Antihyperglycemics (2)- injectable

Antihyperglycemics (2)- injectable

Currently there are 3 recognized classes of injectable antihyperglycemics.


Glucagon-like peptide-1 receptor agonists (GLP-1 RAs): liraglutide, exenatide

These medications mimic endogenous glucagon-like peptide-1 (GLP-1) resulting in a variety of effects: stimulation of insulin secretion, enhancement of insulin sensitivity (secondary to weight loss), slowing of gastric emptying, and endogenous glucose production. Liraglutide also reduces cardiovascular events and mortality for high-risk patients within 3-5 years. Nausea, vomiting, diarrhea, and hypersensitivity reactions are the most common adverse effects.


Amylin mimetics: pramlintide

Pramlintide is a synthetic analog of human amylin, inhibiting high glucagon secretion and reducing the rate of glucose absorption by slowing gastric emptying. This medication should only be considered for patients already receiving insulin for type I or II diabetes. There is a black box warning for severe hypoglycemia, so proper insulin adjustments should be made if initiating concomitant pramlintide. Contraindications for pramlintide include gastroparesis, drugs that stimulate gastrointestinal motility, poor compliance to insulin therapy or blood-glucose monitoring, or glycated hemoglobin (A1C) > 9%.



Endogenous insulin acts to move glucose out of the blood into the cells, resulting in decreased serum glucose levels. There are two groups of exogenous insulin used for hyperglycemia: human insulin and insulin analogues. Human insulins include isophane (NPH) insulin and regular insulin and analogues include insulin aspart, lispro, glulisine, detemir, and glargine. While human insulin is more affordable, insulin analogues act more similarly to endogenous insulin produced by the pancreas. The different types of insulin vary in their onset of action, the time to their peak effects, and the duration of action. The pharmacodynamic profiles of insulin and some clinical analogues are depicted below in a graph that is available from the Diabetes Education Online webpage for 'Types of Insulin'.


The longer-acting analogues, referred to as basal insulin, are used once or twice daily for continuous control of fasting glucose. Insulin analogues with a shorter duration of action, referred to as bolus insulin, are used to control spikes in blood glucose, especially following meals. A brief description of each type of insulin together with more information about the time course of effects of each can be found by searching Diabetes Education Online.

Dylan Smith
Kelly Karpa

Diabetes Education Online- type 2 diabetes

This is a website run by the University of California, San Francisco. It has a wealth of information about diabetes and the medications and therapies that can be used to manage the condition, much of which is suitable for patients and early learners.

Average: 5 (1 vote)

Diabetes Education Online- type 1 diabetes

This page provides access to a wealth of information about the drugs and therapies that are available for patients with type 1 diabetes. The information that is provided is suitable both for patients and early learners. 

Average: 2.6 (9 votes)