Diabetes Medications (non-insulin)

Biguanides

Metformin (glucophage)

Metformin

reduces glucose production in the liver, enhances insulin sensitivity, improves glucose transport

withhold if pt going into surgery

may cause weight loss

take with food to decrease GI side effects

Sulfonylureas

Glipizide (glucotrol), glyburide (glynase), glimepride (amaryl)

increase insulin production from pancreas

side effect: hypoglycemia

Meglitinides

repaglinide (prandin) and neteglinide (starlix)

increases insulin production from pancreas (similar to sulfonylureas but more rapid onset and less likely to cause hypoglycemia)

take 30 before meals, dont give if meal skipped

a-Glucosidase inhibitors “starch blockers”

acarbose (precose) and miglitol (glyset)

slow down absorption of carbohydrate in small intestine

take with first bite of meal

Thiazolidinediones (insulin sensitizers)

Pioglitazone (actos) rosiglitazone (avandia)

improve insulin sensativity, transport, decreases utilization at target tissues

doesn’t cause hypoglycemia

rarely used due to heart and liver toxicity

DDP-4 inhibitors

sitagliptin, saxagliptin, linagliptin, alogliptin

blockes inactivation of incetin hormones (increases insulin release, decreases glucagon secreation, decreased hepatic glucose production)

Dopamine receptor agonist

bromocriptine (cycloset)

increases dopamine receptor activity

SGLT2 inhibitors

Canaglifozin (invokana), dapaglifozin (farxiga), empagliflozin (jardiance)

blocks glucose reapsorption by kidneys, increase urinary glucose secreation, decrease blood glucose

Amylin Analog

Pramilintide (symlin)

Slows gastric emptying, reduces glucagon secreation, increase satiety

can’t mix with insulin

watch for hypoglycemia

Glucagon like Peptide-1 Receptor Agonists

Exanatide, exenatide extended release, liraglutide, albiglutide, semaglutide

Increase insulin synthesis and release from pancreas, inhibit glucagon secreation, glow gastric emptying, increase satiety

Dont use for type 1 or dka