Diabetes Medication: Mechanisms and Side Effects

Diabetes Medication_ Mechanisms and Side Effects

Diabetes Medication: Mechanisms and Side Effects

Metformin (Glumetza, Glucophage, Fortamet):

  • Mechanism: Decreases hepatic glucose production and peripheral glucose utilization, decreases intestinal glucose absorption (these are reasons it leads to weight loss)
  • Side effects: Can cause lactic acidosis and needs to be discontinued 24 hours before contrast and resumed 48 hours after with monitoring for creatinine, stop if creatine is > 1.5

Sulfonylureas - Glyburide (Glynase), Glipizide (Glucotrol, Glucotrol XL), Glimepiride (Amaryl):

  • Mechanism: Stimulates pancreatic beta-cell insulin release (insulin secretagogue)
  • Side effects: Causes hypoglycemia and weight gain

Thiazolidinediones - Pioglitazone (Actos) and Rosiglitazone (Avandia): 

  • Mechanism: Increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells
  • Side effects: Can cause fluid retention, and edema. Cardiovascular toxicity with Avandia.

α-Glucosidase inhibitors - Acarbose (Precose) and Glyset (Miglitol):

  • Mechanism: Delays intestinal glucose absorption
  • Side effects: May cause increased LFTs and hepatitis, diarrhea, flatulence

Meglitinides - Repaglinide (Prandin)  and Nateglinide (Starlix):

  • Mechanism: Stimulates pancreatic beta-cell insulin release
  • Side effects: May cause hypoglycemia

GLP-1 Agonists - Exenatide (Bydureon, Byetta):

  • Mechanism: Lowers blood sugar by mimicking incretin - causes insulin secretion and decreased glucagon and delays gastric emptying
  • Side effects: May cause hypoglycemia, caution if gastroparesis

DDP-4 Inhibitors - Sitagliptin (Januvia):

  • Mechanism: Dipetpidylpetase inhibition - inhibits degradation of GLP-1 so more circulating GLP-1
  • Side effects: May cause pancreatitis and renal failure

SGLT2 Inhibitor - Canagliflozin (Invokana or Sulisent):

  • Mechanism: SGLT2 inhibition lowers renal glucose threshold which results in increased urinary glucose excretion
  • Side effects: hypoglycemia and urinary tract infections

Read more: Diabetes Mellitus Type 2

The Daily PANCE and PANRE

Get 60 days of PANCE and PANRE Multiple Choice Board Review Questions delivered daily to your inbox. It's 100% FREE and 100% Awesome!

You have Successfully Subscribed!