Remember the key points easily with the tips to remember at the bottom.
| Class | Examples | Mechanism | Important points |
|---|---|---|---|
| Biguanides | Metformin[Glucophage] | Activates AMP-kinase | Decreases hepatic glucose prod’n No weight gain-Good for obese pts No hypoglycemia GI side effects-continue for a week and reassess. Acidosis B12 deficiency |
| Sulfonylureas | Glyburide Glipizide[Glucotrol] Gliclazide Glimepiride[Amaryl] | Closes KATP channels on ß-cell plasma mem branes | Insulin secretion Hypoglycemia Weight gain Avoid in Obese Mortality in elderly |
| Meglitinides/glinides | Repaglinide Nateglinide | Closes KATI’ channels on ß-cell plasma membranes | Increases Insulin secretion Repaglinide for Renal pts |
| Thiazolidinediones | Pioglitazone Rosiglitazone | Activates the nuclear transcription factor PPAR-Y | Increases Insulin sensitivity Avoid in CHF NYHA II pts. Thigh high edema. |
| a-Glucosidase inhibitors | Acarbose Miglitol Voglibose | Inhibits intestinal a-glucosidase | Slows intestinal carbohydrate digestion/absorption Give Dextrose for hypoglycemia not orange juice |
| DPP-4 inhibitors | Sitagliptin[Januvia] Vildagliptin Saxagliptin Linagliptin[Tradjenta] Alogliptin | Inhibits DPP-4 activity, increasing postprandial active incretin (GLP-I , GIP) concentrations | Increases Insulin secretion Decreases Glucagon secretion |
| GLP-I receptor agonists | Dulaglutide[Trulicity] Exenatide [Byetta] Liraglutide[Victoza] | Activates GLP-I receptors | Increases Insulin secretion Decreases Glucagon secretion Slows gastric emptying->nausea Early satiety Wt loss->Good for obese |
| SGLT2 inhibitors/ Gliflozins | CanaGliflozin [Invokana] Dapa ” [Farxiga] Empa ”[Jardiance] | Block reabsorption of glu by kidney, urine glucose goes up–>genital fungal inf’ns, fournier gangrene. | Dapa-reduces HF hospitalizations in DM pts. Cana and Empa-reduce ESRD and hospitalizations for HF pts. Decreased CV death and all-cause mortality. DKA with normal blood sugars. |
| Amylin mimetics | Pramlintide | Activates amylin receptors | Decreases Glucagon secretion Slows gastric emptying Increases satiety |
| Insulins | Human NPH Human Regular Lispro Aspart Glulisine Glarglne Detemir Premixed | Activates insulin receptors | Hypoglycemia Weight gain |
Tips to Remember:
Empagliflozin=Jardiance —>EmptyJar.
Canagliflozin=Invokana—>Cana Invokana.
DPP4 inhibitors=gliptins—>Glip Dipp
Glutides will Gulp the Gluteus maximus causing wt loss. [Glutides are GLP1 agonists which help in wt loss]
SGLT2 inhibitors—>Sugar in urine
Exenetide=Byetta —>Bye Ex-girl/boyfriend
Liraglutide =Victoza is used for weight loss—>Lira got Victory in Weight loss
Dulaglutide=Trulicity—>Truly Dull.
Some important points:
Repaglinide and Linagliptin can be used for renal patients.
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1 unit Lispro covers 20gm glucose control
1% HBA1C =29gm Glucose
