Diabetes Mellitus:  Lipids

This summary is specific for hospitalization and assumes that you really have a working knowledge of the oral agents.  If there is a class that you are not familiar with, you should review that area in more detail

 

Drug Class

Mechanism of Action

Issues for Hospitalized Diabetes Patients

Insulin Secretagogues
bulletsulfonylureas (glyburide,glipizide, glimepiride)
Stimulate pancreatic β-cells to increase insulin output Keep in mind the metabolic t1/2 of each drug
Insulin Secretagogues
bulletmeglitinides (repaglinide, nateglinide)
Stimulate pancreatic β-cells to increase insulin output Keep in mind the metabolic t1/2 of each drug
Biguanides
bulletmetformin
Target liver to decrease glucose production Withhold in conditions predisposing to renal insufficiency and/or hypoxia:
bulletCV collapse
bulletAcute MI or acute CHF
bulletSevere infection
bulletUse of iodinated contrast material
bulletMajor surgical procedures
Alpha-glucosidase inhibitors
bulletacarbose
bulletmiglitol
Inhibit intestinal enzymes that break down carbohydrates, which delays carbohydrate absorption In case of hypoglycemia (due to sulfonylurea or insulin treatment) -
Glucose (dextrose) must be administered
Sucrose and complex carbohydrates should not be administered
Thiazolidinediones
bulletrosiglitazone
bulletpioglitazone
Bind to peroxisome proliferator activated receptor-gamma (PPAR) in muscle, fat and liver to decrease insulin resistance 1.Takes 2-3 weeks to see initial effect. Effects continue for weeks or months after discontinuation of medication

2.  Can cause fluid retention and significant edema

3.  Associated with Congestive heart failure