ORAL DIABETES MEDICINES AT A GLA DRUG CLASS DRUG NAMES HOW IT WORKS WHEN TO TAKE Alpha-glucosidase acarbose (Precose) Slows down the digestion Take with the first bite inhibitors miglitol (Glyset) of certain carbohydrates of each meal. in intestines Biguanides metformin (Glucophage, Decreases production of glu- Take with food to mini- Glucophage XR, Riomet cose by the liver; improves mize side effects. [liquid formulation]) insulin 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 nateglinide (Starlix) Stimulates the pancreas Take 1 to 30 minutes derivatives to release more insulin before meals. Meglitinides repaglinide Stimulates the pancreas to Take 15 minutes before (Prandin) release more insulin meals. Sulfonylureas chlorpropamide 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. glimepiride (Amaryl) Take before or with meals. Thiazolidinediones pioglitazone (Actos) Improves insulin sensitivity, Take with or between rosiglitazone (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 thiazolidinedione 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, diarrhea, Increase dose gradually; if hypoglycemia 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 alcohol. 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 DRUG CLASS EXAMPLES GLUCOSE LEVELS DECREASES HbA1c Alpha-glucosidase acarbose (Precose) 35–40 mg/dl 0.7% to 1.0% inhibitors miglitol (Glyset) Biguanides 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).