"Suga, Suga" (...how you get so fly)

...My diabetes medications review! I made this list during my last rotation, since I felt like I was all over the place with my diabetes medications knowledge. Enjoy!

Types of Insulin – insulin is safe in pregnancy

Rapid-acting – for meals eaten at same time as injection

• Humalog (Lispro): 15-20mins/3-5 hours
• Novolog (Aspart): 10-20mins/3-5 hours

Short-acting – for meals eaten within 30-60mins

• Humulin or Novolin (Regular): 20-60mins/5-8 hours
• Velosulin: 30-60mins/2-3 hours

Intermediate-acting – half day or overnight (combo with rapid/short)

• NPH: 1-2 hours/18-24 hours
• Lente: 1-2 hours/18-24 hours

Long-acting – about a full day (combo, if needed, with rapid/short)

• Lantus (glargine): 1-1.5 hours/20-24 hours
• No peak time, delivered at a steady level
• Levemir/Detemir: 1-2 hours/up to 24 hours
• Peak time 6-8 hours

Pre-mixed – twice with meals

Oral Medications

Actos (pioglitazone) – thiazolidinediones (^insulin sensitivity and secretion)

• Maximum 45mg/day, Start 15-30mg/day
• ADR: liver problems (2.5x ULN)
• Contraindications: CHF III-IV (BBW)
• Well tolerated in older adults, don’t cause hypoglycemia, okay for renal dysfunction

Janumet (sitagliptin/metformin) – sitagliptin increases levels of incretin, decreases sugar from liver, metformin restores body’s response to insulin, decreases sugar from liver

• Maximum 100/2000mg/day

Metformin – restores body’s response to insulin, decreases sugar from liver

• Contraindications: renal dysfunction (CHF?)
• Perks: has also been shown to decrease LDL and TC, weight loss, less hypoglycemia  
• ADRs: GI, lactic acidosis (d/t OD or renal dysfunction)

Sulfonylureas (chlorpropamide, glyburide, glimepiride, glipizide) – increase insulin release

• 1^st and 2^nd generations
• ADR: hypoglycemia, weight gain

Meglitinides (repaglinide and nateglinide) – similar to sulfonylureas

• If patient can’t use sulfonylureas, same weight gain as sulfonylureas, possibly less risk of hypoglycemia.

Alpha-glucosidase inhibitors (acarbose and miglitol) – block complex carbs to monosaccharides (slows glucose absorption)

• ADR: GI very common

DDP-IV inhibitors (gliptins) – regulates enzymes involved with glycemic control

• No risk of hypoglycemia and weight-neutral (from UpToDate); however, safety of these drugs has not been established for long-term use. Also expensive, and need to be adjusted in renal insufficiency.

Subcutaneous Medications

Byetta (Exenatide) - ^incretin to ^insulin

• BID with breakfast and dinner, Abx/BC with lunch
• ADR: N/V/D/GI/decreased weight
• Contraindications: T1DM, Renal, Pancreatitis, pregnancy

Victoza (liraglutide) – increases insulin, decreases gastric emptying, decreases glucagon, GLP-1 analog

• BBW for thyroid tumor
• Another one in this class is exenatide, but it is BID injections (should not use with CrCl < 30ml/min)