Digoxin serum concentration
Gastric inhibitory peptide
Medical nutrition therapy
Figure 3.1.1 Pharmacotherapy for Diabetes
Source: Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: A patient centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364.
Table 3.1.2 Insulins |Favorite Table|Download (.pdf)
Table 3.1.2 Insulins
- Inject immediately prior to meal (some patients dose with or after meal)
- Do not use IV: increased cost with no advantage vs. regular
- Inject ˜30 min prior to eating
NPH (Humulin N, Novolin N)
- Peak and duration highly variable, especially in elderly; be aware of nocturnal hypoglycemia
- Some patients do not get full 24 h effect and require BID dosing
- Burning at injection site—pH 4.0
Slow steady rise ˜3–4 h
<0.4 units/kg highly variable; <24 h; >0.4 units/kg ˜24 h
- Administer BID for low doses (<0.4 units/kg)
- Only insulin to show (minor) weight loss vs. gain (DiabetesCare. 2011;34:1487)
70% aspart protamine/30% aspart
- Longer-acting insulin always listed 1st
- Time to onset determined by faster-acting insulin; duration by intermediate insulin
50% lispro protamine/50% lispro
75% lispro protamine/25% lispro
70% NPH/30% regular
Table 3.1.3 Selected Non-Insulin Antihyperglycemic Agents |Favorite Table|Download (.pdf)
Table 3.1.3 Selected Non-Insulin Antihyperglycemic Agents
Acarbosea (Precose) 25, 50, 100 mg tabs
Miglitol (Glyset) 25, 50, 100 mg tabs
25 mg QD-TID @ meals w/1st bite of food, titrate Q 4–8 weeks; adjust based on 1° postprandial glucose; 100 mg TID max
- MOA: Enzyme inhibitor, delays hydrolysis of complex carbohydrates
- 0.5–0.8% decrease in A1C
- Contraindications: Renal dysfunction (Scr ≥ 2 mg/dL); inflammatory bowel disease; GI obstruction
- AEs: Flatulence, diarrhea, abdominal pain, may avoid through slow titration; acarbose ˜14% have ↑ AST/ALT– monitor Q 3 months
- Dosing requirements may decrease compliance
Metformina (glucophage, glucophage XL) 500, 850, 1,000 mg tabs; 500, 750, 1,000 mg XR tabs
IR 500 mg BID; increase by 500 mg Q week up to 2550 mg/day (850 mg TID)
XR 500–1,000 mg/day max 2,500 mg/day; if not controlled with max dose, split BID
- Decrease hepatic glucose production and intestinal glucose absorption; increases insulin ...
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