Hypoglycemic agents
insulin
general
secreted by beta cells in pancreas
fast-acting
insulin analog
aspart
lispro
short-acting
regular insulin
humulin
intermediate-acting
regular insulin with protamine
NPH
long-acting
regular insulin with zinc
ultralente
basal-acting
insulin analog
glargine
detemir
sulfonylureas
secretagogue
act on ATP-associated K channels in beta cells
increase insulin secretion
for type II or gestational only
First generation
tolbutamide
acetohexamide
tolzamide
chlorpropamide
Second generation
glipizide (Glucotrol)
glyburide (Diabeta, Micronase)
glimepiride (Amaryl)
gliclazide (Diamicron)
meglitinides
secretagogue
short-acting
close potassium channels and open calcium channels
increase insulin secretion
for type II or gestational only
First generation
repaglinide (Prandin)
nateglinide (Starlix)
Sensitizers
biguanides
general
reduce hepatic glucose output
increase glucose uptake in periphery
commonly used in type II
can cause lactic acidosis
First generation
phenformin
buformin
Second generation
metformin
thiazolidinediones
general
bind to PPAR-gamma
influence insulin-sensitive genes
better use of glucose by cells
First generation
rosiglitazone (Avandia)
pioglitazone (Actos)
troglitazone (Rezulin)
Digestion modifiers
alpha-glucosidase inhibitor
general
slow starch digestion in SI
useful as adjunct in type II
AE: flatulence and bloating
First generation
miglitol (Glyset)
acarbose (Precose)
Incretin mimetics
GLP-1 analogs
glucagon-like peptide 1
general
secreted by L cell in SI
stimulated by food in SI
rapidly degraded by DPP-4 (few minutes)
actions
increases insulin secretion
decreases glucagon secretion
increases beta-cell mass
increases insulin gene expression
inhibits acid secretion
inhibits gastric emptying
increases satiety
First generation
exenatide (Byetta)
liraglutide (Victoza)
taspoglatide
GIP analogs
general
glucose-dependent insulinotropic peptide
secreted by K cells in duodenum/jejunum
stimulated by hyperosmolarity of glucose in duodenum
actions
increase insulin secretion in pancreas
increase lipoprotein lipase activity in adipocytes
DPP-4 inhibitors
general
inhibits dipeptidyl peptidase-4 (DPP-4)
allows endogenous GLP-1 levels to increase
First generation
vildagliptin (Galvus)
sitagliptin (Januvia)
Amylin analogues
amylin
general
synergistic with insulin
co-secreted with insulin by beta cells
works largely on area postrema of brain
actions
inhibits digestive secretions
slows gastric emptying
inhibits glucagon
First generation
pramlintide (Symlin)