Diabetes Type 2 Medication

Question 1

Biguanides

Answer 1

Metformin (Glucophage)
First line treatment for type 2
Decreases production of glucose from stored glycogen by liver.
Insulin Sensitizer
Slows down conversion of carbohydrates into sugar

Question 2

Biguanides - Adverse Effects and Contraindications

Answer 2

GI Side effects
B12 deficiency
Weight loss
Decreased platelet aggregation and reduces viscosity
Contraindicated: Renal or hepatic impairment, chronic heart failure (CHF)

Question 3

Sulfonylureas

Answer 3

Glipizide, Glyburide, Glymepride
Stimulates beta cells to secrete insulin
Decrease glucose production by liver
Can be given with metformin or insulin.
90 minute onset, peak in 2-3 hours.

Question 4

Sulfonylureas - Adverse Effects and Contraindications

Answer 4

Hypoglycemia, weight gain, GI, sunburn.
Cautiously with renal and liver disease.
Contraindications: Sulfa allergies
Pregnant/lactating, beta blocker.
Interacts with anticoagulants, NSAIDS, H2 blockers.
Decreased concentrations from thiazides, steroids, and TB meds.
NO ALCOHOL - Increase hypoglycemia

Question 5

Metglitinides - All

Answer 5

Repaglinide, Nateglinide (-glinide)
Stimulates beta cells to produce more insulin
Used alone or in combination with metformin
Used in those with sulfa allergy

Taken with first bite of food
Do not take if not eating
Adverse: Weight gain, angina, hypoglycemia

Question 6

Thiazolidinediones - All
(Thia-zol-I-dine-die-own)

Answer 6

Pioglitazone (-glitazone)
Improves effectiveness of insulin by decreasing insulin resistance in adipose and muscle cells
Blocks hepatic gluconeogenesis
Cardioprotection
Alone or in combination, with or without food.
Adverse - Weight gain, fluid retention, osteopenia (reduced bone mass)
Contraindicated - Hepatic impairment and heart failure.
Concerns of bladder cancer in pioglitazone
Monitor liver functions.

Question 7

Alpha Glucosidase Inhibitor
All

Answer 7

Acarbose
Inhibits alpha-glucosidase, which prevents the release of glucose from carbohydrates in the diet (Starch blocker)
Decreases postprandial glucose levels
Take with first bite of food
Adverse - GI, anemia
Contraindications - GI problems, renal impairment
Monitor liver function studies.

Question 8

Glucagon Like Peptide Receptor Agonists (GLP-1)
All

Answer 8

Exenatide, Dulaglutide (-glutide)
Increases insulin secretion
Slowed gastric emptying
Reduction of postprandial glucagon levels
Lower appetite
Promotes growth of beta cells
Can cause weight loss
Low risk of hypoglycemia unless given with sulfonylureas or insulin

Question 9

DPP-4 (Gliptin) Inhibitors

Answer 9

Sitagliptin (-gliptin)
Inhibits DPP-4 enzyme responsible for destroying GI incretin hormones GLP-1 and GIP.
Increases insulin secretion
Decrease glucose production (less glucagon secretion)
Incretin stays in circulation longer.
Does not cause hypoglycemia unless used with insulin or sulfonylureas.
Weight loss
Adverse: Flu symptoms (Headache, runny/stuffy nose, sore throat, upper respiratory infections)
Pancreatitis
Hypoglycemia

Question 10

Sodium Glucose Co-Transporter 2 Inhibitors (SGLT2)
All

Answer 10

Canagliflozin (-gliflozin)
Proteins that enhance glucose reabsorption in kidneys and increase glucose excretion in urine
Weight and volume loss
No hypoglycemia unless used in combo
Can cause hyperkalemia
Contraindicated: Renal failure
*Provide renal protection - reduce damage caused by hyperfiltration and decrease protein loss.

Question 11

Amylin Analogues (Amylinomimetics)
All

Answer 11

Pramlintide
Slows gastric emptying, helps to regulate postprandial rise in BG
Suppresses postprandial glucagon secretion
Increases satiety - less food and promotes weight loss

Give at least 2 inches away from insulin injection.
Do not give if not eating
Will cause hypoglycemia