Oral Hypoglycemics For Type Ii Dm

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Class and Specific Agents: Sulfonylureas

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Tolbutamide [Orinase]
Glipizide [Glucotrol]
Glyburide [Micronase]
Actions: Promote insulin secretion by the pancreas; may also increase tissue response to insulin
Major Adverse Effects: Hypoglycemia

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Class and Specific Agents: Meglitinides

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Repanglinide [Prandin]
Actions: Promotes insulin secretion by the pancreas
Major Adverse Effects: Hypoglycemia

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Class and Specific Agents: Biguanides

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Metformin [Glucophage]
Actions: Decrease glucose production by liver and increase glucose uptake by muscle
Major Adverse Effects: GI symptoms: decreased appetite, nausea, diarrhea
Lactic acidosis (rarely)

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Class and Specific Agents: Alpha-Glucosidase Inhibitors

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Acarbose [Precose]
Miglitol [Glyset]
Actions: Inhibit carbohydrate digestion and absorbtion, thereby decreasing the postprandial rise in blood glucose
Major Adverse Effects: GI symptoms: flatulence, cramps, abdominal distention, borborygmus

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Class and Specific Agents: Thiazolidinediones

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Rosiglitazone [Avandia]
Pioglitazone [Actos]
Actions: Decrease insulin resistance, and thereby increase glucose uptake by muscle and decrease glucose production by the liver
Major Adverse Effects: Hypoglycemia, but only in the presence of excessive insulin

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Lactic Acidosis: definition

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An accumulation of lactic acid in the blood, often as a result of the inadequate perfusion and oxygenation of vital organs, drug overdoses, skeletal muscle overuse, or other serious illnesses (some cancers; diabetes mellitus). Lactic acid is produced more quickly than normal when there is inadequate oxygenation of skeletal muscle and other tissues. Thus, any disease that leads to tissue hypoxia, exercise, hyperventilation, or some drugs (oral hypoglycemic agents) may cause this condition. In general, when blood pH is less than 7.35 and lactate is greater than 5 to 6 mmol/L (5 to 6 mEq/L), lactic acidosis is present.