53: Antidiabetics and Hypoglycemics

Insulin first became available for use in 1922 after Banting and Best successfully treated diabetic patients with pancreatic extracts.10 In an attempt to more closely simulate physiologic conditions, additional “designer” insulins with unique kinetic properties have been developed, including a rapid-acting basal insulin that mimics baseline insulin secretion known as lispro.67,140 Several oral delivery systems for insulin have been studied. 94 However, the development of an oral delivery system for use in humans has not been successful because of poor intestinal absorption and degradation of the oral form of insulin by digestive enzymes. Using zonula occludens toxin, modulation of intestinal tight junctions in animal models significantly increases enteral absorption of insulin.42 An inhaled form of insulin was withdrawn from the market due to poor sales and inability to demonstrate better glucose control than short-acting insulins.90