Oral Diabetic Medications
- stimulate insulin secretion in response to glucose. Watch for weight
generation) - Preferred than Glyburide in elderly due
to its shorter half-life of 2-4 hours.
5-10 mg 1-2 tab 1-2x/d; 5-10 mg tab (Max 40 mg/day)
Glucotrol XL 5-10mg tab once/day
Micronase | (2nd
generation) - Half-life of 5-16 hours
2.5-5mg 1-2 tab 1-2x/d; 1.25-2.5-5 mg tab (Max 20 mg/day)
Glynase 1.5-3 mg 1-2 tab 1-2x/d;
1.5-3 mg tab
1,2,4 mg tab/day. Start 1-2 mg/d, usual maintenance dose is 1-4mg once/d
Gliclazide/ Diamicron 80-160 mg daily, max 320 mg PO daily.
Modified release Diamicron MR 30 mg PO daily, mas 120 mg daily
100-250 mg 1-3 tab/d; 100-250 mg tab
250-500 mg tab 1-3x/d
100-500 mg tab -2x/d; 100-250-500 mg tab.
Dymelor/Acetohexamide 500-750 mg once or divided.
- enhance muscle sensitivity to insulin.
- Side effects are weight gain and edema. Also check liver function
tests at baseline and when clinically indicated thereafter.
Caution: Possible liver damage.
Its primary action is to enhance insulin action in muscle, adipose tissue
& liver; it also reduces excessive hepatic glucose output. It is for
type II diabetes currently on insulin, yet not controlled (insulin >30
u/d) (Parke Davis)
Warning: Liver damage/failure. Check
LFT baseline & monthly x6 months, then every 2 months x6 months.
Pioglitazone/Actos 15-30-45 mg
tablet once daily
Rosiglitazone/Avandia 4 mg 1-2x/day
Avandamet (Rosiglitazone/metformine) 1-2-4 mg/500mg tablets
tab 1/d - discontinued!
- Primary action is reduction of excessive hepatic glucose output; it also
has some activity on insulin resistance in skeleton muscle, though less than
troglitazone. Metformin may cause life-threatening
lactic acidosis. Hold this med prior to IV contrast agents
and for for 48 hours after. Avoid if ethanol abuse, heart failure,
hepatic or renal insufficiency (Cr >1.4-1.5), or hypoxic states.
500 - 850 mg tab 2-3x/day or 1000 mg bid with meals. (MAX 2550 mg/day)
Takes about 2 wks to work well. Do not use
in renal or hepatic dysfunction, dehydrated, or hospital patients.
Glumetza/ Extended Metformin 500-1,000 mg dosage strength
Insulin Secretagogues (Meglitinides)
- stimulate insulin production in response to post-meal hyperglycemia.
- Side effects include hypoglycemia, while repaglinide can bring on headaches.
- 1 - 2 mg tab ac (Max 16 mg/day)
120 mg ac
Starlix (Nataglinide) is an oral prescription drug that lowers your overall
level of blood sugar by reducing the high blood sugar levels following a
meal. It works by helping your body release insulin right at the start of
a meal, when you need it the most.
Who can take Starlix? Starlix is indicated as initial monotherapy or
as add-on therapy to patients on metformin who are not at A1c goal.
- it delays the breakdown of complex carbohydrates in the intestine &
reduces the postprandial rise in blood
- Side effects include bloating and diarrhea.
25- 50- 100 mg tid with first bite of meal. Initially 25 mg 1x/d x2wks,
then bid x2wks, then tid x2months, then may increase to 50 mg tid.
- It slows carbohydrate breakdown & glucose GI absorption. It decreases
postprandial glucose peaks.
May cause GI upset, pain, diarrhea, flatulence.
Miglitol/Glyset 50 mg tid
Combination Oral Diabetic Medications
Data suggest that combination treatment with once-daily metformin-rosiglitazone
improves glycemic control, insulin sensitivity, and Beta-cell function
more effectively than treatment with metformin alone.
* Exenatide (Exendin-4)
5-10 mcg bid subc within 1 hour before breakfast & dinner.
Glucagon-like peptide-1 (GLP-1) type med that enhancse glucose-dependent
insulin secretion & regulation of glucagon release and the rate of gastric
emptying, thereby reducing hyperglycemia; it also enhances pancreatic Beta-cell
function and promotes satiety, resulting in reduced caloric intake &
Byetta (Exenatide) 5-10
mcg BID subc. injection within 1 hour before breakfast & dinner.
- is indicated as adjunctive therapy to improve glycemic controlin patients
with type 2 diabetes who are taking metformin, a sulfonyluria, or a comgination
of metformin and a sulfonylurea but have not achieved adequate glycemic
- by improving acute beta-cell responsiveness
- not recommended for use in patients with end-stage renal disease, severe
renal impairment, or severe GI disease.
- most common adverse event was nausea, excluding hypoglycemia.
Oral Diabetic Agent and Insulin
If oral diabetic agents do not achieve glycemic control, consider combining
them with insulin. Options include:
Bedtime insulin plus daytime sulfonyurea
Bedtime insulin plus metformin
Humalog insulin analog is faster but shorter duration action than
Human regular insulin. Use within 15 min before meals.
Humulin Lente, NPH, Regular, Ultralente, 70/30 (Lilly)
Novolin Lente, NPH, Regular, 70/30 (Novo Nordisk)
Mixtard Human 70/30 (Novo Nordisk)
(Insulin glargine - rDNA origin) once
a day injection, start 10 IU daily (about the same dose as NPH)
Symlin (pramlintide) 15 mcg subc before
meal, titrate by 15 mcg increments up to maintenance 30-60 mcg as tolerated
in Type 1 diabetes. In type 2 diabetes initiate 60 mcg subc before
meals and increase upto 120 mcg as tolerated.
- a synthetic analog of the human neuroendocrine hormone amylin, it is secreted
from beta cells with insulin. The drug slows gastric emptying and decreases
appetite and glucagon secretion after meals.
Inhaled insulin (Exubera -
Jan. 27, 2006 The first inhaled insulin (Exubera) was approved
today by the US Food and Drug Administration (FDA) for the treatment of adult
patients with type 1 and type 2 diabetes. An inhaled powder form of recombinant
human insulin (rDNA), the drug and delivery system is the first new insulin
formulation introduced since the discovery of insulin in the 1920s, according
to the FDA.
Injection, solution, aspart, human:
Injection, solution, lispro, human:
Injection, solution, regular, human:
Humulin® R: 100 units/mL (10 mL vial)
Novolin® R: 100 units/mL (1.5 mL
prefilled syringe, 10 mL vial)
Novolin® R [PenFill®]: 100 units/mL (1.5 mL cartridge, 3 mL cartridge)
Injection, solution, regular, human, buffered :
Injection, solution, regular, purified pork:
Injection, suspension, lente, human [zinc]:
Humulin® L, * Novolin® L [Discontinued]: 100 units/mL
(10 mL vial)
Injection, suspension, lente, purified pork [zinc]:
Lente® Iletin® II: 100 units/mL (10 mL vial) [Discontinued]
Injection, suspension, NPH, human [isophane]:
Humulin® N: 100 units/mL (3
mL disposable pen, 10 mL vial)
Novolin® N: 100 units/mL (1.5
mL prefilled syringe, 10 mL vial)
Novolin® N [PenFill®]: 100
units/mL (1.5 mL cartridge, 3 mL cartridge)
Injection, suspension, NPH, purified pork [isophane]:
Injection, suspension, Ultralente®, human [zinc]:
Injection, solution, glargine, human:
Injection, aspart protamine human suspension 70% and rapid-acting aspart
human solution 30%
Injection, lispro protamine human suspension 75% and rapid-acting lispro
human solution 25%
Injection, NPH human insulin suspension 50% and short-acting regular human
insulin solution 50%
Injection, NPH human insulin suspension 70% and short-acting regular human
insulin solution 30%:
Humulin® 70/30: 100 units/mL (3 mL
disposable pen, 10 mL vial)
Novolin® 70/30: 100 units/mL (1.5
mL prefilled syringe, 10 mL vial)
Novolin® 70/30 [PenFill®]: 100 units/mL (1.5 mL cartridge, 3 mL