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Home Books Poisoning & Drug Overdose, 7e

CHAPTER 2-60: DIABETIC DRUGS

Susan Kim-Katz

INTRODUCTION

Recent advances have resulted in a dramatic increase in the number and types of drugs used to manage diabetes. These agents can be divided broadly into parenteral and oral drugs. Table II–24 lists the various available antidiabetic agents. Metformin is also discussed in a separate chapter (see Metformin). Other drugs and poisons can also cause hypoglycemia (see Table I–25).

TABLE II–24.DIABETIC DRUGSa
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TABLE II–24. DIABETIC DRUGSa
Agent Onset (h) Peak (h) Durationb (h) Hypoglycemiac
Insulins
 Regular insulin 0.5–1 2–3 8–12 Y

 Regular insulin

 Inhaled (Afrezza)

  

 

0.9

 

3

 

Y
 Rapid insulin zinc (semilente) 0.5 4–7 12–16 Y
 Insulin lispro (Humalog) 0.25 0.5–1.5 6–8 Y
 Insulin aspart (Novolog) 0.25 1–3 3–5 Y
 Insulin glulisine (Apidra) 0.3 0.6–1 5 Y
 Isophane insulin (NPH) 1–2 8–12 18–24 Y
 Insulin zinc (lente) 1–2 8–12 18–24 Y
 Insulin glargine (Lantus) 1.5 Sustained effect 22–24 Y
 Insulin detemir (Levemir) 1 6–8 20 Y
 Extended zinc insulin (ultralente) 4–8 16–18 36 Y
 Protamine zinc insulin (PZI) 4–8 14–20 36 Y
Amylin analog
 Pramlintide acetate (Symlin)   0.3–0.5 3 N
GLP-1 agonists
 Albiglutide (Tanzeum)   3–5 days [Half-life 5 days] +/–
 Exenatide (Byetta)   2 6–8 +/–
 Exenatide (Bydureon, extended-release formulation)   Biphasic: 2 weeks then 6–7 weeks 10 weeks +/–
 Liraglutide (Victoza)   8–12 [Half-life 13 h] +/–
Sulfonylureas
 Acetohexamide 2 4 12–24 Y
 Chlorpropamide 1 3–6 24–72b Y
 Glimepiride 2–3   24 Y
 Glipizide [extended-release form] 0.5 [2–3] 1–2 [6–12] <24 [45] Y
 Glyburide [micronized form] 0.5 4 [2–3] 24b Y
 Tolazamide 1 4–6 14–20 Y
 Tolbutamide 1 5–8 6–12 Y
Meglitinides
 Nateglinide (Starlix) 0.25 1–2 [Half-life 1.5–3 h] Y
 Repaglinide (Prandin) 0.5 1–1.5 [Half-life 1–1.5 h] Y
Biguanide
 Metformin (see Metformin)   2 [Half-life 2.5–6 h] +/–
Alpha-glucosidase inhibitors
 Acarbose (Precose)   N/A (<2% of an oral dose absorbed systemically)   N
 Miglitol (Glyset)   2–3 [Half-life 2 h] N
Glitazones (thiazolidinediones)
 Pioglitazone (Actos)   2–4 [Half-life 3–7 h] N
 Rosiglitazone (Avandia)   1–3.5 [Half-life 3–4 h] N
Dipeptidyl peptidase-4 inhibitors
 Alogliptin (Nesina)   1–2 [Half-life 21 h] N
 Linagliptin (Tradjenta)   1.5 [Half-life >100 h] N
 Sitagliptin (Januvia)   1–4 [Half-life 12.4 h] +/-
 Saxagliptin (Onglyza)     [Half-life 2.5 h] N
Sodium-glucose cotransporter 2 inhibitors
 Canagliflozen (Invokana)   1–2 [Half-life 10.6-13.1 h] N
 Dapagliflozen (Farxiga)   2 [Half-life 12.9 h] N

aSee also Table II–66.

bDuration of hypoglycemic effects after overdose may be much longer, especially with glyburide, chlorpropamide, and extended-release products (case report of 45-hour duration in a 6-year-old child after ingestion of extended-release glipizide).

cHypoglycemia likely after an acute overdose as a single agent.

MECHANISM OF TOXICITY

  1. Parenteral agents

    1. Insulin. Blood glucose is lowered directly by the stimulation of cellular uptake and metabolism of glucose. Cellular glucose uptake is accompanied by an intracellular shift of ...

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