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DIABETIC MEDICATIONS: ONE PART OF THE TRIAD

DIABETIC MEDICATIONS: ONE PART OF THE TRIAD. Swedish Family Medicine PAT BORMAN, M.D. THE DIABETIC TRIAD. Think of diabetes as a three legged stool: DIET EXERCISE MEDICATIONS Optimal Care Requires Balance of all Three. DIABETIC DIET. Timing of Meals Content of Meal

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DIABETIC MEDICATIONS: ONE PART OF THE TRIAD

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  1. DIABETIC MEDICATIONS: ONE PART OF THE TRIAD Swedish Family Medicine PAT BORMAN, M.D.

  2. THE DIABETIC TRIAD • Think of diabetes as a three legged stool: • DIET • EXERCISE • MEDICATIONS • Optimal Care Requires Balance of all Three

  3. DIABETIC DIET • Timing of Meals • Content of Meal • Protein 10-20% • Carbohydrates and MonoFats 60-70% • Saturated and Poly Fats <10% • Exchange Systems for Carbohydrate Counting • High Fiber, Weight Loss as Indicated

  4. EXERCISE AND DIABETES • Aids glucose utilization • Promotes weight loss • Regular intervals and consistent duration of work outs lend optimal control

  5. DIABETIC MEDICATIONS FIVE CLASSES OF MEDICATIONS • SULFONYLUREAS • MEGLITINIDES • BIGUANIDES • THIAZOLIDINENDIONE • ALPHA-GLUCOSIDASE INHIBITOR

  6. SULFONYLUREAS • Glyburide: Diabeta, Micronase $16-81 Micronized: Glyburide $16-81 • Glipizide: Glucotrol $18-76 Slow Release: Glucotrol XL $10-42 • Glimepiride: Amaryl $ 7-42

  7. SULFONYLUREAS • Mechanism of action • Increase insulin secretion from beta cells • Mild decrease in insulin resistance peripherally • Lower HbA1C 0.8-2.0 % Side Effects • Hypoglycemia, Weight gain • Cautions • Renal failure increases hypoglycemia

  8. MEGLITINIDES • Repaglinide: Prandin $51-199 • Nateglinide: Starlix $83-86

  9. METIGLITINIDES • Mechanism of Action • Increase insulin secretions from beta cells, very short onset and half life, dose right before meals , Lower HbA1C 0.5-2.0% • Side Effects • Less hypoglycemia than sulfonylureas • Cautions • Skip meal skip dose, Extra meal extra dose flexibility for those who eat irregularly

  10. BIGUANIDES • Metformin: Glucophage $58-99 • Glucophage XR $39-74

  11. BIGUANIDES • Mechanism of Action • Reduces hepatic glucose excretion and enhances insulin sensitivity peripherally, Reduces HbA1C 1.5-2.0% • Side Effects • GI upset, Metallic taste, potentiate hypoglycemia • Caution • lactic acidosis 3/100,000, avoid in renal dz,

  12. THIAZOLIDINEDIONES • Pioglitazone: Actos $ 85-148 • Rosiglitazone: Avandia $ 75-136

  13. THIAZOLIDINEDIONES • Mechanism of Action • Enhance insulin sensitivity in muscle and fat, Inhibit hepatic glucose production, Lower HbA1C 0.5-1.5 %, alter lipids favorably • Side Effects • Weight gain, metabolized in liver • Cautions • Idiosyncratic Liver toxicity, monitor LFT every other month for first year

  14. ALPHA-GLUCOSIDASE INHIBITORS • Acarbose: Precose $46-60 • Miglitol: Glyset $51-59

  15. Alpha-Glucosidase Inhibitors • Mechanism of Action • Inhibit absorption of carbohydrates from intestines • Side Effects • GI upset, bloating, flatulence, elevate LFTs • Caution • Avoid with renal failure, reduces effective po treatment of hypoglycemia

  16. Management of Type II DM • 1. Confirm diagnosis • 2. 3 month trial diet and exercise • 3. Initiate monotherapy • Check triad for balance • 4. Initiate Combination therapy • Check triad for balance • 5. Consider insulin +/- oral agent • Check triad for balance

  17. REFERENCES • Luna B, Feinglos MN: Oral Agents in the management of type II DM, AFP 63:9 1747-1756, May 2001. • Davidson MB: Diabetes Mellitus Diagnosis and Treatment, 4th Ed.,W.B.Saunders Co. • Feinglos MN, Bethel MA: Treatment of Type II DM, Medical Clinics of NA 82:4, 757-803, July 1998.

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