This document summarizes different types of medications used to treat diabetes. It discusses mechanisms of action, side effects, and important details about popular classes of antidiabetic medications including biguanides (e.g. metformin), sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, meglitinides, GLP-1 receptor agonists, and various types of insulin. The types of insulin are categorized based on their onset, peak effects, duration of action and administration details. The document provides a comprehensive overview of common antidiabetic drugs.

1. medicationsAntidiabetic
-Stop prior to IV contrast &
48 hours after angiography
-CC < 30 mL/min - Do not
use
Category B in pregnancy
-B12 deficiency
Gi upset-
-No hypoglycemia
or weight gain
-Improves CKD
- lactic acidosis( Rare)
 in the liver:
1↓gluconeogenesis,
2-↓Glycogenolysis
3-↓Fatty acid
oxidation
 in skeletal muscle
1-↑ glycogenesis
2-↓Fatty acid
oxidation
 in intestine:
1-Anerobic glucose
metabolism
Biguanide Metformin
(max 2550)
▼HbA1c by 1.to 2.0 %
-Avoid Glimepiride ,
glibenclamide in elderly
-Weight gain
-hypoglycemia
Cholestasis(Chlorpropamide)-
-Retinopathy (Gliclizide)
-Stimulate pancreatic beta cells
to release insulin
Sulfonylureas
-Glipizide,
-Glyburide
(glibenclamide),
Glimepiride-
-Gliclazide
(Diamicron)
▼HbA1c by 1 to 2%
-Black Box warning for
class III or IV HF
Category C in pregancy-
-Risk of bladder, prostate,
pancreatic cancers ,edema
-Decrease bone density and
increase fractures
Weight gain-
Increases ovulation-
-Decreases insulin resistance
at muscle and fat level
Thiazolidinedion
-Pioglitazone (Actos)
Rosiglitazone (Avandia)-
.-Do not use in MEN2 and
CC below 30.
Category C in pregnancy
Weight loss-
-Pancreatitis
-Hypoglycemia with
Sulfonylureas
Thyroid C-cell T-
1- Potentiate insulin secretion
2- Suppress postprandial
glucagon secretion
3- Slow gastric emptying
4- Promote satiety
5- Increases insulin response
to postprandial rise in glucose
GLP-1
Exenatide-
-Liraglutide( Victoza )
Dose 0.6, 1.2, 1.8 mg
daily
Dulaglutide-
1-Linagliptin not renally
excreted and good choice in
elderly
2-Better insulin release and
blood sugar control,
particularly postprandial
-URI, sore throat, diarrhea,
pancreatitis-
Joint pain-
weight neutral-
Decrease breakdown-
of GLP-1
DPP-4 Inhibitors
Linagliptin 5mg daily-
Sitagliptin(Januvia)100mg
daily-
Saxagliptin
▼HbA1c by .5 to .7 %-
Lower BB-
-Improve renal F
- Decrease risk of MI,
stroke, CKD
B12 deficiency-
Weight loss-
DKA-
-Increase fractures and risk of
foot amputation
Fournier's gangrene-
Increased UTIs-
1-Block reabsorption of
glucose in the kidney
2- Increase urinary excretion of
glucose
SGLT2 Inhibitors
Canagliflozin-
Dapagliflozin-
Empagliflozin
▼HbA1c by .5 to .8 %-
Weight neutral-
no hypoglycemia-
Category B in pregnancy-Delay carbohydrate absorption
in gut
A-Glucosidase
Inhibitors
Acarbose-
Miglitol-
- May be used in
elderly, renal failure, &
cardiopulmonary
disorders
Rapid-acting-Meglitinides
-Repaglinide
-Nateglinide
++Side effectMechanism of actionMedication

2.  Types of insulins:
Side effect : Systemic : Hypoglycemia, Wight gain, Insulin resistance
Local : Hypersensitivity Infection ,Lipodystophy
Long actingIntermediateShort actingRapid acting
,)Lantus(Glargine
)Levemir(etemirD
Neutral protamine
Hagedorn (NPH)
Regular(Humulin R),)NovoRapid(spartA
glulisine
)Humalog(),lisproApidra)
Onset 30-60 min,
Glargine No peak
Detemir dose
dependent ,
duration 16-24 hr
Onset 1-2 H,
peak 4-8 hr,
duration 8-12 hr
Onset 30 min,
peak 1-3 hr,
duration 4-8 hr
Onset 15 min,
peak 1-3 hr,
duration 2-5 hr
Administered once
daily
● Route: SubQ
injection
○ NOT for IV use
● Appearance:
Clear-
-Can NOT be mixed
with other types of
insulin
Administered once
or twice daily
● Route: SubQ
injection
NOT for emergency
IV use
● Appearance:
Cloudy
Only :insulin that
can be mixed with
short-acting
-Administered immediately
before eating a meal
● Route: May be given IV
● Appearance: Clear
Prepared by Dr.Anas alsaab