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Sulfonylureas

*Read package insert each time you refill your medications in case there is new information
SULFONYLUREAS

ACTION: Sulfonylureas stimulate the pancreas to make more insulin (pancreas has to be making insulin) and increases
insulin absorption in the muscles.
EFFECTS AND PRECAUTIONS
WHEN TO TAKE
Possible hypoglycemia Don’t skip meals – Do not use if taking medications to decrease alcohol use
Do not break, crush or chew Glucotrol XL
pill
Part of the Glucotrol XL pill may pass in the
bowel movement - this is normal
Amaryl may cause sun sensitivity, use
sunscreen
If taking Amaryl, notify surgeons and dentist
before procedures.
BIGUANIDES
ACTION: Biguanides are insulin sensitizers that decrease the amount of glucose released by the liver to normalize blood
glucose production. Decreases insulin resistance. Increases insulin sensitivity. Increases the amount of glucose used by EFFECTS AND PRECAUTIONS
WHEN TO TAKE
Nausea, diarrhea, abdominal discomfort – Decreases appetite. May have initial weight Use with alcohol increases the action of Metformin – do not use if drinking alcohol. Do not take with Tagamet. Decreases absorption of B12 scan dye and Xray tests. Increase fluids during those 48 hours. Do not take if any kidney problems. ALPHA GLUCOSIDASE INHIBITORS
ACTION: Alpha Glucosidase Inhibitors slow down digestion of starches in the intestines to delay absorption of the
carbohydrates to decrease after meal blood sugars. Used for high after meal blood sugars. EFFECTS AND PRECAUTIONS
WHEN TO TAKE
*Use glucose tablets, glucose gel or milk
only to treat hypoglycemia.
Hypoglycemia may occur if used with other Gas, bloating, diarrhea, abdominal discomfort. Should not be used in persons with bowel disease – irritable bowel, colitis, intestinal blockage, cirrhosis, DKA. Check bloodwork (liver enzymes) every 3 months first year then periodically there after. Weight neutral. Exercise after meals to prevent build-up of GI tract gas from the fermenting carbs. Decrease absorption of Digoxin. MEGLITINIDES
ACTION: Meglitinides stimulate the pancreas to make and release more insulin right at the start of meals to lower after
meal blood sugars. Insulin levels are elevated for a short period of time right after meals. The drug’s peak time is 1 hour after taking and out of the system 3-4 hours after taking. WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Rapid action of the drug matches the timing Meal based dosing – good for people that vary meal times or only eat 2 meals. If you skip a meal, skip that dose of medication. Possible hypoglycemia Meal = 240 calories or more. Weight gain, diarrhea, back pain, dizziness, upper respiratory infection, skin rash TZD’S -THIAZOLIDINEDIONES
ACTION: TZD’s make the muscle cells more sensitive to insulin. Helps the skeletal muscles and fat use insulin.
WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Water retention, weight gain, shortness of Before, during or after food but should breath. Notify your doctor of shortness of be taken approximately the same time breath, edema, muscle pain and/or Use with caution for patients with CHF.
Check liver enzymes before starting med,
then every 2 months for 12 months, then
periodically.
Take other oral medications 2 hours before or
after taking the TZD.
Use with caution in pre-existing liver disease
– watch for nausea and vomiting, abdominal
pain, loss of appetite, and dark urine.
Actos can be given with insulin, insulin dose
may need to be decreased. (doctor will
adjust dose)
Potential fracture risk of women – upper arm,
hand and foot. Limit use with osteoporosis.
Decreases lipids – LDL and cholesterol.
Increases fertility and decreases absorption of
birth control meds.
Avandia – suggested not to be used with
insulin.
Actos has been linked to bladder cancer
Black Box Warning. Use with caution in pre-
existing heart disease (New York Heart
Association class III and IV heart failure)
DPP – 4 INHIBITORS
ACTION: DPP - 4 Inhibitors increase insulin produced when blood sugar is high, and reduces the amount of sugar made
by the liver after eating. (DPP - 4 = dipeptidyl peptidase - 4) WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Enhances the body’s own ability to decrease Use for Type 2 diabetics only Weight neutral Side effects – runny nose, stuffy nose, sore Tell your doctor if you have a fever, any infection, injury, or if you have had or are Not suggested to be used with insulin or other Not used for children 18 years old or younger Unlikely to cause hypoglycemia if used alone Tell your doctor if you have a history of Has not been studied in use with insulin If starting or stopping HIV/AIDS drugs, anti- If you miss a dose, do not take 2 doses at the same time. If you take too much, call your physician or Poison Control Center 1-800-222-1222 or go to the nearest hospital. Possible side effects – upper respiratory Infections, urinary tract infection, swelling of hands, feet or ankles – may be worse Can be used with insulin but NOT for Type 1 or if in DKA May have hypoglycemia when used with insulin or Not used during pregnancy or if breast feeding Tell your doctor if you have high cholesterol or triglycerides or history of pancreatitis Side effects: hives, difficulty breathing, swelling of face, lips, tongue or throat; severe abdominal pain; nausea, vomiting; loss of appetite; increased heart rate; runny, stuffy nose; weight gain; muscle or joint pain; headache; back pain May cause pancreatitis – severe abdominal pain radiating to the back, nausea and vomiting, SYNTHETIC INCRETIN MIMETIC
ACTION: Incretin hormones are intestinal hormones that are released in response to food intake and decrease blood
glucose. Incretin mimetics “mimic” the action of the incretins (GLP-1 glucagon like peptide-1). GLP-1 is secreted in the
gut in response to food intake. Works on the stomach, liver, pancreas, and brain to regulate blood glucose. Slows the
rate of nutrient absorption and gastric emptying. Decreases food intake due to increased feeling of fullness.
WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Nausea, vomiting, diarrhea, dizziness, headache, feeling jittery, acid stomach. Due to delayed gastric emptying – take antibiotics, thyroid hormones, oral contraceptives, coumadin, pain meds requiring rapid absorption, 1-2 hours Weight loss – decrease desire for food, decrease sense of hunger, decrease calorie intake **Pancreatitis – more risk if triglycerides are high, signs and symptoms are acute back pain from front to back abdominal pain, nausea, vomiting Not suggested for patients with severe problems digesting food, or severe If you miss a dose, re-start stomach or kidney disease. May delay and decrease concentration of digoxin. Store unopened pens in refrigerator, protect from light. Pens that have been used, store in a closed container at room temperature, away from heat and protected from light Do NOT freeze or use if it has been frozen Discard pen after 30 days of first use. Byetta is made from the saliva of the Gila monster (lizard). Not used with insulin
May have hypoglycemia if taken with other medicines. Must follow 1st time use directions with each new pen or if pen dropped.
Nausea is common when initially started. If the temperature of the pen is above 86º, throw pen away. Helps the body make insulin only when needed every 7 days; anytime with Store at room temperature up to 4 weeks or without food Bydureon is a powder that needs to be mixed; keep unused powder in the Refrigerator protected from light Do NOT freeze or use if it was frozen Avoid alcohol NOT used with Byetta or insulin BLACK BOX WARNING – Possible thyroid tumors; not for patients with a family history of thyroid cancer or multiple endoplasmic neoplasia syndrome. AMYLIN MIMETIC GLP - ANALOG
ACTION: GLP-1 (glucagon-like peptide-1) is made in the intestine and released in response to meals. The Amylin
mimetic is a synthetic drug that mimics Amylin and replaces the Amylin that is missing from the body. Amylin is co-
secreted in the beta cells with insulin. When eating, the Amylin decreases after meal blood sugars by decreasing liver glucose output, regulates rate of gastric emptying from the stomach to the small intestine, and decreases appetite. WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Must be taken BEFORE eating Insulin dose should be decreased by 50% when starting Symlin (your doctor will adjust the Inject abdomen or thighs only for injections (arm Slows absorption of other oral medications, including pain meds, take 1 hour before or 2
hours after Symlin
Counters weight gain of insulin
May cause hypoglycemia
Do not use if you have hypoglycemia
unawareness, gastroparesis or taking
medications to alter gastrointestinal motility
Refrigerate unopened vials in the original carton
to protect from light
Store opened vial or pen in a closed container at
room temperature
Do Not use if the medication looks cloudy,
changed color, has been frozen or exposed to
high temperatures
Black Box Warning – hypoglycemia may occur
within 3 hours of taking Symlin
COMBINATION ORAL AGENTS
(see individual drug sheets for more information) WHEN TO TAKE
EFFECTS AND PRECAUTIONS
See specific
See specific medications
medications
___________
__________________
_______________________________________
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Sitagliptin
Juvisync
Take daily with evening
Do not take with grapefruit or grapefruit juice
(Januvia)/
meal; swallow whole Do not use if pregnant or breast feeding, have
Simvastatin
disease, severe kidney disease, drink more than 2
alcoholic beverages/day, have an underactive
thyroid or of Chinese descent
Side effects – unexplained muscle pain, weakness,
fever, unusually tired, dark colored urine, severe
skin reaction

Source: http://www.hmpartners.org/images/Diabetes%20Education/diabetes_medsheet.pdf