Diabetes Medications

Question 1

Pre-diabetes

Answer 1

fasting plasma glucose: 100-125 mg/dL
or
2-hr plasma glucose in 75mg oral gluc. tolerance test of 140-199 mg/dL
or
A1C 5.7-6.4%

Question 2

Diabetes

Answer 2

classic hyperglycemia symptoms (polyuria, dipsia, unexplained weight loss) or hyperglycemic crisis AND random plasma glucose >= 200 mg/dL
or
fasting (8hr period) plasma glucose >= 126 mg/dL
or
2 hr plasma gluc. of >= 200 mg/dL for 75 g OGTT
or
A1C >= 6.5%

Question 3

Metformin

Answer 3

Glucophage, Fortamet, Glumetza
Class: biguanide
MOA: decr. hepatic glucose production, decr. intestinal glucose absorption, incr. insulin sensitivity
Dosing: IR - 500 BID or 850 daily
ER - 500-1,000 with dinner
titrate up to 1.5-2 g daily
WARNING: lactic acidosis
temporarily d/c for receipt of i.v. iodinated contrast media
SE’s: diarrhea, nausea, vomiting
interacts with: alcohol (incr. risk of lactic acidosis), iodinated contrast dye (“ “)
decr. vitamin B12 absorption (supplement?)
weight neutral

w/ sitagliptin - Janumet
w/ glyburide - Glucovance

Question 4

Sulfonylureas

Answer 4

MOA: stimulate insulin secretion from pancreatic beta cells

WARNINGS:
contraindicated with meglitinides (similar M.O.A.)
contraindicated with type 1 diabetes mellitus, with INSULIN

old, do not use: chlorpropamide, tolazamide, tolbutamide (can cause long-lasting hypoglycemia)

Glipizide (Glucotrol) - IR: 5-10 daily/BID, max 40
XL: 5-10 daily, max 20
Glimepiride (Amaryl) - 1-2 daily, max 8
Glyburide (DiaBeta or Glynase) - 2.5-5 daily, or 1.5 - 3 daily
glyburide is NOT preferred (renally cleared metabolite that’s partially active)

SE’s - weight gain, hypoglycemia
lose efficacy after long-term use

CYP 2C9 substrate
take with FOOD

Question 5

Meglitinides

Answer 5

MOA: incr. insulin secretion from pancreatic beta cells

WARNINGS:
contraindicated with sulfonylureas (similar M.O.A.)
contraindicated with type 1 diabetes, diabetic ketoacidosis, gemfibrozil (if gemfibrozil, recommend fenofibrate)
interaction with insulin (both can cause hypoglycemia)

Repaglinide (Prandin)* - A1C < 8%, 0.5 mg with meals; A1C > 8%, 1-2 mg each meal [15-30 mins before meals]
Nateglinide (Starlix) - 60 mg before each meal if near goal, otherwise 120
take 1-30 minutes pre-meal

*repaglinide is slightly more effective
SE’s: hypoglycemia, mild weight gain, upper respiratory tract infection

SKIP dose if not taken before eating