Diabetes medications: Difference between revisions
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===Dose=== | ===Dose=== | ||
Metformin 500mg PO BID is first-line agent for type II diabetics | Metformin 500mg PO BID is first-line agent for type II diabetics | ||
*Do not prescribe if | *Do not prescribe if creatinine > 1.4 (GFR <40), CHF, hepatic insufficiency, ETOH abuse | ||
*Should be withheld for 48hr after IV contrast | *Should be withheld for 48hr after IV contrast | ||
===Side Effects=== | ===Side Effects=== |
Revision as of 07:37, 11 August 2016
Background
- Hypoglycemics
- Sulfonylureas
- Benzoic acid derivatives
- Antihyperglycemics
- Biguanides
- Alpha glucosidase inhibitors
- Thiazolidinediones
Common Anti-hyperglycemic Drugs and Pharmacology
Drug | Pharmacology | ||
---|---|---|---|
Onset | Peak | Duration | |
Rapid-acting insulin
|
15-30min | 1-2h | 3-5h |
Short-acting insulin
|
30-60min | 2-4h | 6-10h |
Intermediate-acting insulin
|
1-3h | 4-12h | 18-24h |
Long-acting insulin
|
2-4h | None | 24h |
Sulfonylurea
|
– | 2-6h | 12-24h |
See also GLP-1 agonists
Insulin
Biguanides (Metformin)
Suppresses liver glucose production
Dose
Metformin 500mg PO BID is first-line agent for type II diabetics
- Do not prescribe if creatinine > 1.4 (GFR <40), CHF, hepatic insufficiency, ETOH abuse
- Should be withheld for 48hr after IV contrast
Side Effects
- Lactic acidosis (due to increased lactate production)
- Seen almost exclusively in patients with renal failure
- Nausea, diarrhea, crampy abdominal pain
Toxicity
- Almost never causes hypoglycemia when taken alone, but can exacerbate hypoglycemia when taken in combination with hypoglycemic agents
- Toxic dose unknown
- Management: Supportive care
Sulfonylureas
- Increases insulin secretion (glipizide, glyburide)
- Hypoglycemia is the major adverse effect (esp with glyburide)
Alpha Glucosidase Inhibitors
- acarbose, miglitol, voglibose
- 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
- does not affect lactose absorption
- if hypoG- sucrose/ table sugar will not work- use glucose- PO or IV
- taken with first bite of each meal
- since limited absorption, stays in gut and side effects mostly GI- bloating, gas, diarrhea
- contraindications- cirrhosis, IBD, malabsorption synd
- alpha glucs do not cause hypoG when used as monotreatment
- acarbose- can cause transaminitis/ liver inj
- since minimal absorption- systemic toxicity from OD unlikely
Thiazolidinediones
- rosiglitazone and poiglitazone
- enhance insulin effect on muscle, fat, liver without increasing panc insulin secretion
- protein bound and hep metab- not good if liver disease
- side effects- induce ovulation, decrease effectiveness of OCP's, increase plasma volume (bad if CHF)
Benzoic Acid Derivatives
- repaglinide- mono or combined with metformin
- binds to ATP dependent potassium channel like sulfonyls but at different site.
- Unlike sulfonyls, it decreases insulin lvls
- Dose 30 min before meal to decrease post prandial hyperglycemia