The following is a hierarchical listing of all the pages in this web that can be reached by following links from the top

This summary is specific for hospitalization and assumes that you really have a working knowledge of the oral agents. If there is a class that you are not familiar with, you should review that area in more detail

Drug Class

Mechanism of Action

Issues for Hospitalized Diabetes Patients

Insulin Secretagogues

sulfonylureas (glyburide,glipizide, glimepiride)

Stimulate pancreatic β-cells to increase insulin output

Keep in mind the metabolic t1/2 of each drug

Insulin Secretagogues

meglitinides (repaglinide, nateglinide)

Stimulate pancreatic β-cells to increase insulin output

Keep in mind the metabolic t1/2 of each drug

Biguanides

metformin

Target liver to decrease glucose production

Withhold in conditions predisposing to renal insufficiency and/or hypoxia:

	CV collapse
	Acute MI or acute CHF
	Severe infection
	Use of iodinated contrast material
	Major surgical procedures

Alpha-glucosidase inhibitors

	acarbose
	miglitol

Inhibit intestinal enzymes that break down carbohydrates, which delays carbohydrate absorption

In case of hypoglycemia (due to sulfonylurea or insulin treatment) -
Glucose (dextrose) must be administered
Sucrose and complex carbohydrates should not be administered

Thiazolidinediones

	rosiglitazone
	pioglitazone

Bind to peroxisome proliferator activated receptor-gamma (PPAR) in muscle, fat and liver to decrease insulin resistance

1.Takes 2-3 weeks to see initial effect. Effects continue for weeks or months after discontinuation of medication

2. Can cause fluid retention and significant edema

3. Associated with Congestive heart failure