Primary therapy for newly diagnosed patients Little to no risk of hypoglycemia

Primary therapy for newly diagnosed patients little

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Primary therapy for newly diagnosed patients Little to no risk of hypoglycemia when used as monotherapyWeight neutral ( few patients may lose weight)May TG, LDLPregnancy Category BER formulations may appear in stool
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METFORMINCan reduce A1C by 1-2%May decrease progression to diabetes from pre-diabetesPositive cardiovascular benefits when used in obese patients
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METFORMINBrand NameCommon DosesMax Dosesper dayGlucophage®Glucophage XR®500mg, 850mg, 1000mgXR: 500mg, 750mg2550mgFortamet (XR)®500mg, 1000mg2550mgGlumetza®500mg, 1000mg2550mgRiomet®500mg/5mL2550mg
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METFORMINHow it works??Decreases hepatic glucose productionDecreases intestinal glucose absorptionIncreases peripheral insulin sensitivityDoes not stimulate insulin secretionIndications: Type 2 DM
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BBW’S, CONTRAINDICATIONS, AND WARNINGSBlack box warnings (BBW)Lactic acidosis ContraindicationsSerum Cr > 1.4 females, > 1.5 malesCreatinine clearance < 60 ml/minMetabolic acidosisHold metformin x 48 hours after iodinated contrast media WarningsShould be stopped in any case of hypoxia (decompensated heart failure, respiratory failure, acute MI, sepsisExcessive alcohol intake > 2 drinks per day or in one sitting
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METFORMIN SIDE EFFECTSDiarrheaNausea & VomitingFlatulenceVitamin B12/folic acid deficiency long termCaution in renal and hepatic impairmentMetallic taste
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METFORMIN COUNSELINGTake with morning and evening meals to decrease GI side effectsDo not crush, chew, or break an extended release tablet, swallow the pill wholeSupplement with B12 and folic acid as neededThe metallic taste is a temporary side effect and should go away
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SULFONYLUREASGenericBrandCommon Doses Max Doses per dayGlyburideDiabeta®,Micronase®1.25mg, 2.5mg, 5mg20mgGlyburide micronizedGlynase®1.5mg, 3mg, 6mg12mgGlipizideGlucotrol®Glucotrol XL®5mg, 10mgXL: 2.5mg, 5mg 10mg40mgXL: 20mgGlimepirideAmaryl®1mg, 2mg, 4mg8mg
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SULFONYLUREASHow do they work??:in blood glucose by stimulating insulin release from the pancreasin hepatic gluconeogenesisin insulin resistance in the muscleIndicated for Type 2 DM
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WARNINGS & CAUTIONS FOR USERenal and/or hepatic insufficiencyUse glipizide or glimepirideSulfa allergyNot likely to cross reactDisulfiram-like reaction w/ETOHMore common with 1stgeneration sulfonylureasDrug interactions: Worse with 1stgeneration sulfonylureas↑ risk of hypoglycemia: anticoagulants, fluconazole, gemfibrizol, TCAs, digoxinPregnancy Category C
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SIDE EFFECTS(GLYBURIDE, GLIMEPIRIDE, GLIPIZIDE)HypoglycemiaNausea, vomiting, dyspepsiaWeight gainPruritus, rash
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SULFONYLUREAS COUNSELING(GLYBURIDE, GLIMPIRIDE, GLIPIZIDE)Take 30 minutes before foodAvoid alcohol. If drinking alcohol, also eat at same timeEat meals and snacks at scheduled timesA1c should fall 1-2% Sulfonylureas can help reduce microvascular complicationsRemind patients to carry fast acting oral CHO
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MEGLITINIDESGeneric BrandCommon DosesMax doses per dayRepaglinidePrandin1 mg 3x/day16 mgNateglinideStarlix60 mg 3x/day360 mg
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MEGLITINIDESHow do they work??:
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