Anti-Diabetics

Front 1

Rapid-Acting

Back 1

Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glulisine (Apidra)

onset: 5-15 min
peak: 30-60 min
duration: 2-6 hrs

considerations: Clear liquid.
Must have food available before administering

Front 2

Short-Acting

Back 2

Insulin regular (Humulin R, Novolin R, Iletin Regular Insulin)

onset: 30-60 min
peak: 2-4 hrs
duration: 6-8 hrs

considerations: Clear liquid.
Only insulin that may be given IV.

Front 3

Intermediate-Acting

Back 3

Insulin isophane NPH (Humulin N, Novolin N)
Insulin zinc suspension Lente (Humulin L, Novolin L)

onset: 1-2 hrs
peak: 8-12 hrs
duration: 16-24 hrs

considerations: Cloudy liquid.
Gently rotate vial to mix before administration to ensure uniform suspension. Do not shake to avoid damaging molecules.
Peaks in late afternoon before evening meal.

Front 4

Long-Acting

Back 4

Ultralente insulin zinc suspension extended (Humulin U)

onset: 4-8 hrs
peak: 16-18 hrs
duration: 36 hrs

considerations: Cloudy liquid.
Rarely used.

Front 5

Constant-Acting:

Back 5

Insulin glargine (Lantus)

onset: 1-2 hrs
peak: none
duration: 24hrs

considerations: Recommended administration time is prior to bedtime.
Less risk of hypoglycemia or hyperglycemia.
Do not mix with any other insulin.
Acts like basal insulin secretion

Front 6

Amylin Analog

Back 6

Pramlintide (Symlin)

action:
↓ glucagon secretion for approx 3 hrs
Slows gastric emptying
↓ appetite by ↑ satiety

adverse effects: Nausea, GI distress, headache, anorexia, fatigue, dizziness

considerations: Subcu injection only in abdomen or thigh; do not give within two inches of injection site of insulin; never give in same site as insulin
Never give in arm.
If miss dose, do not administer until next scheduled meal; pt must take at least 30GMs CHO with meal when this med taken
Report nausea lasting 3-7 days as dose may be too high

Front 7

Sulfonylureas:
First-Generation
Tolbutamide (Orinase)
Tolazamide (Tolinase)
Chlorpropamide (Diabinese)
Acetohexamide (Dymelor)
Second-Generation
Glipizide (Glucotrol, Glucotrol XL)
Glyburide (DiaBeta, Glynase, Micronase)
Glimepiride (Amaryl)

Back 7

action: Stimulate insulin release from β cells, Also called insulin secretagogues

adverse effects: GI distress, nervousness, tremors, confusion, aplastic anemia, leucopenia, thrombocytopenia;
-weight gain
-all carry risk of hypoglycemia

considerations: Less risk of prolonged hypoglycemia as duration of action is short.
Drinking alcohol concurrently may cause hypoglycemia & disulfiram-like reaction (facial flushing, sweating, ↑ P, HA, dyspnea lasting up to 24 hrs).
Second generations lower glucose levels with smaller doses, have less drug interactions and longer duration of action.
Given 30 min a.c. breakfast and evening meal.
Monitor CBC.

Front 8

Biguanides:
Metformin (Glucophage)

Back 8

action:
•↓ hepatic production of glucose from stored glycogen
•Enhances insulin sensitivity at tissues
•Improves glucose transport into cells
•↓ absorption of glucose from small intestine

adverse effects: GI distress, anorexia, gas, abdominal pain, HA, dizziness, agitation, fatigue.
Bitter or metallic taste (will subside).

considerations: Hold metformin 48 hrs before or after diagnostic studies in which iodinated contrast dye is used .
Give with meals to ↓ GI effects.
Monitor CBC, renal & hepatic function tests periodically.
Contraindicated in renal insufficiency.
Avoid alcohol to ↓ risk of lactic acidosis.
Given alone does not cause hypoglycemia

Front 9

Meglitinides: (glinides) (non-sulfonyureas)
Repaglinide (Prandin)
Neteglinide (Starlix)

Back 9

action: ↑ insulin release from pancreas

adverse effects: GI distress, rhinitis, bronchitis, HA, arthralgia, back pain, paresthesia;
Cause hypoglycemia
Cause weight gain but less than sulfonylureas

considerations: More rapid onset and shorter duration that sulfonylureas;
Given 30 min a.c.
Contraindicated in liver dysfunction.
Dose should be reduced in elderly

Front 10

Thiazolidinediones:
Pioglitazone (Actos)
Rosiglitazone (Avandia)

Back 10

action:
•↑ insulin sensitivity, transport, & utilization at target tissues
•↓ insulin resistance

adverse effects: HA, pain, myalgia, infections, fatigue, rhinitis, URIs, liver dysfunction, fluid retention and edema, wt gain; given alone do not produce hypoglycemia

considerations: Avoid if patient in heart failure; med increases risk of heart failure when taken with insulin a/o nitrates
Monitor liver enzymes.
Reduces effectiveness of oral contraceptives (consider higher dose or alternative contraception)

Front 11

α-Glucosidase Inhibitors:
Acarbose (Precose)
Miglitol (Glyset)

Back 11

action: Slows digestion of CHO in small intestine

adverse effects: GI distress, gas, abdominal pain, weakness, dizziness, drowsy, HA, anemia, wt loss, ↑ liver function levels
Difficult for many pts to tolerate because of nausea
If this medication is taken in combination with insulin, sulfonylurea, or glinide pt is suspectibile to hypoglycemia

considerations: Use with caution with hepatic dysfunction.
Monitor H&H, CBC, liver function tests.
Digoxin levels are lowered with concurrent use
Take at first bite with each meal.
Because medication slows CHO absorption patients who take this medication who do develop hypoglycemia must be treated with glucose-gel, tablets or IV; foods containing complex CHO are ineffective when hypoglycemia develops with these meds

Front 12

Incretin Modifiers (Dipeptidyl Peptidase Inhibitors:
Sitagliptin (Januvia)
Saxagliptin (Onglyza) does not cause wt gain

Back 12

action: ↑ insulin release
↑ β cell responsiveness
↓ hepatic glucose production
Suppress glucagon secretion
Slows gastric emptying increasing satiety

adverse effects: GI distress, wt loss, headache, dizziness, jitteriness

considerations: Give with first bite of each meal.
Does not produce weight gain