*Read package insert each time you refill your medications in case there is new information SULFONYLUREAS ACTION: Sulfonylureas stimulate the pancreas to make more insulin (pancreas has to be making insulin) and increases insulin absorption in the muscles. EFFECTS AND PRECAUTIONS WHEN TO TAKE
Possible hypoglycemia Don’t skip meals –
Do not use if taking medications to decrease
alcohol use Do not break, crush or chew Glucotrol XL pill Part of the Glucotrol XL pill may pass in the bowel movement - this is normal Amaryl may cause sun sensitivity, use sunscreen If taking Amaryl, notify surgeons and dentist before procedures. BIGUANIDES ACTION: Biguanides are insulin sensitizers that decrease the amount of glucose released by the liver to normalize blood
glucose production. Decreases insulin resistance. Increases insulin sensitivity. Increases the amount of glucose used by
EFFECTS AND PRECAUTIONS WHEN TO TAKE
Nausea, diarrhea, abdominal discomfort –
Decreases appetite. May have initial weight
Use with alcohol increases the action of
Metformin – do not use if drinking alcohol.
Do not take with Tagamet. Decreases absorption of B12
scan dye and Xray tests. Increase fluids during those 48 hours. Do not take if any kidney problems.
ALPHA GLUCOSIDASE INHIBITORS ACTION: Alpha Glucosidase Inhibitors slow down digestion of starches in the intestines to delay absorption of the
carbohydrates to decrease after meal blood sugars. Used for high after meal blood sugars.
EFFECTS AND PRECAUTIONS WHEN TO TAKE *Use glucose tablets, glucose gel or milk only to treat hypoglycemia.
Hypoglycemia may occur if used with other
Gas, bloating, diarrhea, abdominal discomfort.
Should not be used in persons with bowel
disease – irritable bowel, colitis, intestinal
blockage, cirrhosis, DKA. Check bloodwork (liver enzymes) every 3 months first year then periodically there after. Weight neutral. Exercise after meals to prevent build-up of GI tract gas from the fermenting carbs. Decrease absorption of Digoxin.
MEGLITINIDES ACTION: Meglitinides stimulate the pancreas to make and release more insulin right at the start of meals to lower after
meal blood sugars. Insulin levels are elevated for a short period of time right after meals. The drug’s peak time is 1 hour
after taking and out of the system 3-4 hours after taking.
WHEN TO TAKE EFFECTS AND PRECAUTIONS
Rapid action of the drug matches the timing
Meal based dosing – good for people that
vary meal times or only eat 2 meals. If you skip a meal, skip that dose of
medication. Possible hypoglycemia Meal = 240 calories or more. Weight gain, diarrhea, back pain, dizziness, upper respiratory infection, skin rash
TZD’S -THIAZOLIDINEDIONES ACTION: TZD’s make the muscle cells more sensitive to insulin. Helps the skeletal muscles and fat use insulin. WHEN TO TAKE EFFECTS AND PRECAUTIONS
Water retention, weight gain, shortness of
Before, during or after food but should breath. Notify your doctor of shortness of
be taken approximately the same time breath, edema, muscle pain and/or
Use with caution for patients with CHF. Check liver enzymes before starting med, then every 2 months for 12 months, then periodically. Take other oral medications 2 hours before or after taking the TZD. Use with caution in pre-existing liver disease – watch for nausea and vomiting, abdominal pain, loss of appetite, and dark urine. Actos can be given with insulin, insulin dose may need to be decreased. (doctor will adjust dose) Potential fracture risk of women – upper arm, hand and foot. Limit use with osteoporosis. Decreases lipids – LDL and cholesterol. Increases fertility and decreases absorption of birth control meds. Avandia – suggested not to be used with insulin. Actos has been linked to bladder cancer Black Box Warning. Use with caution in pre- existing heart disease (New York Heart Association class III and IV heart failure) DPP – 4 INHIBITORS ACTION: DPP - 4 Inhibitors increase insulin produced when blood sugar is high, and reduces the amount of sugar made
by the liver after eating. (DPP - 4 = dipeptidyl peptidase - 4)
WHEN TO TAKE EFFECTS AND PRECAUTIONS
Enhances the body’s own ability to decrease
Use for Type 2 diabetics only Weight neutral
Side effects – runny nose, stuffy nose, sore
Tell your doctor if you have a fever, any
infection, injury, or if you have had or are
Not suggested to be used with insulin or other
Not used for children 18 years old or younger
Unlikely to cause hypoglycemia if used alone
Tell your doctor if you have a history of
Has not been studied in use with insulin
If starting or stopping HIV/AIDS drugs, anti-
If you miss a dose, do not take 2 doses at
the same time. If you take too much, call
your physician or Poison Control Center
1-800-222-1222 or go to the nearest hospital.
Possible side effects – upper respiratory
Infections, urinary tract infection, swelling
of hands, feet or ankles – may be worse
Can be used with insulin but NOT for Type 1 or if in DKA
May have hypoglycemia when used with insulin or
Not used during pregnancy or if breast feeding
Tell your doctor if you have high cholesterol or
triglycerides or history of pancreatitis
Side effects: hives, difficulty breathing, swelling of
face, lips, tongue or throat; severe abdominal
pain; nausea, vomiting; loss of appetite;
increased heart rate; runny, stuffy nose; weight
gain; muscle or joint pain; headache; back pain
May cause pancreatitis – severe abdominal pain radiating to the back, nausea and vomiting,
SYNTHETIC INCRETIN MIMETIC ACTION: Incretin hormones are intestinal hormones that are released in response to food intake and decrease blood glucose. Incretin mimetics “mimic” the action of the incretins (GLP-1 glucagon like peptide-1). GLP-1 is secreted in the gut in response to food intake. Works on the stomach, liver, pancreas, and brain to regulate blood glucose. Slows the rate of nutrient absorption and gastric emptying. Decreases food intake due to increased feeling of fullness. WHEN TO TAKE EFFECTS AND PRECAUTIONS
Nausea, vomiting, diarrhea, dizziness, headache, feeling jittery, acid stomach.
Due to delayed gastric emptying – take antibiotics, thyroid hormones, oral
contraceptives, coumadin, pain meds requiring rapid absorption, 1-2 hours
Weight loss – decrease desire for food, decrease sense of hunger, decrease calorie intake
**Pancreatitis – more risk if triglycerides are high, signs and symptoms
are acute back pain from front to back abdominal pain, nausea, vomiting
Not suggested for patients with severe problems digesting food, or severe
If you miss a dose, re-start stomach or kidney disease.
May delay and decrease concentration of digoxin.
Store unopened pens in refrigerator, protect from light.
Pens that have been used, store in a closed container at room
temperature, away from heat and protected from light
Do NOT freeze or use if it has been frozen Discard pen after 30 days of first use.
Byetta is made from the saliva of the Gila monster (lizard).
Not used with insulin
May have hypoglycemia if taken with other medicines.
Must follow 1st time use directions with each new pen or if pen dropped.
Nausea is common when initially started.
If the temperature of the pen is above 86º, throw pen away.
Helps the body make insulin only when needed
every 7 days; anytime with Store at room temperature up to 4 weeks or without food
Bydureon is a powder that needs to be mixed; keep unused powder in the Refrigerator protected from light Do NOT freeze or use if it was frozen Avoid alcohol NOT used with Byetta or insulin BLACK BOX WARNING – Possible thyroid tumors; not for patients with a family history of thyroid cancer or multiple endoplasmic neoplasia syndrome.
AMYLIN MIMETIC GLP - ANALOG ACTION: GLP-1 (glucagon-like peptide-1) is made in the intestine and released in response to meals. The Amylin mimetic is a synthetic drug that mimics Amylin and replaces the Amylin that is missing from the body. Amylin is co-
secreted in the beta cells with insulin. When eating, the Amylin decreases after meal blood sugars by decreasing liver
glucose output, regulates rate of gastric emptying from the stomach to the small intestine, and decreases appetite.
WHEN TO TAKE EFFECTS AND PRECAUTIONS
Must be taken BEFORE eating Insulin dose should be decreased by 50% when
starting Symlin (your doctor will adjust the
Inject abdomen or thighs only for injections (arm
Slows absorption of other oral medications,
including pain meds, take 1 hour before or 2 hours after Symlin Counters weight gain of insulin May cause hypoglycemia Do not use if you have hypoglycemia unawareness, gastroparesis or taking medications to alter gastrointestinal motility Refrigerate unopened vials in the original carton to protect from light Store opened vial or pen in a closed container at room temperature Do Not use if the medication looks cloudy, changed color, has been frozen or exposed to high temperatures Black Box Warning – hypoglycemia may occur within 3 hours of taking Symlin COMBINATION ORAL AGENTS
(see individual drug sheets for more information)
WHEN TO TAKE EFFECTS AND PRECAUTIONS See specific See specific medications medications ___________ __________________ _______________________________________ ________________________________ Sitagliptin Juvisync Take daily with evening Do not take with grapefruit or grapefruit juice (Januvia)/ meal; swallow whole Do not use if pregnant or breast feeding, have Simvastatin disease, severe kidney disease, drink more than 2 alcoholic beverages/day, have an underactive thyroid or of Chinese descent Side effects – unexplained muscle pain, weakness, fever, unusually tired, dark colored urine, severe skin reaction
Alcohol based emulsifiers for Emulsifiable Concentrates ”Matched pair” system Key benefits The total concentration of the emulsifierblend is normally 5-10% of the formulation. The optimum ratio of anionic and non-ionicwith regards to spontaneous emulsificationin water and the stability of the emulsion inrequired temperature and water hardness. All recipes optimised in accord
*Read package insert each time you refill your medications in case there is new information