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Home , Glipizide, Miglitol, Sulfonylurea

Oral

Daily Onset/ Class Drug Action Dose Peak Duration Patient Education

Glyburide- 2.5-10 mg 1-4 h Take 30 minutes before meals. DiaBeta *Lowers blood Max/day 24 h Increased risk for ,

Micronase glucose by 20mg 2-4 h even at low doses, teach s/sx/tx for Glynase increasing hypoglycemia. - secretion by the 2.5-20 mg 30 min Take 30 minutes before meals. Glucotrol pancreatic beta Max/day 24 h Teach s/sx/tx for hypoglycemia. cells. 40mg 1-3 h Glipizide XL- *May also lead to 5-20 mg 2-3 h Take with first meal of the day. Glucotrol XL increased peripheral Max/day 24 h Teach s/sx/tx for hypoglycemia. sensitivity to 20 mg 6-12 h - insulin. 1-4 mg <1 h Take with first meal of the day. Amaryl Max/day >24 h Teach s/sx/tx for hypoglycemia.

8 mg 2-3 h

Repaglinide- 0.5-4 mg ¼- ½ h Take up to 30 minutes before all Prandin *Stimulates insulin ac meals 2-3 h meals (if extra meal is added, take secretion; rapid Max/day 1 h extra dose of med). onset and 16 mg/day Do not take the med if not eating (no - elimination. 120 mg Within 20 meal = no med). Starlix *Associated with ac meals min 2-3 h Test blood sugar 2 hours after eating less hypoglycemia. Max/day to determine effectiveness of dose.

120 mg ac 1 h - May be taken with or without meals.

Actos *Reduces insulin 15-30 mg Unknown Unknown Do not double up if a dose is missed. resistance Max/day Have enzymes tested every 2 *Improves insulin 45 mg 2 h months for the first year, then

sensitivity in periodically after that. - muscle and adipose Report jaundice, nausea, Avandia tissue. 4 mg Unknown Unknown vomiting, fatigue, abdominal pain,

Glitazone **Use cautiously Max/day anorexia, or dark urine to in patients with 8 mg 1 h physician immediately. CHF or edema. ** Daily Onset/ Class Drug Action Dose Peak Duration Patient Education

Metformin- *Improves May cause GI upset/; these Glucophage peripheral insulin 500-850 Unknown Unknown symptoms last only a few weeks. sensitivity and mg tid or Take with food to reduce symptoms. glucose uptake 1000 bid 2-4 h Usually no risk for hypoglycemia. *Decreases hepatic Max/day Not for use in patients with liver gluconeogenesis 2550 mg or kidney disease or CHF.

Acarbose- *Delays digestion Take at every meal with first bite of Precose of , 50-100 Immediate ~6 h food. Prandase resulting in a mg ac May cause gas/ bloating. Glucobay smaller rise in post- Max/day Dose will be gradually increased to meal blood glucose. 300 mg decrease GI side effects. - *Can improve over- 25-100 Rapid “short” Not for use in patients with Glyset all glucose levels. mg ac chronic bowel disorders. Glucosidase - Glucosidase Inhibitor Alpha *Enhances glucose- For ONLY. Sitagliptin dependent insulin 100 mg Rapidly ~24 h Take once daily at a consistent time. daily in one Januvia secretion. dose. absorbed/ May be taken with or without food. *Suppresses 50 mg daily peaks at May cause low blood sugar when glucagon secretion. for renal 1-4 h with used in combination with a sulfonyl- *Slows gastric failure, half-life urea; lower doses of sulfonylurea emptying, reducing 25 mg for of 12h may be needed. ESRD food intake. Lower doses are available for those Saxagliptin 2.5 - 5.0mg with renal disease. Onglyza Once daily Renal dose:

DPP Inhibitor - 4 2.5 mg

New Diabetes Medications

Class Drug Action Daily Patient Education Dose *Enhances glucose- Indicated for Type 2 diabetes only.

Exenatide dependent insulin Starting dose: NOT for use in those with gastroparesis. Byetta secretion. 5 mcg bid ac Breakfast & Given by subcutaneous injection. *Suppresses Supper May cause hypoglycemia in patients taking glucagon secretion. Final dose: . Exenatide *Slows gastric 10 mcg bid ac Breakfast Take 15 – 60 minutes prior to meals. emptying, reducing & Supper If dose forgotten, do not take after the meal. food intake. May cause nausea; if nausea is a problem try to Liraglutide *Increases Starting dose: eat within 15 minutes of the injection. Victoza mass and function. 0.6 mg daily x 1 week Do not take Byetta if blood sugar is too low. Final dose: Liraglutide 1.2 – 1.8 mg daily Take once a day at the same time. Does not need to be timed with meals Incretin Hormone *Liraglutide should not be used in pts with history or family history of thyroid cancer. : Indicated for Type 1 diabetes, and Type 2 * Suppresses 2 ½ units (15mcg) before diabetes using insulin. Acetate glucagon secretion. major meals. NOT for use in those with gastroparesis. Symlin *Slows gastric Increase dose by 2 ½ With first dose decrease usual mealtime emptying, reducing units (15 mcg) every 3 – insulin dose by 50% to reduce the risk of food intake. 7 days if no nausea up to hypoglycemia. maximum dose 10 units Major meals have at least 30 gm

ylin ylin (60 mcg). or at least 250 calories). Use standard U-100 insulin syringe. Type 2 Diabetes: Inject in same manner as insulin. Am Start with 10 units (60 Never mix insulin and Symlin; use separate mcg) before major meals. syringes for each. Increase dose to 20 May cause nausea initially; usually subsides units (120 mcg) in 3 – 7 after the first few weeks. days if no nausea. DO NOT TAKE Symlin if blood sugar is too low, or when not eating.