-
acarbose and miglitol
- alpha glucosidase inhibitors
- inhibits upper GI enzymes that convert polysaccharide carbohydrates into monosaccharides
- slows absorption of glucose
- decreases post-meal hyperglycemia
- doesn't affect insulin secretion: no hypoglycemia
- side effects: flatulence and diarrhea
-
glipizide, glimepiride, glyburide
- sulfonylureas
- insulin seretagogues
- intermediate or long-acting - given once or twice a day
- lead to glucose-independent insulin secretion: should be taken with food
-
repaglinide, nateglinide
- meglitinides
- insulin seretagogues
- act by regulating ATP-dependent K+ channels in pancreatic beta cells, but use different receptors than sulfonylureas
- short acting - given before each meal
- lead to glucode-independent insulin secretion: should be taken with food
-
exenatide, liraglutide
- GLP-1 agonist
- glucode-dependent insulin secretion = no gypoglycemia
- enhances insulin secretion but still relies on glucose to cause cell depolarization
- slows gastric emptying (nausea)
- weight loss (~5 lb) because of nausea and slowed gastric emptying
- adverse effects: nausea, pancreatitis in some cases
-
sitagliptin, saxagliptin, linagliptin
- DPP-IV inhibitor
- glucode
- glucose-dependent insulin secretion = no gypoglycemia
- makes endogenous GLP-1 last longer
-
metformin
- biguanide
- reduces endogenous glucose production by inhibiting gluconeogenesis
- does not affect insulin sensitivity in muscle or adipose tissue
- does not lead to increased insulin levels
- adverse effects: nausea, abdominal pain, bloating, diarrhea, possibly lactic acidosis
-
pioglitazone
- thiazolidinediones
- PPAR γ agonist
- lowers blood glucose by enhancing effects on insulin
- lower plasma FFA = enhance fat storage
- do not lead to increased insulin secretion = not assoc. with hypoglycemia
- adverse effects: weight gain, fluid retention (contraindicated in CHF)
-
canagliflozin
- SGLT-2 inhibitor
- non-insulin mediated decrease in glucose
- no hypoglycemia
- decrease in blood pressure
- decrease in weight (~5 lbs)
- adverse effects: vulvovaginal candidiasis, UTI, risk of ketoacidosis
-
glargine, detemir, NPH
long acting insulin: mimics basal insulin
-
regular, aspart, lispro, glulisine
short acting insulin: mimics food insulin
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