Snapshot A 45-year-old woman comes to her primary care physician complaining of pain with urination. She thinks she has a urinary tract infection. She states that this would be the 5th time in the past 3 months. The patient has poorly controlled type II diabetes mellitus. She had a hernia repair as a child. She takes metformin and danagliflozin. Her mother had end stage kidney disease. (Adverse effect of sodium-glucose co-transporter-2 (SGLT-2) inhibitors) Introduction Drugs login to view 1 more bullet Mechanism of action login to view 1 more bullet Overview of Diabetes Drugs Class Example ↑ Insulin secretion ↑ Insulin utilization ↓ Glucose production Glucose absorption/ excretion Weight Hypoglycemia Insulin Insulin ++ Biguanides Metformin + ++ None Sulfonylureas Glyburide ++ (glucose independent) + + ++ Meglitinides Repaglinide ++ (glucose independent) + Glitazones (thiazolidinediones) Pioglitazone ++ +/- + Glucagon-like peptide-1 (GLP-1) mimetics (incretin mimetics) Exenatide ++ (glucose dependent) + + Gipeptidyl peptidase-4 (DPP-4) inhibitors Sitagliptin ++ (glucose dependent) + Sodium-glucose co-transporter-2 (SGLT-2) inhibitors Dapagliflozin ↑ Excretion None None α-glucosidase inhibitors Acarbose ↓ Absorption None None Amylin analog Pramlintide + + + Adverse effects login to view 7 more bullets Insulin Drugs login to view 1 more bullet Preparation Onset Peak Duration Lispro, aspart, and glulisine (rapid-acting) ~15 min 30 min-2 hr 3-4 hrs Regular (short-acting) ~30 min-1 hr 2-5 hr 4-12 hr NPH (intermediate) 1-2 hr 6-12 hr 14-24 hr Glargine and detemir (long-acting) 2-4 hr Flat ~24 hr Mechanism of action login to view 14 more bullets Clinical use login to view 10 more bullets Adverse effects login to view 8 more bullets Biguanides Drugs login to view 1 more bullet Mechanism of action login to view 8 more bullets Clinical use login to view 1 more bullet Adverse effects login to view 10 more bullets Sulfonylureas Drugs login to view 7 more bullets Mechanism of action login to view 8 more bullets Clinical use login to view 3 more bullets Adverse effects login to view 9 more bullets Meglitinides (Sulfonylurea Analogs) Drugs login to view 2 more bullets Mechanism of action login to view 2 more bullets Clinical use login to view 1 more bullet Adverse effects login to view 8 more bullets Glitazones (Thiazolidinediones) Drugs login to view 2 more bullets Mechanism login to view 7 more bullets Clinical use login to view 1 more bullet Adverse effects login to view 10 more bullets GLP-1 Analogs Drugs login to view 3 more bullets Mechanism of action login to view 7 more bullets Clinical use login to view 3 more bullets Adverse effects login to view 8 more bullets DPP-4 Inhibitors (-gliptins) Drugs login to view 2 more bullets Mechanism of action login to view 6 more bullets Adverse effects login to view 6 more bullets SGLT-2 Inhibitors (-gliflozins) Drugs login to view 3 more bullets Mechanism of action login to view 3 more bullets Clinical use login to view 2 more bullets Adverse effects login to view 10 more bullets α-Glucosidase Inhibitors Drugs login to view 2 more bullets Mechanism of action login to view 5 more bullets Clinical use login to view 2 more bullets Adverse effects login to view 9 more bullets Amylin Mimetics Drugs login to view 1 more bullet Mechanism of action login to view 5 more bullets Clinical use login to view 1 more bullet Adverse effects login to view 5 more bullets