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

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1 DIABETES EDUCATION *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. rev. 12/2014 Glipizide Extended Release Glipizide Glyburide Glimepiride Glucotrol Glucotrol XL Micronase, Diabeta, Glynase Prestabs Amaryl 30 minutes before a meal on an empty stomach 30 minutes before a meal on an empty stomach Take with meal - Breakfast or 1 st main meal Take with meal Do not take if severe allergy to sulfa Possible hypoglycemia Don t skip meals do not take if meal skipped Skin rash Weight gain May cause nausea and vomiting if taking while drinking alcohol Do not use if taking medications to decrease alcohol use Do not break, crush or chew Glucotrol XL pill Amaryl may cause sun sensitivity, use sunscreen 1

2 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 the muscles. Helps to improve lipids. Metformin Fortamet Glumetza Riomet Liquid (measure with marked measuring spoon, oral syringe or measuring cup) Metformin Extended release Glucophage Glucophage XR With meals, start with evening meal With evening meal Do not break, crush or chew Metformin/Glucophage XR tablet Nausea, diarrhea, abdominal discomfort cramping, bloating Decreases appetite. May have initial weight loss Improves lipids and cholesterol Avoid alcohol Rare hypoglycemia if used alone Increases fertility Stop drug for 48 hours after IV Dye, CT scan dye and Xray tests. Increase fluids during those 48 hours Do not take if any kidney problems 2

3 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. Acarbose Miglitol Precose Glyset Take with 1 st bite of food each meal *Use glucose tablets, glucose gel or milk only to treat hypoglycemia Gas, bloating, diarrhea, abdominal discomfort. Weight neutral Exercise after meals to prevent build-up of GI tract gas 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. Repaglinide Nateglinide Prandin Starlix Take within minutes of starting to eat meals Must eat after taking the pill 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 Weight gain, diarrhea, back pain, dizziness, upper respiratory infection, skin rash 3

4 TZD S -THIAZOLIDINEDIONES ACTION: TZD s make the muscle cells more sensitive to insulin. Helps the skeletal muscles and fat use insulin. Decreases liver glucose production. Rosiglitazone Pioglitazone Avandia Actos With main meal or 2 primary meals Before, during or after food but should be taken approximately the same time every day. Water retention, weight gain, shortness of breath. Notify your doctor of shortness of breath, edema, muscle pain and/or abdominal pain Use with caution for patients with CHF. Take other oral medications 2 hours before or after taking the TZD Actos can be given with insulin 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 preexisting heart disease 4

5 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) Sitagliptin Saxagliptin Linagliptin Alogliptin Januvia Onglyza Tradjenta Nesina Take once a day in the morning with or without food Once a day, with or without food Once a day, with or without food Once a day, with or without food Watch for allergic reactions and kidney problems Use for Type 2 diabetics only Weight neutral Store at room temperature Side effects runny nose, stuffy nose, sore throat, upper respiratory infections,headache Tell your doctor if you have a fever, any infection, injury, or if you have had or are going to have surgery Not suggested to be used with insulin or other diabetes injectable medications 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 kidney problems, or have had DKA; pregnant or planning a pregnancy If you miss a dose, do not take 2 doses at the same time. Can be used with insulin in Type 2 May have hypoglycemia when used with insulin or Sulfonylureas Not used during pregnancy or if breastfeeding Side effects: hives, difficulty breathing, swelling of face, lips, tongue or throat; severe abdominal pain; nausea, vomiting; loss of appetite; urinary tract infection; increased heart rate; runny, stuffy nose; weight gain; muscle or joint pain; headache; back pain 5

6 SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT 2) INHIBITOR Canagliflozin Dapaglifozin Invokana Farxiga Starting dose 100mg. once daily prior to 1 st meal of the day. Can be increased to 300mg once daily in appropriate patients mg in the morning, with or without food Not for treatment of Type 1 Not used in severe renal impairment or when on dialysis Precautions: Hypotension, impaired renal function, genital infections, urinary tract infections Empagliflozin Jardiance Start with 10 mg. daily, may be increased to 25 mg. daily 6

7 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. Exenatide Liraglutide Exenatide Byetta Victoza Bydureon Take within 60 minutes of meal. Start dose is 5 mcg. before breakfast and supper. Take doses at least 6 hours apart. Do not give after starting to eat. If you miss a dose, re-start at next scheduled time. Inject 1 time a day anytime with or without food. Given once a week every 7 days; anytime with or without food Pancreatitis, 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 before injection Weight loss Used in Type 2 diabetics only 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 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 Store at room temperature up to 4 weeks Avoid alcohol BLACK BOX WARNING Possible thyroid tumors Albiglutide Dulaglutide Tanzeum Trulicity Inject once a week, same day each week Inject once a week 7

8 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 cosecreted 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. Pramlintide Symlin Must be taken BEFORE eating Meal = 250 calories or 30 gm. carbohydrate Do not take Symlin if you do not eat Can be used with Type 1 or Type 2 Nausea and vomiting DO NOT mix with anything in syringes Slows absorption take other oral medications, 1 hour before or 2 hours after Symlin Counters weight gain of insulin Do not use if you have hypoglycemia unawareness, gastroparesis or taking medications to alter gastrointestinal motility Refrigerate unopened vials in the original carton Store opened vial or pen in a closed container at room temperature Do Not use if it looks cloudy, changed color, has been frozen or exposed to high temperatures Black Box Warning hypoglycemia may occur within 3 hours of taking Symlin 8

9 COMBINATION ORAL AGENTS (see individual drug sheets for more information) Glyburide/Metformin Glucovance Glipizide/Metformin Metaglip Rosiglitizone/Metformin (Avandia) Avandament Rosiglitizone/Glimepride (Avandia) (Amaryl) Avandaryl See specific medications See specific medications Pioglitizone/Metformin (Actos) Acto Plus Met Pioglitizone/Glimepride (Actos) (Amaryl) Duetact Sitagliptin/Metformin (Januvia) Janumet Metformin/Saxagliptin (Onglyza) Kombiglyze XR Repaglinide/ Metformin PrandiMet 9

10 (Prandin) Linagliptin/Metformin (Tradjenta) Jentadueto Dapaglifozin/Metformino Xigduo Take in the morning with food with non-caffeine liquid Sitagliptin/Simvastatin (Januvia) (Zocor) Juvisync Take daily with evening meal; swallow whole Do not take with grapefruit or grapefruit juice Do not use if pregnant or breast feeding, have liver 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 If had been on Metformin XR twice a day, skip the supper dose and start Xigduo in the morning with breakfast 10