Biguanide: metformin |
• Diarrhea and abdominal discomfort
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• B-12 deficiency
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• History of DKA, lactic acidosis, metabolic acidosis (contraindication)
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• Renal Adjustment (eGFR <30 contraindicated)
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Sulfonylureas: glyburide, glipizide, glimepiride, glibenclamide, gliclazide |
• Hypoglycemia
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• Weight gain
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• Diarrhea, nausea
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• Caution renal insufficiency
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• Uncertain cardiovascular safety
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Meglitinides: repaglinide, nateglinide |
• Hypoglycemia
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• Weight gain
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• Uncertain cardiovascular safety
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• Must be taken with meals
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Thiazolidinediones: pioglitazone, rosiglitazone |
• Weight gain
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• Macular edema
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• Edema/increased risk of CHF (avoid NYHA class III/IV CHF)
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• Rosiglitazone increases LDL
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• Fracture risk
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• Avoid in increased liver function tests
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SGLT-2 inhibitors: canagliflozin, dapagliflozin, empagliflozin, ertugliflozin |
• Urinary tract infections
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• Genital fungal infections
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• Necrotizing fasciitis (Fournier’s Gangrene)
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• Hypotension
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• Dehydration
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• Fracture risk (canagliflozin)
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• Amputation risk (canagliflozin)
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• Euglycemia ketoacidosis
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• Increase in LDL
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• Increase serum creatinine (acute kidney injury)
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• Bladder cancer risk (dapagliflozin)
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Dipeptidyl peptidase-4 inhibitors: sitagliptin, saxagliptin, alogliptin, linagliptin, vildagliptin |
• Joint pain
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• Pancreatitis (rare)
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• Hypersensitivity reactions
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• Heart failure risk (saxagliptin, alogliptin)
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α-Glucosidase inhibitors: acarbose, miglitol |
• Diarrhea, flatulence, abdominal pain
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• Avoid in severe renal or hepatic disease
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• Hypoglycemia must be treated with glucose, not sucrose or complex carbohydrates
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• Must take with food
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Bile acid sequestrant: colesevelam |
• Constipation, nausea, bloating
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• Increased triglycerides
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• Space doses with other medications
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Dopamine receptor agonist: bromocriptine |
• Orthostatic hypotension
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• Dizziness, headache, somnolence
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• Nausea, vomiting, diarrhea
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• Worsen psychiatric disorders
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Injectable antidiabetic medications |
Glucagon-like peptide-1 (GLP-1) agonists: exenatide, lixisenatide, dulaglutide, liraglutide, semaglutide (available orally and injectable) |
• Black box warning: medullary thyroid carcinoma and multiple endocrine neoplasia syndrome type 2
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• Nausea, vomiting, diarrhea
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• Jittery feeling, headache, dizziness
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• Hypoglycemia risk with sulfonylureas and insulin
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• Risk of acute pancreatitis
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• Risk of cholelithiasis
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• Caution gastroparesis
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• Avoid all GLP-1 agonists in severe renal impairment
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• Caution retinopathy and semaglutide titrate slowly
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Amylin analog: pramlintide acetate |
• Hypoglycemia
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• Nausea, vomiting, anorexia
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• Caution with gastroparesis
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Insulin: |
• Hypoglycemia
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• Weight gain
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• Possible injection site reactions or erratic absorption from not rotating sites
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• Incorrect use of pen or technique of injecting insulin can affect blood sugar
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• Not storing insulin correctly and using expired insulin can affect blood sugar
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• Multiple injections may be required with different insulin
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• Frequent dose adjustments
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• Misidentification, inaccurate dosing, incorrect timing
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• Inhaled insulin requires lung function monitoring; cannot be used if you have asthma, COPD, smoker, lung cancer, dexterity problems, children
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