Insulins

MOA: Lowers blood glucose by stimulating peripheral glucose uptake, especially in skeletal muscle and fat, and by inhibiting hepatic glucose production

SE: Hypoglycemia (anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating), weight gain

CI: Use during severe hypoglycemia, allergy or sensitivity to any ingredient of the product

Rapid Acting Insulins

 Insulin lispro (Humalog®)

Insulin aspart (Novolog®)

Insulin glulisine (Apidra®)

Onset of action: 0.2-0.5 hours

Duration of action: 3-4 hours

Insulin lispro

Humalog®

 Rapid Acting

Insulin aspart

Novolog®

Rapid Acting

Insulin glulisine

Apidra®

Rapid Acting

Short Acting Insulins

Insulin regular (Humulin® R, Novolin® R)

Onset of action: 0.5 hours

Duration of action: 4-12 hours

Insulin regular

Humulin® R, Novolin® R

Short Acting

Intermediate Acting Insulins

Insulin NPH (isophane suspension) (Humulin® N, Novolin® N)

Onset of action: 1-2 hours

Duration of action: 18-24 hours

Insulin NPH

(isophane suspension)

Humulin® N, Novolin® N

Intermediate Acting

Intermediate-Long Acting Insulins

Insulin detemir (Levemir®)

Onset of action: 3-4 hours

Duration of action: 6-23 hours

Insulin detemir

Levemir®

Intermediate-Long Acting

Long Acting Insulins

Insulin glargine (Lantus®)

Onset of action: 3-4 hours

Duration of action: ≥24 hours

Insulin glargine

Lantus®

Long Acting

Combinations

Insulin aspart/Insulin aspart protamine (Novolog® Mix 70/30)

Insulin lispro/Insulin lispro protamine (Humalog® Mix 75/25)

Insulin NPH/Insulin regular (Novolin® 70/30)

Onset of action: 0.2-0.5 hours

Duration of action: 18-24 hours

Alpha Glucosidase Inhibitors

Acarbose (Precose®)

Miglitol (Glyset®)

MOA: Inhibits pancreatic alpha-amylase and intestinal brush border alpha-glucosidases, resulting in delayed hydrolysis of ingested complex carbohydrates and disaccharides and absorption of glucose

SE: GI distress, bloating, flatulence

CI: Allergy or sensitivity to any component, DKA, inflammatory bowel disease, intestinal disorders

Reduction in A1C: 0.7-1.0; Reduction in FPG: 35-40

Acarbose

Precose®

Alpha Glucosidase Inhibitor

Miglitol

Glyset®

Alpha Glucosidase Inhibitor

Biguanide

Metformin

(Fortamet®, Glucophage®, Riomet®)

MOA: Improves glucose tolerance by lowering both basal and postprandial plasma glucose, decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization

SE: Diarrhea, vomiting, metallic taste, dyspepsia, flatulence, weight loss

CI: Renal disease (males: SrCr ≥1.5 mg/dl; females: SrCr ≥1.4 mg/dl), heart failure requiring pharmacologic therapy, acute or chronic metabolic acidosis, active liver disease

Reduction in A1C: 1.5-2.0; Reduction in FPG: 50-70

Metformin

Fortamet®, Glucophage®, Riomet®

Biguanide

Dipeptidyl Peptidase IV (DPP-IV) Inhibitors

Sitagliptin (Januvia®)

Saxagliptin (Onglyza®)

MOA: Inhibits DPP-IV enzyme resulting in prolonged active incretin levels. Incretin hormones regulate glucose homeostasis by increasing insulin synthesis and release from pancreatic beta cells and decreasing glucagon secretion from pancreatic alpha cells

SE: Nasopharyngitis, upper respiratory tract infection, headache

CI: Allergy or sensitivity to any component

Sitagliptin

Januvia®

DPP-IV Inhibitor

 Saxagliptin

Onglyza®

DPP-IV Inhibitor

Meglitinide Derivatives

Nateglinide (Starlix®)

Repaglinide (Prandin®)

MOA: Stimulates insulin release from the pancreatic beta cells to reduce postprandial hyperglycemia

SE: Hypoglycemia

CI: Allergy or sensitivity to any component, DKA, type 1 diabetes

Reduction in A1C: 0.5-2.0; Reduction in FPG: 65-75

Nateglinide

Starlix®

Meglitinide Derivative

Repaglinide

Prandin®

Meglitinide Derivative

Sulfonylureas

(1st Generation)

Chlorpropamide (Diabinese®)

Tolazamide (Tolinase®)

Tolbutamide (Orinase®)

MOA: Lowers blood glucose by stimulating insulin release from the beta cells of the pancreatic islets

SE: Hypoglycemia, GI distress, dizziness

CI: DKA, type 1 diabetes, pregnancy

Reduction in A1C: 0.8-2.0; Reduction in FPG: 60-70

Chlorpropamide

Diabinese®

Sulfonylurea (1st Generation)

Tolazamide 

Tolinase®

Sulfonylurea (1st Generation)

Tolbutamide

Orinase®

Sulfonylurea (1st Generation)

Sulfonylureas

(2nd Generation)

Glimepiride (Amaryl®)

Glipizide (Glucotrol®)

Glyburide (Diabeta®, Glynase®, Micronase®)

MOA: Lowers blood glucose by stimulating insulin release from the beta cells of the pancreatic islets

SE: Hypoglycemia, GI distress, dizziness

CI: DKA, type 1 diabetes, pregnancy

Reduction in A1C: 0.8-2.0; Reduction in FPG: 60-70

Glimepiride

Amaryl®

Sulfonylurea (2nd Generation)

Glipizide

Glucotrol®

Sulfonylurea (2nd Generation)

Glyburide

Diabeta®, Glynase®, Micronase®

Sulfonylurea (2nd Generation)

Thiazolidinediones

Pioglitazone (Actos®)

Rosiglitazone (Avandia®)

MOA: Increase insulin sensitivity by affecting the peroxisome proliferator-activated receptor gamma (PPAR gamma), decreases insulin resistance in adipose tissue, skeletal muscle, and the liver

SE: Weight gain, edema, hypoglycemia

CI: Patients with NYHA class III and IV heart failure, active liver disease, concurrent insulin or nitrate use (Rosiglitazone)

Reduction in A1C: 0.5-1.5; Reduction in FPG: 25-50

Pioglitazone

Actos®

Thiazolidinedione

Rosiglitazone

Avandia®

Thiazolidinedione

Glucagon-Like Peptide 1

(GLP-1)

Exenatide (Byetta®)

Liraglutide (Victoza®)

MOA: Mimic the enhancement of glucose dependent insulin secretion and several other antihyperglycemic action of incretins, increase beta cell growth and replication, slows gastric emptying, and may decrease food intake

SE: Nausea, vomiting, diarrhea, hypoglycemia, appetite decrease, headache, dizziness

CI: Several hypersensitivity, type 1 diabetes, DKA

Exenatide

Byetta®

GLP-1

Liraglutide

Victoza®

GLP-1

Amylin Agonists

Pramlintide (Symlin®)

MOA: Modulate gastric emptying, prevent postprandial glucagon secretion, and satiety which leads to decreased caloric intake and potential weight loss

SE: Abdominal pain, anorexia, nausea, vomiting, headache, cough, pharyngitis, fatigue

CI: Mixing with insulin, comfirmed diagnosis of gastroparesis, hypoglycemia, hypersensitivity

Pramlintide

Symlin®

Amylin Agonist