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Clinician’s Corner: Diabetes Drug Chart

My students frequently ask me to create charts to help them have a “fast and dirty” means to look things up based on efficacy, cost and mechanism.  I have rolled the past 15 newsletters into this chart for your reference.

As always feel free to reach out to your Thompson Pharmacist to help you make the best decisions affecting your health.  Go Ahead and ASK, at Thompson Pharmacy it’s ALL for YOU!!!

 

Class / Generic name Brand name Physiologic action (Mechanism) Comments
Biguanide

(HbA1c=-1.5)

  Decreases hepatic glucose production Used first line. Weight neutral. GI side effects.
Metformin Glucophage    
Sulfonylureas (2nd gen) (HbA1c= -1-1.5)   Increases insulin secretion from the beta cells of pancreas Causes hypoglycemia, weight gain (5lb) , low durability
Glyburide Micronase or Diabeta   Avoid Glyburide in elderly (Beers List)
Glipizide Glucotrol    
Glimepiride Amaryl    
Meglitinides (HbA1c=- 1-1.5)   Increases insulin secretion Fast acting. Give with meal. May cause hypoglycemia
Repaglinide Prandin    
Nateglinide Starlix    
Thiazolidinediones

(HbA1c-.5-1)

“TZD’s” Increases insulin sensitivity No hypoglycemia, some weight gain (7lb) , heart failure,
Pioglitazone Actos   Bladder cancer(?)
Rosiglitazone Avandia   Heart failure (?)
Alpha glucosidase inhibitors

(HbA1c=-.5-.8)

  Slows intestinal carbohydrate digestion and absorption GI upset, gas, dosed with each meal. Must use glucose tablets for hypoglycemia
Acarbose Precose    
Miglitol Glyset    
DPP4 inhibitors (HbA1c= -.5-1)   Increase insulin secretion; blunts glucagon secretion Weight neutral. No hypoglycemia. Pancreatitis (?)
Sitagliptin Januvia    
Saxagliptin Onglyza    
Linagliptin Tradjenta No renal adjustment No drug interactions
Alogliptin Nesina    
SGLT-2 Inhibitors (HbA1c=-.5-1)   Blocks reabsorption of glucose. Increases glucose in urine Slight increase in candida genital infections. Weight loss (-5 lbs)
Canagliflozin Invokana    
Empagliflozin Jardiance   (cardio protective)
Dapagliflozin Farxiga    
Ertugliflozin Steglatro    

 

NON-oral

MEDICATIONS

     
GLP-1 agonists (HbA1c=-1-1.5)   Decrease glucagon secretion, increases insulin secretion. Slows GI emptying, increases satiety Rarely causes pancreatitis and gastroparesis. Weight loss (-6lb). once weekly GLP’s may cause medullary thyroid carcinoma.
Exenatide

 

Byetta and Bydureon Byetta dosed twice daily.

Bydureon given once a week

 
Liraglutide Victoza Dosed once daily cardioprotective
Liraglutide Saxenda Dosed once daily Approved only for weight loss
Dulaglutide Trulicity Dosed once weekly  
Semaglutide Ozempic Dosed once weekly  
Lixisenatide Adlyxin Dosed once daily  
Insulin (HbA1c-greater than 1.5)     Weight gain  7-11 lbs. Hypoglycemia
Inhaled Afrezza Ultra-rapid acting First inhaled insulin
Lispro Humalog

Admelog

Fast acting Mealtime insulin
  Humalog     U-200 U-200 Kwikpen Double strength Mealtime insulin
Aspart Novlog

Fiasp

Fast acting

(Fiasp:2.5 minute onset)

Mealtime insulin
Glulisine Apidra Fast acting Mealtime insulin
Regular Novolin-R Humulin-R    
NPH insulin Humulin-N Novolin-N Intermediate acting  
Detemir Levemir Long acting Basal insulin
Glargine Lantus

Basaflar

Long acting Basal insulin
Glargine Toujeo U300 Long acting First U-300 insulin. 300units/ml
Degludec Tresiba Long acting Available as U-100 and U-200pens
Insulin/Incretin combos      
Glargine & lixisenatide Soliqua 100/33 Long acting insulin + incretin Inject once daily, within one hour of first meal of the day. Use alternative treatments if doses below 15 Units or above 60 Units are required. Discard pen 14 days after first use.
Degludec& liraglutide Xultophy 100/3.6   Dose 10-50 units (max) same time each day; with or without food.
Glucagon Glucagon (Eli Lilly) (glucagon for reconstitution) Ultra-short acting treatment for hypoglycemia. Glucagon increases glucose by mobilizing conversion of glycogen stored in the liver Used to rescue insulin dependent diabetics with hypoglycemia, that can’t swallow. (naturally produced in alpha cells in Islet of Langerhans)
Auto injector Gvoke® (Xeris Pharmaceuticals) Stabilized glucagon for injection. 1mg and 0.5mg Autoinjector (Hypopen®) and prefilled syringe available
Nasal powder Baqsimi ® (Eli Lilly) Powder for nasal inhalation Available as 3mg powder