Sulfonylureas (Glyburide, Glimepiride, Glipizide)
Triggers insulin release. Requires beta cells (Type 2 DM). Associated with weight gain and hypoglycemia.
Secretagogues (Repaglinide and Nateglinide)
short acting, Type 2DM, increase insulin secretion of beta cells.
Mechanism unknown, decreases glucogeneogensis in liver. increases peripheral glucose utilization. No weight gain, no hypoglycemia risk. FIRST CHOICE THERAPY. Can cause lactic acidosis, avoid in patients with renal or liver disease.
Thiazolidinediones (TZDs) (Pioglitazone, Rosiglitazone)
Increase insulin sensitivity in peripheral tissue. For type 2 DM. Risk of weight gain, edema, hepatotoxicity, CV toxicity.
Alpha-glucosidase Inhibitors (Acarbose, Miglitol)
inhibit intestinal brush border alpha-glucosidases. Delays sugars hydrolysis and glucose absorption. Delays breakdown of dissaccharides. For type 2 DM. GI disturbances.
GLP-1 Mimetics (Exenatide)
Incretin, small intestine peptide that increases insulin secretion with a meal. Nausea weight loss, pancreatitis.
analogue of pancreatic hormone, amylin. Decreases glucagon. Type 2DM. Hypoglycemia and diarrhea.
Treatment strategy for Type 1 DM
low-sugar diet, insulin replacement
Treatment strategy for Type 2 DM
dietary modification, exercise for weight loss, oral hypoglycemics, insulin replacement - stress situation aka infection, accident, trauma, basal insulin may be only necessary at bedtime, uncontrollable state - when can't get glucose control on oral meds.
Blood pressure <130/80, <120/75 with renal disease or African Americans. ACE inhibitors , diuretics, lipid control , aspirin , bariatric surgery with BMI >40