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In this section you will learn about the different types of antidiabetic medications, including oral, non-insulin injectables, and insulin. Refer to the last toggle to access downloadable and printable charts and pages to help you study this important topic. You will work with patients who are on these medications throughout your day at work.
Biguanides are a class of medications used to treat type 2 diabetes. They work by reducing the amount of glucose produced by the liver and improving the body’s sensitivity to insulin, which helps the body use glucose more effectively. This results in lower levels of glucose in the blood.
Metformin is the most commonly prescribed biguanide. It is often the first-line treatment for people with type 2 diabetes, particularly for those who are overweight or obese
Biguanides are a class of medications used to treat type 2 diabetes. They work by reducing the amount of glucose produced by the liver and improving the body’s sensitivity to insulin, which helps the body use glucose more effectively. This results in lower levels of glucose in the blood.
Metformin is the most commonly prescribed biguanide. It is often the first-line treatment for people with type 2 diabetes, particularly for those who are overweight or obese
- It does not cause weight gain, which is a common side effect of some other types of diabetes medications.
- It also has a low risk of causing hypoglycemia (low blood sugar) compared to some other diabetes drugs.
- Its primary mode of action involves decreasing hepatic glucose production and increasing insulin sensitivity in the liver and muscle. This leads to a decrease in the level of circulating glucose.
Usage
Metformin is primarily used to manage type 2 diabetes, particularly in overweight and obese patients. It’s often the first medication introduced when lifestyle modifications (diet, exercise) are insufficient in controlling blood glucose levels. Metformin can be used alone (monotherapy) or in combination with other antidiabetic medications.
Side Effects
- Gastrointestinal disturbances such as nausea, vomiting, diarrhea, abdominal discomfort, and a metallic taste in the mouth
- These are usually transient and may be minimized by taking metformin with meals or starting with a low dose and gradually increasing it.
- Long-term use of metformin can lead to Vitamin B12 deficiency, which should be monitored.
- A rare but serious side effect is lactic acidosis – a buildup of lactic acid in the blood, which can occur if too much metformin accumulates in the body. This is more likely to occur in patients with certain risk factors, including kidney disease, severe heart failure, and excessive alcohol intake.
Sulfonylureas (e.g., Glipizide, Glyburide, Glimepiride): Sulfonylureas are a class of oral antidiabetic drugs that are commonly used in the management of type 2 diabetes. They work by stimulating the beta cells of the pancreas to secrete more insulin. Because they work on stimulating the beta cells, these medications can only be used with Type 2 diabetes.
Types of Sulfonylureas
Sulfonylureas are categorized into two generations based on their potency, duration of action, and side effect profiles.
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First-generation Sulfonylureas include medications such as tolbutamide, chlorpropamide, and tolazamide. They are less potent and have a shorter duration of action compared to second-generation sulfonylureas. These are less commonly used today.
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Second-generation Sulfonylureas include medications such as glipizide, glyburide, and glimepiride. These are more potent, have a longer duration of action, and are generally preferred over first-generation sulfonylureas due to their better side effect profiles.
Usage
Sulfonylureas are used in the management of type 2 diabetes when lifestyle modifications (diet, exercise) and metformin are not sufficient to control blood glucose levels. They can be used alone or in combination with other antidiabetic medications.
Side Effects
The most common side effect of sulfonylureas is hypoglycemia (low blood sugar), as they can increase insulin secretion even when blood glucose levels are low.
Other side effects include
- weight gain
- skin rash
- nausea
- Rarely, sulfonylureas can cause disulfiram-like reactions with alcohol, leading to symptoms like flushing, nausea, and palpitations.
3. Thiazolidinediones (e.g., Pioglitazone, Rosiglitazone): Thiazolidinediones, also known as glitazones, work by increasing the body’s sensitivity to insulin, allowing more glucose to enter cells. They also decrease the amount of glucose produced by the liver.
DPP-4 Inhibitors (e.g., Sitagliptin, Saxagliptin): DPP-4 inhibitors work by blocking the action of an enzyme called DPP-4, which destroys a hormone called incretin. Incretins help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it’s not needed.
5. SGLT2 Inhibitors (e.g., Canagliflozin, Dapagliflozin): SGLT2 inhibitors block the reabsorption of glucose in the kidneys, leading to more glucose being excreted in the urine. This lowers the overall blood glucose levels in the body.
Alpha-Glucosidase Inhibitors (e.g., Acarbose, Miglitol): These medications work by slowing down the breakdown of complex sugars and starches in the gut, slowing the rise in blood glucose levels after meals.
Meglitinides (e.g., Repaglinide, Nateglinide): Similar to sulfonylureas, meglitinides stimulate the pancreas to release more insulin. However, they act more quickly and for a shorter duration than sulfonylureas, making them useful for controlling blood glucose levels after meals.
