Diabetes medications

Background

• Hypoglycemics
  • Sulfonylureas
  • Benzoic acid derivatives
• Antihyperglycemics
  • Biguanides
  • Alpha glucosidase inhibitors
  • Thiazolidinediones

Biguanides (Metformin)

Suppresses liver glucose production

Dose

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

• Do not prescribe if Cr > 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 w/ 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
• take these meds with each meal with first bite
• since limited aborption, 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 monotx
• acarbose- can cause transaminitis/ liver inj
• since min absorption- systemic tox 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 dz
• side effects- induce ovulation, increase plasma vol bad if CHF, decrease effectiveness of OCP's

Benzoic Acid Derivatives

• repaglinide- mono or combo tx c 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

See Also

• Diabetes Mellitus (Main)

References

Tintinalli