Transcript DDP-IV Inhibitors

Diabetes Medications
An in-depth look at the
medications used to treat
diabetes
Type 1 Diabetes

Type 1

Usually diagnosed
in children and
young adults

People with type 1
diabetes do not
make insulin
Diabetes: Type 1. < http://www.medicinenet.com/script/main/art.asp?articlekey=42943 > Online Image. Retrieved 20 July 2007.
Type 2 Diabetes

Most common type
of diabetes

People with type 2
diabetes do not
make enough
insulin or the insulin
they make does not
work very well
Diabetes: Type 2. < http://www.medicinenet.com/script/main/art.asp?articlekey=42940 > Online Image. Retrieved 20 July 2007.
Diabetes Goals

Fasting blood sugar goal: 90-130mg/dl

Blood sugar 2 hours after starting a meal:
Below 180mg/dl

Bedtime blood sugar goal: 100-140mg/dl

A1c goal: Less than 7%
Abbott Diabetes Care. < http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20:20/product/Products_By_Category.htm > Online Image. Retreived
20 July 2007.
HbA1c Goals
Importance of A1c. < http://www.apidra.com/a1c_glucose_control/Default.aspx > Online Image. Retrieved 07 July 2007.
Oral Medications
Biguanides
Biguanides work by decreasing the
amount of sugar produced by the liver.
They also increase the ability for sugars
to be absorbed by muscle and fat cells,
and decrease the body’s ability to resist
insulin.
Glucophage® (metformin)

Indicated for type 2 diabetes


Will not see any effect for a few days


Can take up to 2 weeks
Take with food to decrease GI side effects


Has been proven safe in children
Most common side effects are diarrhea, nausea/vomiting,
flatulence, and lactic acidosis
If taking the once daily Metformin, take with your
evening meal
Glucophage® (metformin)

If you have kidney problems, make
sure your physician is aware of them

If you are having any kind of radiologic
studies (CT scan, MRI, etc) stop taking
your Glucophage® 72 hours before
your test
Sulfonylureas
These work by increasing insulin
release from the pancreas,
decreasing glucose output from
the liver, and increasing the
body’s sensitivity to insulin.
FreeStyle Flash®. < http://www.abbottdiabetescare.com/content/en_US/20.10.10:10/product/Product_Profile_0002.htm > Online Image.
Retrieved 23 July 2007.
glimepiride/glipizide/glyburide

Indicated for type 2 diabetes

Not approved for use in children

Begins to work within 15 minutes to 3 hours

If taking more than once a day


If dosed once a day


Take 30 minutes before meals
Take daily with breakfast
Do not take other medications within 2 hours of taking your
sulfonylurea
glimepiride/glipizide/glyburide

Sulfonylurea’s are structurally similar to sulfa
medications. If you are allergic to sulfa medications,
make sure your doctor or pharmacist are aware of
your allergy.

Common side effects include:
Sun sensitivity

Dizziness

Hypoglycemia

Headache

Nausea
(Side effects such as headache and nausea will improve
within 1 to 2 weeks of starting your medication)

Thiazolidinediones
These medications work to
decrease blood glucose by
improving the cells response to
insulin.
Recent news on Avandia®

Recent articles have focused on cardiovascular
safety and Avandia®

If you have any type of heart disease speak with your
doctor about the new information

Do not stop taking Avandia® without talking to your doctor
first

GlaxoSmithKline (GSK) has full confidence in the safety of
Avandia®, and at this time, Avandia® is not being removed
from the market

The FDA is conducting further studies to ensure the safety
of Avandia®
Avandia® /Actos®

Indicated for type 2 diabetes

Take once or twice daily

Take with or without food

Begins to work in 2 weeks, however, full
effect may not be seen for 2 to 3 months
Avandia® /Actos®

If you have heart disease, make sure
your doctor is aware

Have yearly eye exams and liver
function tests

Found to decrease A1c by up to 1.4%
Avandia® /Actos®

Side effects:

Increased risk of bone fractures in women
(typically hand, arm, ankle, and foot)

Increased risk of becoming pregnant if
postmenopausal and still menstruating

Fluid retention

Edema
Avandia® /Actos®

Added Benefits of Actos® :



Decreases triglycerides
Improves HDL cholesterol
Disadvantages of Avandia® /Actos®:


Possible weight gain of up 2 to 6lbs
Slight increase in LDL cholesterol
Meglitinides
These work to help the body
release insulin at the start of
each meal to help control
mealtime blood sugar spikes
Accu Chek meter systems. < http://www.accu-chek.com/us/rewrite/content/en_US/2.1:10/article/ACCM_general_article_2353.htm > Online Image. Retrieved
20 July 2007.

Indicated for type 2 diabetes

Take one tablet 30 minutes before each meal


Begins to work within 20 minutes
Effects last for up to 4 hours

May be taken alone or in combination with other
diabetes medications

Most common side effects were hypoglycemia, joint
aches, dizziness, and cold/flu symptoms

Store at room temperature

Do not take if you have liver disease

Do not take if you have type 1 diabetes
Alpha Glucosidase Inhibitors
These medications slow the
breakdown of carbohydrates
in the intestine.
Precose® (acarbose) /
Glyset® (Miglitol )

Indicated for type 2 diabetes


Start this medication slowly. Gradually
increase your dose to three times a day.


Not approved for use in children
Take these medications with your first bite of
your main meals
Do not take other medications within 2 hours
of these medications
Precose® (acarbose) /
Glyset® (Miglitol )

Have your liver enzymes checked every 3
months during your first year of treatment,
then periodically

Adverse reactions include:




Hypoglycemia
Diarrhea
Abdominal pain
Flatulence
DDP-IV Inhibitors
The newest class of diabetic medications. The
pancreas gives the liver messages to make less
sugar, while it makes more insulin. However, because
of a substance in your blood called DDP-4, those
messages do not make it through. DDP-IV inhibitors
work by blocking the DDP-4 so that those important
messages can get through.
Januvia. < www.januvia.com > Online Image. Retrieved 07 July 2007.

Increases insulin when blood sugars are high

Reduces the amount of sugar made by your liver
after you eat

Has been found to decrease A1C by up to 1.5%

Improves fasting and after meal blood glucose
levels

Rarely causes hypoglycemia

Dosed once a day, with or without food

Has not been found to cause weight gain

Most common side effects:


Runny nose
Headache
Galvus®

Soon to be available from Novartis

Improves after meal blood glucose levels

Found to decrease A1C by 1-1.8%

When combined with Actos® it has been found to decrease A1C
by up to 2.8%

Low risk of hypoglycemia

Dosed once a day

Side effects include headache, dizziness, and cold/flu
symptoms
Injectable Medications
Incretin Mimetics
These drugs mimic the incretin hormones
found in your body. These drugs work by
increasing your insulin secretion,
increasing your beta cell
growth/replication, slowing gastric
emptying, and by decreasing your food
intake.
Byetta®

Byetta® is NOT an insulin

Administer 60 minutes prior to morning and evening
meals

Administer injection in the upper arm, thigh or
abdomen

Take any other medications 1 hour prior to Byetta®
because it may alter the ability of those medications
to work
Byetta. <www.byetta.com > Online image. Retrieved 07 July 2007
Byetta®
Byetta. < www.byetta.com > Online Image. Retrieved 07 July 2007.
Byetta®

Before your pens first use, store it in the
refrigerator, after you begin using your pen it may
be stored at room temperature.

Discard your pen 30 days after initial use.

If your pen gets frozen, discard it.

Do not store your pen with the needles on it. This
can cause air bubbles to form in the pen which can
be dangerous.
Byetta®

May decrease A1c by up to 2.1%

May cause a weight loss of up to 11.2lbs

Most common side effect was nausea,
which does decrease over time

Only indicated for type 2 diabetic patients
Byetta LAR

Expected to be released in 2008

Once weekly version of Byetta®

Decreases fasting blood glucose levels by up to
50mg/dL, and decreases A1c by 2%

Most common side effect is nausea

Rarely found to cause hypoglycemia
Liraglutide

Brand name has not yet been released

Drug Expected to be released in 2008/2009

Indicated for type 2 diabetics

Can be used alone or in combination with
metformin or glimepiride

Once daily injection
Amylinomimetic
When used in combination with insulin
this class of medications will decrease
after meal blood glucose levels by
prolonging gastric emptying time,
reducing after meal glucagon secretion,
and by decreasing your appetite.
Bayer Health Care. < http://www.bayercarediabetes.com/prodServ/products/contour/index.asp > Online Image. Retrieved 20 July 2007.

This is NOT an insulin

It does not replace your insulin, but it is used in combination
with your insulin and therefore your insulin dose might be
decreased

Do not use this if you have been diagnosed with gastroparesis

Monitor your blood sugar before and after meals while taking
this medication

If your A1c level is above 9, this medication is not right for you
Symlin. < www.symlin.com > accessed 07 July 2007.

Store unopened vials in the refrigerator. Once opened, the vial
may be stored at room temperature.

Discard your vial 28 days after initial use

Administered as a SQ injection in the thigh or abdomen (do
not inject into the arm) at least 2 inches away from a site
where you injected insulin

Administer immediately prior to meals containing at least 30
grams of carbohydrates

Take other oral medications 1 hour before or 2 hours after you
inject Symlin®

This can cause your blood sugar to drop to low
(hypoglycemia). If this is going to occur, it will occur
within 3 hours following your injection.

Monitor your blood sugar frequently to prevent
hypoglycemia

Never mix Symlin® in the same syringe as insulin

The most common side effect is nausea

Benefits:

Fewer blood sugar “swings” throughout
the day

You will feel fuller, so you will eat less,
therefore possibly losing weight

You may not need as much insulin
Insulin
Insulin is a hormone produced by the
pancreas. It allows the body to use the
sugar in food as a source of energy.
When you have diabetes, often your
body cannot produce its own insulin, so
patients use man made insulin instead.
Insulin. < http://health.howstuffworks.com/insulin.htm >. Online Image. Retrieved 20 July 2007.
Insulin Myths
Insulin should be a last resort for treatment
1.

New guidelines suggest adding insulin earlier in
treatment. Your A1c level should be your goal in
determining your treatment plan.
Insulin injections are painful
2.

You might be surprised at how small and thin the needle
really is. Using an insulin pen can be even less painful.
Insulin causes weight gain
3.

You may gain a few pounds, however, the benefits to
insulin far outweigh the risk of weight gain.
Benefits to using Pen Insulin

No need to carry insulin vials and syringes


Less painful


Pen has a smaller, thinner needle
Ensures the correct dose


Pen contains the needle and insulin
Dial in the exact units.
Little preparation

Pens are fast, easy to use, and easy to store
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
Insulin Summary
Types of
Insulin
Onset
Duration
Examples
Rapid Acting
1 to 30
minutes
2 to 6 hours
Apidra®
Humalog®
Novolog®
Exubera®
Arx iDMS®
Short Acting
30 minutes to
1 hour
6 to 8 hours
Humulin® R
Novolin® R
Intermediate
Acting
1 to 4 hours
16 to 24
hours
Humulin® N
Novolin® N
Long Acting
1 to 4 hours
12 to 24
hours
Lantus®
Levemir®
Rapid Acting Insulin
They work fast to manage
mealtime blood sugar spikes.
Rapid acting insulin’s act like
insulin the body would make in a
patient without diabetes.
Insulin. < http://www.sawstonmedicalpractice.co.uk/display.php?location=Common%20drugs&title=Insulin&home=easy&dir=drug&page=insulin > Online Image. Retrieved 20
July 2007.
Apidra®

Indicated for type 1 or type 2 diabetics

Should be used in combination with a
long acting insulin

This is a rapid acting insulin.


It begins to work within 1 to 2 minutes
It will last for 2 to 4 hours
Apidra®

Should be given 15 minutes before a meal or within
20 minutes of starting a meal

May be given via the OptiClik® injection pen, via an
insulin pump, or with a vial and syringe.

May be injected into the thigh, abdomen, or upper
arm

Should be clear in color, if not clear then discard
Humalog® /Novolog®

Indicated for type 1 or 2 diabetes

In type 1 diabetes it should be used in combination with a long acting
insulin

In type 2 diabetes it should be used in combination with either a long
acting insulin or an oral sulfonylurea

Will begin to work within 15 to 30
minutes and will last for
3 to 6 hours
Humalog® /Novolog®

Unopened insulin should be stored in the
refrigerator

Once opened insulin may be stored at room
temperature for 28 days

If placed in a pump, insulin should be
replaced every 48 hours and cartridges
should be replaced within 7 days
Humalog® /Novolog®

Humalog® Should be injected 15 minutes before a meal, or immediately after
a meal

Novlog® should be administered at the start of a meal, or within 5 to 10
minutes of the start of the meal

May be injected SQ in the upper arm, thigh or abdomen

Available in a vial or in a pen

There are 3 Humalog® pens to choose from




HumaPen® MEMOIR ™
HumaPen® LUXURA™ HD
Prefilled Pen
There are 4 Novolog® pens to choose from




NovoPen® Jr
NovoPen® 3
NovoPen® 4
Novolog® FlexPen®
Humalog. < www.humalog.com > Online Image. Retrieved 07 July 2007.

This pen is
designed for
parents and
caregivers of
children

Can provide doses
in ½ unit
increments from 1
to 30 units
Humalog. < www.humalog.com > Online Image. Retrieved 07 July 2007.

Only insulin pen
available with a
memory

Records the date,
time, and amount
of insulin for your
last 16 doses
Humalog. < www.humalog.com > Online Image. Retrieved 07 July 2007.

Prefilled pen

Pocket size

Simple to dial up

Audible clicks

No refrigeration
needed after the first
dose
Novolog®

Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
NovoPen® Jr.

Designed for kids

Colorful

Able to dial ½ unit
increments
Novolog®

NovoPen® 3

Can dial up 2 to 70
units

Can dial backwards to
correct a dose

Uses cartridges for
refills

Store at room temp
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
Novolog®

NovoPen® 4


Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.
For use with Novolog®,
NovoRapid®, or Levemir®
End of dose click so you’ll
know your insulin has all
been delivered

Available in 2 colors-silver
and blue

50% less force needed to
inject the insulin
Novolog®
Novolog. < www.novolog.com > Online Image. Retrieved 07 July 2007.

Prefilled disposable
pen with 300 units

Can dial backwards
if a mistake is
made
Exubera®
Exubera. < www.exubera.com > Online Image. Retreived 07 July 2007.

The first inhaled insulin

Indicated for patients with
type 1 or type 2 diabetes
above the age of 18

Begins to work within 10 to
20 minutes

Effects last for up to 6
hours

Decreases A1c by up to
1.9%
Exubera®

If you use any other inhalers, be sure to use
those before using your Exubera®

Administer dose 10 minutes before a meal

Available in 1mg and 3mg blisters

Three 1mg blisters do NOT equal 3mg
Exubera®

Stored at room temperature

No batteries needed

You must have a lung
function test prior to
beginning treatment with
Exubera®

Dry powder inhaler

You won’t feel the powder
as you inhale

Do Not use if you:

Smoke-you must be
smoke free for at least 6
months

Have a lung disease
(asthma, COPD, etc)

Pregnant or under the age
of 18
Exubera®
Exubera. < www.exubera.com > Online Image. Retrieved 07 July 2007.
Exubera®
Exubera. < www.exubera.com > Online Image. Retrieved 07 July 2007.
Exubera®

Once a foil blister is opened it needs to be used
within 3 months

Inhaler must be cleaned once a week


Release unit must be replaced every 2 weeks


Do not place any components in the dishwasher
Reminder stickers are included in the kit
Inhaler device should be replaced once a year
Exubera®

Potential Side effects

Shortness of breath

Chest pain

Hypoglycemia


Monitoring your blood sugar regularly can help prevent this
Cough

Tends to occur with minutes after use, but does decrease
over time
AERx® iDMS

Soon to be released from Novo Nordisk ®

Indicated for type 1 and type 2 diabetes

A liquid inhalation

Administered 30 minutes before meals

Inhaler device records the date, time, and units of
insulin administered
Short Acting Insulin’s
Cover insulin needs for meals
eaten within 30 to 60 minutes
Humulin® R / Novolin® R

Begins to work within a ½ hour

Lasts for 6 to 8 hours

Should be a clear solution

Discard if solution is not clear

Injected SQ into the thigh, arm, buttock, or
abdomen

Do not inject cold insulin

Roll vial gently in hand first to warm and mix the insulin
Humulin® R / Novolin® R

Typically this medication is injected 30
to 60 minutes before a meal

This is usually given 2 to 4 times a day
Humulin® R / Novolin® R

If mixing with another insulin, draw regular
insulin into the syringe first

Do not freeze


If insulin has frozen, discard
Store unopened vials in the refrigerator

Upon opening, insulin may be stored at room
temperature for 28 days
Novolin® R

Novolin® R Pen

Can be used with the
pens featured under
Novolog

Store in the refrigerator
until ready to use

Store at room
temperature once
opened

Discard 28 days after
initial use
Novolin® R

Novolin® R innolet

Disposable

Large numbers

Audible clicks

Store refrigerated
until ready to use

Store at room
temperature once
opened
Insulin Devices. < http://www.insulindevice.com/innolet/features.asp > Online Image. Retrieved 07 July 2007.
Intermediate Acting Insulin’s
Begins to work after a couple
of hours, but can last for up to
24 hours.
Humulin® N, Novolin® N

Indicated for type 1 or type 2 diabetes

Begin to work in 1 to 2 hours

Duration is 16 to 24 hours

Store unopened vials and pen cartridges in refrigerator


If freezing occurs, discard insulin
Store opened vials at room temperature for 28 days, and
opened pen cartridges at room temperature for 14 days
Humulin® N, Novolin® N

Usually administered 1 to 2 times daily

Inject SQ into abdomen, buttocks, thigh, or upper arm


Solution should be clear, discard if not clear
Do not inject cold insulin

Roll insulin vial in palm of hands to warm and mix before
injecting

May be used with a vial and syringe or in a pen

If mixing with regular insulin, draw regular insulin into the
syringe first
Long Acting Insulin’s
Provide steady 24 hour blood
sugar control.
One Touch Ultra 2. < http://www.lifescan.com/products/meters/ultra2/;jsessionid=OTGAYXOAK5NKGCQPCAMFRZAKB2IIWTT1 > Online Image. Retrieved 20 July
2007

Indicated for type 1 or type 2 diabetics

Not indicated for children under the age of 6

Onset of action is 1 to 2 hours

Duration is 24 hours

Dosed once daily at any time of day


Inject at the same time each day
Do NOT mix with any other insulin

Store unopened vials in the refrigerator


If insulin freezes, discard
Opened vials and pen cartridges may be stored at
room temperature for 28 days

Available in vials for use with a syringe or in cartridges for
use in a pen

Injected SQ into thigh, arm, buttock, or abdomen

Clear solution, if solution is not clear then discard

OptiClik® Pen:

Pen available FREE
from your physician

Insulin cartridges
available from your
pharmacy

Digital dose display

Audible clicks

Doses from 1 unit to 80
units

Pen may also be used
with Apidra®

Added benefits of Lantus®

Decreases A1c by up to 1.7%

Once a day injection

When used in combination with Metformin or a
sulfonylurea, Lantus® has been found to
decrease free fatty acids which are linked to
complications of diabetes such as insulin
resistance

Indicated for type 1 or type 2 diabetics

Not indicated for children under the age of 6

Begins to work in 3 to 4 hours

Store unopened in the refrigerator

Discard if insulin freezes

Once opened vials and pens are stable at room
temperature for 42 days

Long acting insulin

Except at low doses-then it becomes an intermediate
acting insulin

Do not use in an insulin pump

May be used in a syringe or a pen

Dosed once or twice a day

Once daily dose is given with the evening meal or at
bedtime

Twice daily dosing is given in the morning and then 12
hours later

May be injected in the arm, thigh, buttock, or
abdomen

Solution should be clear


Discard insulin if solution is not clear
Do not inject insulin cold

Roll vial in palm of hand to warm and mix
solution

Novolog. < www.novolog.com >Online Image. Retrieved 07 July 2007.
Levemir. < www.levemir.com > Online Image. Retrieved 07 July 2007.
FlexPen®

Disposable

Prefilled

Store at room
temperature for up to
42 days

Do not store pen with
needles attached
Hypoglycemia
If your blood sugar gets to
low, your brain can run out of
“fuel”, this can cause serious
complications if not treated.
Hypoglycemia

Signs/Symptoms:











Anxiety
Blurred vision
Feeling Cold
Feeling Weak
Drowsiness
Weak
Headache
Hunger
Sweating
Trembling
Unconscious

Make sure your family
& friends know what to
do if your blood sugar
gets to low.
Hypoglycemia

Treatment of hypoglycemia:

15g of Carbs, which include things like:





Glucose tabs (3-4 or equivalent to 15g)
4oz fruit juice
Frosting (equivalent to 15g)
Meat & Cheese sandwich
Test your blood sugar 15 minutes later


If still low repeat treatment options
Recheck another 15 minutes later-if still low, contact
your health care provider
GlucaGen® Hypokit

Small, compact

Quick, easy to use

Contains everything
needed to increase
your bloodsugar

No medical training
required for use
Glucagen. < http://www.novonordisk.com/diabetes/public/hypokit/glucagenhypokit/actualsize.asp. > Online Image. Retrieved 12 July 2007.
References
•
Abbott Diabetes Care.
<http://www.abbottdiabetescare.com/adc_dotcom/url/content/en_US/20:20/product/Products_By_Category.htm > Online
Image. Retreived 20 July 2007.
•
Accu Chek meter systems. < http://www.accuchek.com/us/rewrite/content/en_US/2.1:10/article/ACCM_general_article_2353.htm > Online Image. Retrieved 20 July 2007.
Actos. < www.actos.com > Retrieved. 07 July 2007.
Apidra. < www.apidra.com > Retrieved 07 July 2007.
Armstrong, L. Lacy, C., Goldman, M., Lance, L. (2007). Drug Information Handbook (15th ed). Hudson, Oh: Lexi-Comp.
Avandia. < www.avandia.com > Retrieved 07 July 2007.
Avandia in the News: Questions and Answers. < http://www.avandia.com/pdf/Important_Information_for_Patients_2.pdf >
Retrieved 15 July 2007.
Bayer Health Care. < http://www.bayercarediabetes.com/prodServ/products/contour/index.asp > Online Image. Retrieved 20
July 2007.
Bellaire, S., Clauson P., Cramer J., Okikawa J. Compliance with inhaled insulin treatment using the AERx® iDMS insulin
Diabetes Management system. Diabetes Tchnology and Therapeutics. 2004: 800-807.
Berkrot, Bill. Novo Nordisk’s liragulatide effective in Japan study. Reufers. 23 June 2007. <
www.aletnet.org/thenews/newsdesk/n21400781.htm >. Accessed 07 July 2007.
Byetta. < www.byetta.com > Retrieved 07 July 2007.
Diabetes: Type 1. < http://www.medicinenet.com/script/main/art.asp?articlekey=42943 > Online Image. Retrieved 20 July
2007.
Diabetes: Type 2. < http://www.medicinenet.com/script/main/art.asp?articlekey=42940 > Online Image. Retrieved 20 July 2007.
Exubera. < www.exubera.com > Retrieved 07 July 2007.
FreeStyle Flash®. < http://www.abbottdiabetescare.com/content/en_US/20.10.10:10/product/Product_Profile_0002.htm >
Online Image. Retrieved 23 July 2007.
Galvus. <http://www.pharma.us.novartis.com/newsroom/pressReleases/releaseDetail.jsp?PRID=2007 > Retrieved 07 July
2007.
Glucagon. < http://www.novonordisk.com/diabetes/glucagenhypokit_splash.asp > Retrieved 07 July 2007.















References continued



Humalog. < www.humalog.com > Retrieved 07 July 2007.
Importance of A1c. < http://www.apidra.com/a1c_glucose_control/Default.aspx > Online Image.
Retrieved 07 July 2007.
Insulin. <
http://www.sawstonmedicalpractice.co.uk/display.php?location=Common%20drugs&title=Insulin&home=
easy&dir=drug&page=insulin > Online Image. Retrieved 20 July 2007.

Insulin. < www.virtualsciencefair.org > accessed 15 July 2007.
Insulin Devices. < http://www.insulindevice.com/innolet/features.asp > Retrieved 07 July 2007.

Insulin Myths and Realities. < http://www.goinsulin.com/insulin_myths_and_facts/default.aspx > accessed 15 July 2007.

Januvia. < www.januvia.com > Retrieved 07 July 2007.
Lantus. < www.lantus.com > Retrieved 07 July 2007.
Levemir. < www.levemir.com > Retrieved 07 July 2007.
Liraglutide. < www.glucagon.com >. Retrieved 10 July 2007.
Novolog. < www.novolog.com > Retrieved 07 July 2007.
One Touch Ultra 2. <






http://www.lifescan.com/products/meters/ultra2/;jsessionid=OTGAYXOAK5NKGCQPCAMFRZAKB2IIWTT1 > Online Image.
Retrieved 20 July 2007



Prandin. < www.prandin.com > Retrieved 15 July 2007.
Starlix. < www.starlix.com > Retrieved 15 July 2007.
Symlin. < www.symlin.com > Retrieved 07 July 2007.