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Diabetes Mellitus Type 2

Discussion

Diabetes Mellitus Medications

Oral Agents

Sulfonylureas: Major effect: stimulate insulin secretion

First generation

• tolbutamide (Orinase), tolazamide (Tolinase), acetohexamide (Dymelor)
• chlorpropamide (Diabinese)

Second generation

• glyburide: (Micronase Ph-Upj/Diabeta HMR /generic) 1.25, 2.5, 5 mg (s) micronized glyburide (Glynase Pharmacia-Upj/generic) 1.5, 3, 6 mg (s)
• glipizide: (Glucotrol Pfizer/generic) 5, 10 mg (s) GITS (extended release) (Glucotrol XL Pfizer) 2.5, 5, 10 mg
• glimepiride (Amaryl HMR) 1, 2, 4 mg (s)

Meglitinides: Major effect: stimulate insulin secretion (short-acting)

• repaglinide (Prandin NovoN) 0.5, 1, 2 mg
• nateglinide (Starlix Novartis) 60, 120 mg

Biguanides: Major effect: decrease hepatic glucose production

• metformin (Glucophage BMS) 500, 850,1000 mg; Glucophage XR 500mg

alpha-Glucosidase inhibitors: Major effect: slow absorption of starches

• acarbose (Precose Bayer) 50, 100 mg
• miglitol (Glyset Pharmacia-Upj) 25, 50, 100 mg

Thiazolidinediones: Major effect: decrease peripheral insulin resistance

• rosiglitazone (Avandia SKB) 2, 4, 8 mg
• pioglitazone (Actos Takeda/Lilly) 15, 30, 45 mg

Dipeptidyl peptidase inhibitors Major effect: increase incretin levels

• sitagliptin
• saxagliptin

Combination:

• glyburide + metformin (Glucovance BMS) 1.25/250, 2.5/500, 5/500 mg
• other combinations are available

Insulins

Long-acting:

• insulin glargine (Lantus Aventis)
• insulin detemir (Levemir NovoNordisk)

Intermediate:

• NPH (Neutral Protamine Hagedorn) (Humulin N or Novolin N)

Short-acting:

• insulin lispro (Humalog Lilly)
• insulin aspart (Novolog NovoNordisk)
• insulin glulisine (Apidra Aventis)

Mixes:

• NPH/regular: 70/30, 50/50
• NPH/lispro: (Humalog Mix Lilly) 75/25

Other injectable medications

• incretin mimetics
• amylin analogues