humalog
- Short Acting 5-7 hrs

Insulin zinc suspension (lente)
Isophane insulin suspension (NPH)
18-24 hrs

Extended insulin Suspension (Humulin U)
Insulin Glargine (Lantus)
36 hrs

MOA - Stimulates the release of insulin and increases the sensitivity of beta cells to glucose. Basically increases Ca inside a cell - releasing Insulin.
Tolbutamide (Orinase)
Newer agents – more frequent use today
Glipizide (Glucotrol)
Glyburide (Micronase)
Glimepiride (Amaryl)

Hypoglycemia (can be profound)
Nausea
Rash
Blood disorders
Jaundice
Muscle weakness and ataxia
Dizziness and mental confusion

Repaglinide (Prandin) and nateglinide (Starlix)
MOA -stimulates insulin release from active beta cells
Short duration – used only preprandially
Can cause hypoglycemia (less likely than sulfas), nausea, dyspepsia, and diarrhea

Metformin (Glucophage)
- Decreases glucose production and increases insulin action on muscle
- Lactic Acidosis !!
- Commonly – diarrhea, nausea, other GIT symptoms

Acarbose (Glucobay) (Precose)
Miglitol (Glyset)
MOA - Inhibits GIT enzymes that breakdowns complex carbohydrates
Side affects - GIT disturbances, diarrhea, pain, and gas

- Increasing the sensitivity of insulin receptors
- Common side effect is weight gain and fluid retention.
Significant but infrequent toxicities include; hepatotoxicity, and congestive heart failure