Metformin
​Mechanism of action
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Decreases gluconeogenesis
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Increases peripheral utilisation of glucose
Dose
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Initially start with 500mg OD, increase to 1g BD
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Other available doses: 850mg tablets
​Metformin SR
A slow-release or modified-release form for patients who experience significant gastro-intestinal intolerance from standard metformin.
Side effects
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Abdominal pain, decreased appetite, diarrhoea (usually transient), gastrointestinal disorder; nausea, altered taste, vomiting
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Hepatitis, lactic acidosis (discontinue), skin reactions, vitamin B12 malabsorption
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Acute metabolic acidosis (including lactic acidosis and DKA)
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Avoid if eGFR is <30 mls/min
Sulfonyureas
​Mechanism of action
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Stimulates insulin secretion from pancreatic β-cells
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Decreases hepatic clearance of insulin
​Classified into 2 groups (or generations)
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Gliclazide, Glipizide, Glibenclamide and Glimepiride are second-generation Sulfonylureas, currently used, while first-generation drugs (such as Tolbutamide and Chlorpropamide) are no longer used.
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Sulfonylureas should be considered for diabetic patients who are not overweight, or those for whom metformin is contraindicated or is not enough to achieve adequate glycaemic control
Dose
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Gliclazide- Initially 40–80 mg daily, adjusted according to response, increased if necessary up to 160 mg once daily, dose to be taken with breakfast, doses higher than 160 mg to be given in divided doses; maximum 320 mg per day.
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Side effects
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The most common side effect is Hypoglycaemia.
DDP-4 Inhibitors
Inhibits Dipeptidyl peptidase-4 enzyme, prevents the metabolism of Incretins like GLP-1
SGLT-2 Inhibitors
GLP-1 Analogues
Insulin
Forms of Insulin
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Animal Insulin – as the name suggests, comes from animals. HYPURIN range
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Human Insulin – laboratory made, doesn’t come from humans.
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Analogue Insulin – laboratory grown human insulin modified to affect how quickly/slowly it acts
When prescribing Insulin you need the BRAND NAME, the DOSE in UNITS, The TIME the patient takes it and the MODE OF DELIVERY.
Not all insulin preparations are U100 (100 units/ml), a few are available as U200 or U300. Be certain what you prescribe. NEVER draw out of prefilled pens or cartridges.
Types on Insulin
