Oral tx for DM

Question 1

Metformin

Answer 1

Biguanide
"Gold standard" for DM 2 and prediabetes 
Not 100% sure how it works 
Increases insulin SENSITIVITY
Weight NEUTRAL
NO RISK for hypoglycemia (euglycemic)
Boxed warning: lactid acidosis
Interactions w/alcohol and IV radiocontrast

Question 2

Glipizide

Answer 2

2nd gen sulfonylurea
Increases insulin SECRETION - mimics mealtime by “squeezing” pancreas to make insulin
Weight GAIN
RISK for hypoglycemia

Question 3

Repaglinide

Answer 3

Glinide
“Miss a meal, miss a dose” - must take w/food
Increases insulin SECRETION - mimics mealtime by “squeezing” pancreas to make insulin
Weight GAIN
RISK for hypoglycemia

Question 4

Pioglitazone

Answer 4

TZD
Originally "new Metformin" but AEs...
Activates PPAR gamma in cells --> decreases insulin resistance/increases insulin SENSITIVITY
Weight GAIN
NO RISK for hypoglycemia (euglycemic)
Boxed waring: not for HF pts
Liver damage/failure 
Fluid retention/edema

Question 5

Acarbose

Answer 5

Alpha-glucosidase inhibitor
Slows intestinal absorption of carbs
Has nothing to do w/beta cells 
Weight NEUTRAL
NO RISK for hypoglycemia (euglycemic)
Gas is 74% of pts

Question 6

Sitagliptin

Answer 6

DPP-4 inhibitor
Delays breakdown of GIP (hormone that stimulates insulin secretion) and GLP (hormone that delays gastric emptying)
Has nothing to do w/beta cells
Weight LOSS
NO RISK for hypoglycemia (euglycemic)
Boxed warning: joint pain that can be disabling

Question 7

Canagliflozin

Answer 7

SGLT-2 inhibitor
Being marketed as “next Metformin” but AEs…
Binds to SGLT-2 receptors in kidneys and prevents glucose resorption –> increased excretion of glucose in urine
Has nothing to do w/beta cells
Weight LOSS
NO RISK for hypoglycemia (euglycemic)
Lots of FDA warnings: bone fractures, DKA, acute kidney injury, amputations, serious UTIs requiring hospitalization

Question 8

DM 2 drugs that –> weight LOSS

Answer 8

Sitagliptin
Canagliflozin
(Exenatide, Liraglutide - non-insulin injectables)

Question 9

DM 2 drugs that = weight NEUTRAL

Answer 9

Metformin

Acarbose

Question 10

DM 2 drugs that –> weight GAIN

Answer 10

Glipizide
Repaglinide
Pioglitazone
(All insulin injectables)