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Oral Medications
For Type 1 diabetics, insulin shots are needed to keep optimal blood glucose levels, since the pancreata of Type 2 diabetics do not make glucose.
All diabetics are counseled to lose weight, if needed, to eat a balanced low-carbohydrate diet, and to exercise every day. For many Type 2 diabetics (those whose bodies don’t make enough insulin, and whose cells don’t take in the right amount of glucose), oral medications can help lower blood glucose levels to within normal ranges.
Oral diabetic medications belong to six classes of drugs:
- Sulfonlyureas
- Meglitinides
- Biguanides
- Thiazolidinediones
- Alpha-glucose inhibitors
- DPP4 inhibitor
Your physician should answer questions about oral diabetic medications or insulin prescribed. A registered pharmacist can also provide background information about any prescribed medication. Diabetics should take all medications as prescribed, and should inquire about interaction with medications taken for other conditions. A brief look at the five classes of oral diabetic medications follows:
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Class
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Brand Name
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Activity
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Sulfonylureas
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Glucotrol®, Glucotrol XL®, Micronaser, Glynase®, Diabetar®, Amaryl®
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Stimulate insulin release from the pancreas and also decrease insulin resistance. Most significant adverse effect is hypoglycemia but also may cause nausea or weight gain.
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Meglitinides
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Prandin®, Starlix®
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Stimulates beta cells in pancreas to release insulin. Because it blocks the breakdown of table sugar, patients should have alternate source of fast-acting glucose (Glutose®) available in cases of hypoglycemia
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Biguanides
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Glucophage® (metformin), GluMetza®
Combinations containing metformin: Glucovance®, Avandamet® and Metaglip®
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Decrease intestinal absorption of glucose and glucose production in the liver, also increases insulin sensitivity. Primarily prevent blood glucose levels from rising. Adverse effects include abdominal pain and diarrhea. Should be held for two days after procedures using contrast dyes (cardiac cath).
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Thiazolidinediones
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Avandia®, ACTOS®
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Decreases insulin resistance, lowers blood glucose by improving target cell response and suppresses glucose production. Often combined with sulfonylurea to maximize effect. Routine monitoring of liver function tests is recommended.
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Alpha-glucosidase inhibitors
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Precose®, Glyset®
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Slows absorption of starches and sugars in the small intestine. Especially beneficial in patients that have post-meal hypoglycemia.
Should be taken with the first bite of each meal. Adverse effects may include gas and diarrhea.
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DPP4 inhibitor
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Januvia®, Onglyza®
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DPP4 blockers enhance the body's own ability to control blood sugar levels. It is taken once per day.
Very few minor side effects.
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Diabetes Medications (Insulins)
For Type I diabetics, insulin shots are needed to keep optimal blood glucose levels, since the pancreas of Type I diabetics do not make insulin (or doesn’t produce adequate supplies). There are many insulin options currently available for patients.
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INSULINS
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Brand name
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Description
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RAPID-ACTING
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Novulin-R® or Humulin-R®
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Quick acting insulins that are often used for coverage of meals. May be combined with other types of insulins.
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Humalog®, Novolog®, Apidra®
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INTERMEDIATE
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Novulin-N® or Humulin-N®
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Usually given 1-2 times daily for glycemic control.
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Novulin-L® or Humulin-L®
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LONG-ACTING
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Lantus®
Levemer®
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Basal insulin that releases small amount of insulin throughout the entire day. Do not mix in same syringe as other insulins!
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COMBINATION (Intermediate/Rapid-acting)
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Novulin® 70/30 or Humulin® 70/30
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Combination insulins that are pre-mixed in same bottle.
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Novolog Mix® 70/30
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Humalog Mix® 75/25
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INJECTABLES (NON-INSULINS)
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Symlin®
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Synthetic form of the hormone, amylin, which is produced by beta cells in pancreas.
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Adverse effects include nausea, which resolves over time. When used with insulin may cause hypoglycemia
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Subcutaneous Injection daily. Separate injection cannot be mixed with insulin.
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Can be used to treat either Type 1 or Type 2 diabetics.
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Byetta®, Victoza®
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Incretin mimetics increase glucose-dependent insulin secretion and decrease post-meal glucose rise.
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Adverse effects may include hypoglycemia (when used with other diabetic medications) and jitteriness.
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Subcutaneous Injection given twice daily.
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Use to treat only Type 2 diabetics.
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Source: ADA
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