Summary Drug Table Antidiabetic Drugs Continued

Type 2 Diabetes Defeated

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GENERIC NAME

TRADE NAME*

USES

ADVERSE REACTIONS

DOSAGE RANGES

Biguanide

metformin met-for'-min

Glucophage, Glucophage XR, generic

Type 2 diabetes; with a sulfonylurea or insulin to improve glycemic control

Anorexia, nausea, vomiting, epigastric pain, heartburn, diarrhea, hypoglycemia, allergic skin reactions

5GG—3GGG mg/d PO; XR (extended release): 5GG—2GGG mg/d

Meglitinides

nateglinide nah-teg'-lah-nyde

Repaglinide re-pag'-lah-nyd

Starlix Prandin

Type 2 diabetes; in combination with metformin to improve glycemic control Type 2 diabetes; in combination with metformin to improve glycemic control

Headache, upper respiratory tract infection, back pain, flu symptoms, bronchitis

Hyperglycemia, hypoglycemia, nausea, diarrhea, upper respiratory tract infection, sinusitis, headache, arthralgia, back pain

60-120 mg TID before meals

0.5—4 mg before meals PO (maximum dose is 16 mg/d)

Thiazolidinediones

pioglitazone HCl pie-oh-glit'-ah-zohn rosiglitazone maleate roh-zee-glit'-ah-zohn

Actos Avandia

Type 2 diabetes; with sulfonylurea, metformin, or insulin to improve glycemic control Type 2 diabetes; in combination with metformin to improve glycemic control

Headache, pain, myalgia, aggravated diabetes, infections, fatigue

Headache, pain, diarrhea, hypoglycemia, hyperglycemia, fatigue, infections

15—45 mg/d PO 4—8 mg/d PO

Antidiabetic Combination Drugs

glyburide/ metformin HCl

Glucovance

Type 2 diabetes

See individual drugs

Starting dose: 1.25 mg/250 mg PO once or twice daily with meals, second-line therapy: 2.5 mg/500 mg-5 mg/ 500 mg PO BID with meals; maximum daily dosage: 20 mg/2500 mg

Glucose-Elevating Agents

diazoxide, oral die-aze-ox'-ide glucagon glue-kuh-gahn

Proglycem

Glucagon Emergency Kit

Hypoglycemia due to hyperinsulinism

Hypoglycemia

Sodium and fluid retention, hyperglycemia, glycosuria, tachycardia, congestive heart failure

Nausea, vomiting, generalized allergic reactions

3-8 mg/kg/d PO in 2 or 3 equal doses every 8 or 12 h

See instructions on the product

•The term generic indicates the drug is available in generic form.

•The term generic indicates the drug is available in generic form.

Initial Intervention*

Education/Nutrition/Exercise Goal: FPG < 126 mg/dL, HbAlc < 7.0%

Goal Met

F/U every 3 months f

Monotherapy adequate FPG < 126 mg/dL, HbAlc < 7.0%

Continue therapy HbAlc q 6 months

Goal Not Met After 1 Month FPG >126 mg/dL, HbAlc > 7.0%

Start initial monotherapy Sulfonylureas Metformin*

Other initial monotherapy options: Acarbose/Miglitol Pioglitazone/Rosiglitazone Repaglinide Insulin

Monotherapy Inadequate After 3 Months HbAlc > 7.0%

Combine sulfonylurea/metformin f

Other combination options: Metformin or a Sulfonylurea plus Acarbose/Miglitol, or Pioglitazone/ Rosiglitazone or Repaglinide (with metformin), or Insulin

Combination Therapy Adequate HbAlc < 7.0%

Combination Therapy Inadequate HbAlc >7.0% within 6 months

Continue Combination Therapy HbAlc q 6 months

Add intermediate bedtime insulin or add third oral agent or switch to insulin monotherapy or refer to specialist

*If initial presentation with fasting glucose > 260 mg/dL is a symptomatic patient, consider insulin as initial intervention. "Preferred in obese or dyslipidemic patients -Normal HbAlc = 4-6.1% -Normal FPG: < 126 mg/dL -Goals and therapies must be individualized.

Figure 49-3. Pharmacological algorithm for treating type 2 diabetes.

reactions, and are more likely to react with other drugs. More commonly used sulfonylureas are the second and third generation drugs, such as glimepiride (Amaryl), glipizide (Glucotrol), and gly-buride (DiaBeta, Micronase).

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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