Specific Medications

Diabetes Pills

Insulins

• Aspart (Novolog)
• Insulin Glargine (Lantus)
• Lente
• Lispro (Humalog)
• NPH
• Premixed
• Regular
• Ultralente

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Sulfonylureas

Brand Name Amaryl DiaBeta Diabinese Dymelor Glucotrol Glucotrol XL Glynase PresTab Micronase Orinase Tolinase Generic Name glimepiride glyburide chlorpropamide acetohexamide glipizide glipizide glyburide glyburide tolbutamide tolazamide

These pills do two things:

• They help your pancreas make more insulin, which then lowers your blood glucose.
  
  
• They help your body use the insulin it makes to better lower your blood glucose.
  
  

For these pills to work, your pancreas has to make some insulin. Sulfonylureas can make your blood glucose too low, which is called hypoglycemia (HY-po-gly-SEE-mee-ah). The section What should I know about hypoglycemia? provides more information.

How often should I take sulfonylureas?

Some sulfonylureas work all day, so you take them only once a day. Others you take twice a day. Your doctor will tell you how many times a day you should take your diabetes pill(s). Ask if you are not sure.

When should I take sulfonylureas?

The time you take your pill depends on which pill you take and what your doctor tells you. If you take the pill once a day, you will likely take it just before the first meal of the day (breakfast). If you take the medicine twice a day, you will likely take the first pill just before your first meal, and the second pill just before the last meal of the day (supper). Take the medicine at the same times each day. Ask your doctor when you should take your pills.

What are possible side effects of sulfonylureas?

• hypoglycemia
• an upset stomach
• a skin rash or itching
• weight gain

Biguanides

Brand Name Glucophage Generic Name metformin

A new, extended-release form of metformin is now available.

Brand Name Glucophage XR Generic Name metformin hydrochloride extended release

Biguanides are another type of diabetes medicine. Metformin (met-FOR-min) is a biguanide that helps lower blood glucose by making sure your liver does not make too much glucose. Metformin also lowers the amount of insulin in your body.

You may lose a few pounds when you start to take metformin. This weight loss can help you control your blood glucose. Metformin can also improve blood fat and cholesterol levels, which are often not normal if you have type 2 diabetes.

A good thing about metformin is that it does not cause blood glucose to get too low (hypoglycemia) when it is the only diabetes medicine you take.

How often should I take metformin?

Two or three times a day.

When should I take metformin?

With a meal. Your doctor should tell you which meals to take it with.

What are possible side effects?

• Metformin can make you sick if you drink more than about 2 to 4 alcoholic drinks a week. If you drink more than that, tell your doctor. You should probably not take metformin.

• If you already have a kidney problem, taking metformin may make it worse. Make sure that, before you start taking metformin, your doctor knows your kidneys work well.

• If you are vomiting, have diarrhea, and can't drink enough fluids, you may need to stop taking metformin for a few days.

• Once in a while people on metformin can become weak, tired, or dizzy and have trouble breathing. If you ever have these problems, call your doctor or get medical help right away.

• You may have nausea, diarrhea, and other stomach symptoms when you first start taking metformin. These usually go away.

• You may notice a metallic taste in your mouth.

How often should I take metformin extended release?

Once a day.

When should I take metformin extended release?

With the evening meal.

What are possible side effects?

The side effects of this medicine are the same as for metformin.

Are other diabetes medicines used with metformin extended release?

Yes, it can be used with sulfonylureas or insulin.

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Alpha-Glucosidase Inhibitors

Brand Name Glyset Precose Generic Name miglitol acarbose

There are now two alpha-glucosidase inhibitors, acarbose (AK-er-bose) and miglitol (MIG-leh-tall). Both medicines block the enzymes that digest the starches you eat. This action causes a slower and lower rise of blood glucose through the day, but mainly right after meals.

Neither acarbose nor miglitol causes hypoglycemia when it is the only diabetes medicine you take.

How often should I take acarbose or miglitol?

Three times a day, at each meal. Your doctor might ask you to take the medicine less often at first.

When should I take acarbose or miglitol?

With the first bite of a meal.

What are possible side effects?

Taking this pill may cause stomach problems (gas, bloating, and diarrhea) that most often go away after you take the medicine for a while.

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Thiazolidinediones

Brand Name Actos (ACT-ose) Avandia (uh-VAN-dee-uh) Generic Name pioglitazone (py-oh-GLIT-uh-zone) rosiglitazone (rose-ee-GLIT-uh-zone)

Note: Troglitazone (Rezulin) was withdrawn from the market in March 2000.

Thiazolidinediones (THIGH-ah-ZO-li-deen-DYE-owns) help make your cells more sensitive to insulin. The insulin can then move glucose from your blood into your cells for energy.

How often should I take pioglitazone or rosiglitazone?

• Pioglitazone: Usually once a day.

• Rosiglitazone: Either once or twice a day.

When should I take pioglitazone or rosiglitazone?

• Pioglitazone: At about the same time each day, with or without a meal.
  
  
• Rosiglitazone: At about the same time each day, usually in the morning, with or without a meal. Or in the morning and in the evening, with or without meals.
  
  

What are the possible side effects of pioglitazone or rosiglitazone?

• If you take pioglitazone or rosiglitazone, it is important for your health care provider to check your liver enzyme levels regularly. Call your doctor right away if you have any signs of liver disease: nausea, vomiting, stomach pain, lack of appetite, tiredness, yellowing of the skin or whites of the eyes, or dark-colored urine.

  (Some people who took troglitazone, another thiazolidinedione, have had serious liver problems. Troglitazone is no longer available.)

• Medicines in this group don't cause blood glucose to drop too low. But if you take other diabetes medicines along with medicines in this group, your blood glucose might drop too low. (See What should I know about hypoglycemia?)

• If you take birth control pills, medicines in this group might make your birth control pills less effective in preventing pregnancy. These medicines may increase your chances of getting pregnant.

• You may gain weight while taking these medicines.

• You may be at risk for developing anemia (uh-NEE-mee-ah), which will make you feel tired. Anemia causes your blood to carry less oxygen (OX-ih-jen) than normal.

• You may have swelling in your legs or your ankles, also called edema (eh-DEE-mah).

• The U.S. Food and Drug Administration advises patients who are taking Avandia, especially those who are known to have underlying heart disease or who are at high risk of heart attack, to talk to their doctor about whether they should continue taking Avandia. Complete FDA alert

Are other diabetes medicines used with thiazolidinediones?

Yes, your health care provider may ask you to take another diabetes medicine along with a thiazolidinedione. Or you may take a thiazolidinedione as your only diabetes medicine. These combinations work well together to control blood glucose:

• pioglitazone with a sulfonylurea, metformin, or insulin
• rosiglitazone with metformin

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Meglitinides

Brand Name Prandin Generic Name repaglinide

Meglitinides (meh-GLIT-in-ides) are another type of diabetes medicine. Repaglinide (re-PAG-lyn-ide) is the name of a meglitinide. This medicine helps your pancreas make more insulin right after meals, which lowers blood glucose. Your doctor might prescribe repaglinide by itself or with metformin (another diabetes medicine) if one medicine alone does not control your blood glucose levels.

A good thing about repaglinide is that it works fast and your body uses it quickly. This fast action means you can vary the times you eat and the number of meals you eat more easily using repaglinide than you can using other diabetes medicines.

How often should I take repaglinide?

Your doctor will tell you to take repaglinide before you eat a meal. If you skip a meal, you should not take the dose of repaglinide.

When should I take repaglinide?

From 30 minutes before to just before a meal. Repaglinide lowers blood glucose the most 1 hour after you take it, and it is out of the bloodstream in 3 to 4 hours.

What are possible side effects of repaglinide?

• hypoglycemia
• weight gain

D-Phenylalanine Derivatives

Brand Name Starlix Generic Name nateglinide

Nateglinide (nah-TAG-lin-ide) is the first medicine in a new group of diabetes pills called D-phenylalanine (dee-fen-nel-AL-ah-neen) derivatives. Nateglinide helps your pancreas make more insulin quickly and for a short time. Then the insulin helps lower your blood glucose after you eat a meal.

How often should I take nateglinide?

You take it with each meal. If you skip a meal, you should not take your nateglinide pill.

When should I take nateglinide?

You should take it from 1 to 30 minutes before a meal.

What are possible side effects?

This medicine may cause your blood glucose to drop too low. If you have liver disease, talk with your health care provider, since this medicine has not been tested in people with liver disease. Also, ask whether your other medicines might interact with nateglinide.

Are other diabetes medicines used with nateglinide?

Yes, your health care provider may ask you to take metformin along with nateglinide.

Combination Oral Medicines

Brand Name Glucovance Generic Name glyburide + metformin hydrochloride

Combination pills put together glyburide and metformin into single pills.

How often should I take Glucovance?

Glucovance can be taken once or twice a day. Your health care provider will tell you how often to take it.

When should I take Glucovance?

With meals.

What are possible side effects?

Glucovance may cause your blood glucose to drop too low. Also, your doctor may not want you to take it if you have kidney problems. If you need medical tests that require using dyes, or if you are having surgery, your doctor will tell you to stop taking Glucovance for a short time. This medicine should not be used by people who often drink alcoholic beverages.

For more information on side effects, refer to the glyburide and metformin sections.

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Insulin

The six types of insulin are

• Rapid-acting

• Short-acting

• Intermediate-acting

• Long-acting

• Very long-acting

• Premixed

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