Diabetes medications

Background

1. Hypoglycemics
   1. Sulfonylureas
   2. Benzoic acid derivatives
2. Antihyperglycemics
   1. Biguanides
   2. Alpha glucosidase inhibitors
   3. Thiazolidinediones

Biguanides (Metformin)

Suppresses liver glucose production

Dose

Metformin 500mg PO BID is first-line agent for type II diabetics

1. Do not prescribe if Cr > 1.4 (GFR <40), CHF, hepatic insufficiency, ETOH abuse
2. Should be withheld for 48hr after IV contrast

Side Effects

1. Lactic acidosis (due to increased lactate production)
   1. Seen almost exclusively in patients with renal failure
2. Nausea, diarrhea, crampy abdominal pain

Toxicity

1. Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents
2. Toxic dose unknown
3. Management: Supportive care

Sulfonylureas

1. Increases insulin secretion (glipizide, glyburide)
2. Hypoglycemia is the major adverse effect (esp w/ glyburide)

Alpha Glucosidase Inhibitors

1. acarbose, miglitol, voglibose
2. competitively and reversibly inhibit alpha glucosidase brush border hydrolase enzyme- makes postprandial decrease in carbohydrate absorption since complex polysaccharides not broken down into absorbable monosaccharides
3. does not affect lactose absorption
4. if hypoG- sucrose/ table sugar will not work- use glucose- po or iv
5. take these meds with each meal with first bite
6. since limited aborption, stays in gut and side effects mostly GI- bloating, gas, diarrhea
7. contraindications- cirrhosis, IBD, malabsorption synd
8. alpha glucs do not cause hypoG when used as monotx
9. acarbose- can cause transaminitis/ liver inj
10. since min absorption- systemic tox from OD unlikely

Thiazolidinediones

1. rosiglitazone and poiglitazone
2. enhance insulin effect on muscle, fat, liver without increasing panc insulin secretion
3. protein bound and hep metab- not good if liver dz
4. side effects- induce ovulation, increase plasma vol bad if CHF, decrease effectiveness of OCP's

Benzoic Acid Derivatives

1. repaglinide- mono or combo tx c metformin
2. binds to atp dependent potassium channel like sulfonyls but at different site.
3. Unlike sulfonyls, it decreases insulin lvls
4. Dose 30 min before meal to decrease post prandial hyperglycemia

See Also

• Diabetes Mellitus (Main)

Source

Tintinalli