Oral Antidiabetic Medications Overview

Oral Antidiabetic Medications

• Sulfonylureas: Stimulate insulin secretion from pancreatic beta cells. Common examples include Glipizide, Glyburide, and Glimepiride. Long-term use may not be effective in patients with diminished insulin production.
• Biguanides (Metformin): Reduces hepatic glucose production, increases peripheral glucose uptake, and decreases intestinal absorption of glucose. Important to note that it can cause lactic acidosis, especially in older adults or those with renal dysfunction.
• Alpha-Glucosidase Inhibitors: Delay carbohydrate absorption in the intestines. Examples are Acarbose and Miglitol, which must be taken with meals.
• Thiazolidinediones: Increase insulin sensitivity in muscle and fat tissues but can worsen heart failure. Examples include Rosiglitazone and Pioglitazone.

Hyperglycemic Medications

• Glucagon: Acts quickly (within 5-20 minutes) to elevate blood glucose levels by stimulating glycogenolysis in the liver.

Side Effects

• Metformin: Known for gastrointestinal side effects like diarrhea and stomach upset; serious risk of lactic acidosis.
• Sulfonylureas and Meglitinides: Both can cause hypoglycemia. However, Meglitinides have a lower risk compared to Sulfonylureas.
• Thiazolidinediones: Associated with weight gain and edema; can exacerbate heart failure and may lead to rare liver complications.
• Meglitinides: Similar to Sulfonylureas in mechanism but with a shorter duration of action. Can cause hypoglycemia and weight gain.

Administration Considerations

• Metformin: Should be stopped before surgeries or procedures involving contrast dye due to lactic acidosis risk.
• Alpha-Glucosidase Inhibitors: Required to be taken with meals to effectively delay carbohydrate absorption.
• Sulfonylureas: Not recommended for use in patients with liver or kidney dysfunction due to the higher risk of severe hypoglycemia.

Key Points about Specific Medications

• Glyburide and Glipizide: Examples of Sulfonylureas, used for stimulating insulin secretion.
• Acarbose and Miglitol: Both classified under Alpha-Glucosidase inhibitors, they work by inhibiting carbohydrate breakdown in the intestines.
• Meglitinides: Drugs like Repaglinide and Nateglinide provide a rapid and short-term insulin release post-meal.

Drug Classifications

• Weight Gain: Associated with Thiazolidinediones, Meglitinides, and Sulfonylureas.
• Hypoglycemia Risk: Significant with Sulfonylureas and Meglitinides.
• Dairy Interaction: Metformin should not be taken concurrently with dairy products.

Summary of Administration Timing

• Medications such as Meglitinides and Alpha-Glucosidase inhibitors should be administered close to meal times to maximize efficacy and manage blood glucose levels effectively.