Download Medication Sheet

DIABETES EDUCATION
*Read package insert each time you refill your medications in case there is new information
SULFONYLUREAS
ACTION: Sulfonylureas stimulate the pancreas to make more insulin (pancreas has to be making insulin) and increases
insulin absorption in the muscles.
rev. 12/2014
GENERIC
TRADE
WHEN TO TAKE
Glipizide
Glucotrol
30 minutes before a meal on an
empty stomach
Extended Release
Glipizide
Glucotrol XL
30 minutes before a meal on an
empty stomach
Glyburide
Micronase, Diabeta,
Glynase Prestabs
Take with meal Breakfast or 1st main meal
Glimepiride
Amaryl
Take with meal
EFFECTS AND PRECAUTIONS
Do not take if severe allergy to sulfa
Possible hypoglycemia
Don’t skip meals – do not take if meal
skipped
Skin rash
Weight gain
May cause nausea and vomiting if taking
while drinking alcohol
Do not use if taking medications to decrease
alcohol use
Do not break, crush or chew Glucotrol XL
pill
Amaryl may cause sun sensitivity, use
sunscreen
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BIGUANIDES
ACTION: Biguanides are insulin sensitizers that decrease the amount of glucose released by the liver to normalize blood
glucose production. Decreases insulin resistance. Increases insulin sensitivity. Increases the amount of glucose used by
the muscles. Helps to improve lipids.
GENERIC
Metformin
Fortamet
Glumetza
TRADE
WHEN TO TAKE
Glucophage
With meals, start with evening meal
Glucophage XR
With evening meal
Riomet Liquid
(measure with
marked measuring
spoon, oral syringe
or measuring cup)
Metformin
Extended release
EFFECTS AND PRECAUTIONS
Do not break, crush or chew
Metformin/Glucophage XR tablet
Nausea, diarrhea, abdominal discomfort –
cramping, bloating
Decreases appetite. May have initial weight
loss
Improves lipids and cholesterol
Avoid alcohol
Rare hypoglycemia if used alone
Increases fertility
Stop drug for 48 hours after IV Dye, CT
scan dye and Xray tests. Increase fluids
during those 48 hours
Do not take if any kidney problems
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ALPHA GLUCOSIDASE INHIBITORS
ACTION: Alpha Glucosidase Inhibitors slow down digestion of starches in the intestines to delay absorption of the
carbohydrates to decrease after meal blood sugars. Used for high after meal blood sugars.
GENERIC
TRADE
Acarbose
Precose
Miglitol
Glyset
WHEN TO TAKE
st
Take with 1 bite of food each meal
EFFECTS AND PRECAUTIONS
*Use glucose tablets, glucose gel or milk
only to treat hypoglycemia
Gas, bloating, diarrhea, abdominal discomfort.
Weight neutral
Exercise after meals to prevent build-up of GI
tract gas
MEGLITINIDES
ACTION: Meglitinides stimulate the pancreas to make and release more insulin right at the start of meals to lower after
meal blood sugars. Insulin levels are elevated for a short period of time right after meals. The drug’s peak time is 1 hour
after taking and out of the system 3-4 hours after taking.
GENERIC
TRADE
WHEN TO TAKE
Repaglinide
Prandin
Take within 15-30 minutes of starting
to eat meals
Nateglinide
Starlix
Must eat after taking the pill
EFFECTS AND PRECAUTIONS
Meal based dosing – good for people that
vary meal times or only eat 2 meals
If you skip a meal, skip that dose of
medication
Possible hypoglycemia
Weight gain, diarrhea, back pain, dizziness,
upper respiratory infection, skin rash
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TZD’S -THIAZOLIDINEDIONES
ACTION: TZD’s make the muscle cells more sensitive to insulin. Helps the skeletal muscles and fat use insulin.
Decreases liver glucose production.
GENERIC
TRADE
Rosiglitazone
Avandia
Pioglitazone
Actos
WHEN TO TAKE
EFFECTS AND PRECAUTIONS
With main meal or 2 primary meals
Before, during or after food but should
be taken approximately the same time
every day.
Water retention, weight gain, shortness of
breath. Notify your doctor of shortness of
breath, edema, muscle pain and/or
abdominal pain
Use with caution for patients with CHF.
Take other oral medications 2 hours before or
after taking the TZD
Actos can be given with insulin
Limit use with osteoporosis
Decreases lipids – LDL and cholesterol
Increases fertility and decreases absorption of
birth control meds
Avandia – suggested not to be used with
insulin
Actos has been linked to bladder cancer
Black Box Warning. Use with caution in preexisting heart disease
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DPP – 4 INHIBITORS
ACTION: DPP - 4 Inhibitors increase insulin produced when blood sugar is high, and reduces the amount of sugar made
by the liver after eating. (DPP - 4 = dipeptidyl peptidase - 4)
GENERIC
TRADE
WHEN TO TAKE
Sitagliptin
Januvia
Take once a day in the morning with
or without food
Saxagliptin
Onglyza
Once a day, with or without food
Linagliptin
Tradjenta
Once a day, with or without food
Alogliptin
Nesina
Once a day, with or without food
EFFECTS AND PRECAUTIONS
Watch for allergic reactions and kidney
problems
Use for Type 2 diabetics only
Weight neutral
Store at room temperature
Side effects – runny nose, stuffy nose, sore
throat, upper respiratory infections,headache
Tell your doctor if you have a fever, any
infection, injury, or if you have had or are
going to have surgery
Not suggested to be used with insulin or other
diabetes injectable medications
Not used for children 18 years old or younger
Unlikely to cause hypoglycemia if used alone
Tell your doctor if you have a history of
kidney problems, or have had DKA;
pregnant or planning a pregnancy
If you miss a dose, do not take 2 doses at
the same time.
Can be used with insulin in Type 2
May have hypoglycemia when used with
insulin or Sulfonylureas
Not used during pregnancy or if breastfeeding
Side effects: hives, difficulty breathing,
swelling of face, lips, tongue or throat; severe
abdominal pain; nausea, vomiting; loss of
appetite; urinary tract infection; increased
heart rate; runny, stuffy nose; weight gain;
muscle or joint pain; headache; back pain
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SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT 2) INHIBITOR
GENERIC
TRADE
WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Canagliflozin
Invokana
Starting dose 100mg. once daily prior
to 1st meal of the day.
Can be increased to 300mg once daily
in appropriate patients.
Dapaglifozin
Farxiga
5-10 mg in the morning, with or
without food
Not for treatment of Type 1
Not used in severe renal impairment or when
on dialysis
Precautions: Hypotension, impaired renal
function, genital infections, urinary tract
infections
Empagliflozin
Jardiance
Start with 10 mg. daily, may be
increased to 25 mg. daily
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SYNTHETIC INCRETIN MIMETIC
ACTION: Incretin hormones are intestinal hormones that are released in response to food intake and decrease blood
glucose. Incretin mimetics “mimic” the action of the incretins (GLP-1 glucagon like peptide-1). GLP-1 is secreted in the
gut in response to food intake. Works on the stomach, liver, pancreas, and brain to regulate blood glucose. Slows the
rate of nutrient absorption and gastric emptying. Decreases food intake due to increased feeling of fullness.
GENERIC
TRADE
WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Pancreatitis, nausea, vomiting, diarrhea, dizziness, headache, feeling
jittery, acid stomach
Due to delayed gastric emptying – take antibiotics, thyroid hormones, oral
contraceptives, coumadin, pain meds requiring rapid absorption,
1-2 hours before injection
Weight loss
Used in Type 2 diabetics only
Store unopened pens in refrigerator, protect from light.
Pens that have been used, store in a closed container at room
temperature, away from heat and protected from light
Do NOT freeze or use if it has been frozen
Discard pen after 30 days of first use
Nausea is common when initially started
If the temperature of the pen is above 86º, throw pen away.
Helps the body make insulin only when needed
Store at room temperature up to 4 weeks
Avoid alcohol
BLACK BOX WARNING – Possible thyroid tumors
Exenatide
Byetta
Take within 60 minutes of
meal.
Start dose is 5 mcg.
before breakfast and
supper.
Take doses at least 6
hours apart.
Do not give after starting
to eat.
If you miss a dose, re-start
at next scheduled time.
Liraglutide
Victoza
Inject 1 time a day
anytime with or without
food.
Exenatide
Bydureon
Given once a week –
every 7 days; anytime with
or without food
Albiglutide
Tanzeum
Inject once a week, same
day each week
Dulaglutide
Trulicity
Inject once a week
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AMYLIN MIMETIC
GLP - ANALOG
ACTION: GLP-1 (glucagon-like peptide-1) is made in the intestine and released in response to meals. The Amylin
mimetic is a synthetic drug that mimics Amylin and replaces the Amylin that is missing from the body. Amylin is cosecreted in the beta cells with insulin. When eating, the Amylin decreases after meal blood sugars by decreasing liver
glucose output, regulates rate of gastric emptying from the stomach to the small intestine, and decreases appetite.
GENERIC
Pramlintide
TRADE
Symlin
WHEN TO TAKE
EFFECTS AND PRECAUTIONS
Must be taken BEFORE eating Can be used with Type 1 or Type 2
Nausea and vomiting
“Meal” = 250 calories or 30
DO NOT mix with anything in syringes
gm. carbohydrate
Slows absorption take other oral medications, 1 hour before
or 2 hours after Symlin
Do not take Symlin if you do
Counters weight gain of insulin
not eat
Do not use if you have hypoglycemia
unawareness, gastroparesis or taking
medications to alter gastrointestinal motility
Refrigerate unopened vials in the original carton
Store opened vial or pen in a closed container at
room temperature
Do Not use if it looks cloudy, changed color, has been
frozen or exposed to high temperatures
Black Box Warning – hypoglycemia may occur
within 3 hours of taking Symlin
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COMBINATION ORAL AGENTS
(see individual drug sheets for more information)
GENERIC
TRADE
Glyburide/Metformin
Glucovance
Glipizide/Metformin
Metaglip
Rosiglitizone/Metformin
(Avandia)
Avandament
Rosiglitizone/Glimepride
(Avandia) (Amaryl)
Avandaryl
WHEN TO TAKE
See specific medications
Pioglitizone/Metformin
(Actos)
Acto Plus
Met
Pioglitizone/Glimepride
(Actos) (Amaryl)
Duetact
Sitagliptin/Metformin
(Januvia)
Janumet
Metformin/Saxagliptin
(Onglyza)
Kombiglyze
XR
Repaglinide/ Metformin
PrandiMet
EFFECTS AND PRECAUTIONS
See specific medications
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(Prandin)
Linagliptin/Metformin
(Tradjenta)
Jentadueto
Dapaglifozin/Metformino
Xigduo
Sitagliptin/Simvastatin
(Januvia) (Zocor)
Juvisync
Take in the morning with food
with non-caffeine liquid
Take daily with evening
meal; swallow whole
Do not take with grapefruit or grapefruit juice
Do not use if pregnant or breast feeding, have liver
disease, severe kidney disease, drink more than 2
alcoholic beverages/day, have an underactive
thyroid or of Chinese descent
Side effects – unexplained muscle pain, weakness,
fever, unusually tired, dark colored urine, severe
skin reaction
If had been on Metformin XR twice a day, skip the supper
dose and start Xigduo in the morning with breakfast
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