Metformin (Glucophage)

Advantages:

-low risk of hypoglycemia

-weight neutral(possible weight loss)

-possible decrease in LDL and TG

-possible decrease in CHD

Disadvantages:

-metallic taste

-may cause gi side effects-decreased by slow titration

-Contraindicated in renal suffiency-may cause lactic acidosis

Drugs:

Gyburide (Micronase, Diabeta)

Glipezide (Glucotrol, XL)

Glimeperide (Amaryl)

A-

-generally well tolerated

-reduction in CV risks and mortality

D:

-weight gain

-rash

-sun sensitivity

-severe hypoglycemia-high risk in elderly and hepatic adn renl disfunction

-Glyburide has higher risk of hypoglycemia

-glipizide is preferred in elderly and renally impaired

Repaglinide (Prandin)

Nateglinide (Starlix)

A:

-accentuated effects around meal ingestion

-may be used in renal insufficiency

D:

-hypoglycemia and possible weight gain

-shorter half life than sulfonylureas ( more frequent admin)

Thiazolidinediones (Glitazones)

Pioglitazone (Actos)

Rosiglitazone (Avandia)

A of Pio:

-no hypoglycemia

-increase HDL, decrease TG

D of Pio:

-weight gain

-edema

-heart failure

-bone fractures

A of Avandia:

No hypoglycemia

D of Avandia:

-Increase LDL

-contraindicated in heart disease

Acarbos (Precose)

Glycet (Miglotol)

A:

-affective for lowering post-prandial glucose

d:

 increase gas production adn gi symptoms

-contraindicated in IDD, chronic ulceration, adn partial obstruction

Exenatide (Byetta)

Liraglutide (Victoza)

A:

-weight reduction

D:

-NVD

*Injectable

*Long term safety unknown

*black box for thyroid tumors (Victoza)

Sitagliptin (Januvia)

Saxagliptin (Onglyza)

Vildagliptin (Tradjenta)

A:

-no hypolglycemia

-weight neutral

D:

-occasional reports of urticaria/ angiodema

-cases of pancreatitis seen

*Long term safety unknown

Pramlintade (Symlin)

A:

-used in type 1 and type 2 dm

D:

-subcutaneous injection

-only as an adjunct to insulin

-insulin dosage reduction required upon intiation

-never mix Symlin and insulin in same syringe

-severe hypoglycemia-especially in type 1

-nausea-titrate gradually

-anorexia

Lispro (Humulog)

Aspart (Novolog)

Glulisine (Apidra)

Humulin R

Novolin R

Humilin N

Novolin N

Lantus (Glargine)

Levomir (Detmir)