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Biguanides
- Metformin (Fortamet, Glumetza, Glucophage)
- Action: primarily reduces glucose production in liver and also increases glucose uptake in muscle by decreasing insulin resistance
- 1st drug of choice for most type 2 diabetics and pre-DM
- SE: GI (n/v)
- increased risk of lactic acidosis
- HOLD 2 DAYS BEFORE AND AFTER IODINE BASED STUDIES OR SX
- may cause weight loss (helpful for type 2)
-
Sulfonyureas and Meglitinides
- Glimepiride (Amaryl), Glipizide (Glucotrol), Glyburide (DiaBeta, Glynase)
- Repaglinide (Prandin), Neteglinide (Starlix)
- Action: stimulates insulin production
- SE: weight gain, hypoglycemia
- DON'T GIVE TO PT'S WITH SULFA ALLERGY
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Alpha Glucosidase Inhibitors
- Acarbose (precose) and Miglitol (Glyset)
- Action: starch blockers- delay absorption of CHO in small int.
- Notes: most effective at lowering postprandial BG
- GI SE such as gas, cramping, diarrhea
- take w meals to decrease GI SE
-
DPP-4 Inhibitors
- Sitagliptin (Januvia) & Saxagliptin (Onglyza)
- Action: enhance incretin hormone system (increase insulin from pancreas, decrease hepatic glucose production)
- Notes: DPP-4 inhibitors don't work when BS is low, so won't cause hypoglycemia
- don't cause weight gain
-
noninsulin, sub q injection
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists
- Actions: reduces postprandial glucagon secretion, stimulates release of insulin, slows gastric emptying & increases satiety
- SE: n/v/d, hypoglycemia
- Notes: used in type 2, can be used alone or with OA
- may affect absorption of fast acting PO meds due to delayed gastric emptying. advise pt to take fast acting po meds at least 1 hr prior to injection
- may help with weight loss
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noninsulin, sub q injection
Amylin Analog: Symlin/Pramlintide
- actions: reduces postprandial glucagon secretion
- slows gastric emptying & increases satiety
- SE: n/v, decreased appetite
- can cause severe hypoglycemia when used with insulin (reduce bolus dose of insulin and keep fast acting sugars on hand)
- notes: an adjunct to insulin therapy for type 1 & 2 who need better glucose control
- given sq in thigh or abdomen (not arm as absorption is too variable)
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Rapid acting
- lispro (Humalog)
- aspart (NovoLog)
- glulisine (Apidra)
- Onset: 10-30 mins
- peak: 30 min- 3 hr
- duration: 3-5 hr
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short acting
Regular (Humulin R, Novolin R)
- Onset: 30 min- 1 hr
- Peak: 2-5 hr
- Duration: 5-8 hr
-
Intermediate acting
- (CLOUDY)
- NPH (Humulin N, Novolin N)
- Onset: 1.5-4 hr
- Peak: 4-12 hr
- Duration: 12-18 hr
-
Long acting
- glargine (Lantus)
- detemir (Levemir)
- degludec (Tresiba)
- Onset: 0.8-4 hr
- Peak: less defined or no pronounced peak
- Duration: 16-24 hr
-
Inhaled insulin
Afrezza
- Onset: 12-15 min
- Peak: 60 min
- Duration: 2.5-3 hr
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