ORAL DIABETES MEDICINES AT A GLA

DRUG CLASS DRUG NAMES HOW IT WORKS WHEN TO TAKE Alpha-glucosidase (Precose) Slows down the digestion Take with the first bite inhibitors (Glyset) of certain carbohydrates of each meal. in intestines

Biguanides (Glucophage, Decreases production of glu- Take with food to mini- Glucophage XR, Riomet cose by the ; improves mize side effects. [liquid formulation]) sensitivity in liver, muscle, and fat cells

Note: Liver and kidney function should be checked before starting metformin and periodically while taking it; discontinue before and for at least 48 hours after surgical procedures or radiocontrast dye studies.

D-Phenylalanine (Starlix) Stimulates the Take 1 to 30 minutes derivatives to release more insulin before meals. Stimulates the pancreas to Take 15 minutes before (Prandin) release more insulin meals. Stimulates the pancreas to Take with food. (Diabinese) release more insulin glyburide (Diabeta, Take before a meal. Glynase, Micronase)

glipizide (Glucotrol) Take 30 minutes before a meal. glipizide extended- May be taken with a meal; release (Glucotrol XL) do not crush or chew. (Amaryl) Take before or with meals. (Actos) Improves insulin sensitivity, Take with or between (Avandia) decreases production of glu- meals. cose in the liver; takes up to 4–6 weeks for full effect Note: Liver function tests must be done before starting a and periodically while taking it; caution is needed if a person has heart failure; may decrease effectiveness of birth control medicines or cause ovulation to resume. Combination Avandamet (rosiglitazone Drug actions include those for Take as directed. products and metformin) each type of medicine in pill. Glucovance (glyburide and metformin) Metaglip (glipizide and metformin)

The information in this table is based on drug package labeling.

8 Diabetes Self-Management AT A GLANCE

SIDE EFFECTS COMMENTS Upset stomach, , Increase dose gradually; if gas, bloating develops, use glucose gel or tablets for treatment; monitor liver function with acarbose; not to be used by people with inflammatory bowel disease. Nausea, diarrhea, gas, May improve lipid (blood fat) levels; use metallic taste, decreased only with normal kidney function due to absorption of vitamin B12 risk of lactic acidosis. If lactic acidosis is suspected, call for medical help immedi- ately; avoid .

Hypoglycemia, weight Skip dose if meal skipped. gain, headache Hypoglycemia, weight Skip dose if meal skipped; add dose if gain, headache meal added. Hypoglycemia, edema Long acting (up to 72 hours); avoid (swelling), low sodium alcohol. Hypoglycemia, weight gain, With all sulfonylureas, create a regular nausea, diarrhea, constipa- schedule to eat meals. Eat meals on tion, stomach pain, sun time and do not skip. sensitivity, skin rash (can occur with glyburide, glipizide, glipizide extended- release, and glimepiride)

Headache, weight gain, May improve lipid (blood fat) levels. anemia, edema (swelling)

See side effects for each type of medicine in pill.

July/August 2005

EFFECTIVENESS OF ORAL MEDICINES Some classes of diabetes drugs lower blood glucose more than others, but in some cases, two or even three classes of drugs can be combined for more effective treatment.

AMOUNT IT DECREASES FASTING BLOOD AMOUNT IT EXAMPLES GLUCOSE LEVELS DECREASES HbA1c Alpha-glucosidase acarbose (Precose) 35–40 mg/dl 0.7% to 1.0% inhibitors miglitol (Glyset) metformin (Glucophage) 50–70 mg/dl 1.5% to 2.0% D-Phenylalanine nateglinide (Starlix) 65–75 mg/dl 0.5% to 2.0% derivatives Meglitinides repaglinide (Prandin) 65–75 mg/dl 0.5% to 2.0% Sulfonylureas glipizide (Glucotrol, Glucotrol XL) 60–70 mg/dl 0.8% to 2.0% glyburide (DiaBeta, Glynase, Micronase) glimepiride (Amaryl) Thiazolidinediones pioglitazone (Actos) 25–50 mg/dl 0.5% to 1.5% rosiglitazone (Avandia)