sulfonylureas

insulin secretagogues: increase release of endogenous insulin from pancreatic β cells by blocking the ATP-K+ channels —> inhibiting K+ efflux —> depolarization-dependent Ca2+ influx —> insulin release (functional dependent —> cannot use in T1DM)use: fasting + postprandial hyperglycemia AE: hypoglycemia, weight gain, anemia, N/V

meglitinides

short-acting insulin secretagogues: increase release of endogenous insulin from pancreatic β cells by blocking the ATP-K+ channels —> inhibiting K+ efflux —> depolarization-dependent Ca2+ influx —> insulin release (functional dependent —> cannot use in T1DM)use: postprandial hyperglycemia onlyAE: hypoglycemia, weight gain, anemia, N/V

biguanide

decrease glucose absorption and hepatic gluconeogenesis —> increase peripheral glycolysis —> reduces blood glucose in absence of β cell function (EUGLYCEMIC)use: fasting + postprandial hyperglycemia (10-12hrs), insulin resistance syndromeAE: GI effects, lactic acidosisCI: renal/hepatic dz (unbound, excreted in kidneys)

thiazolidinediones

stimulates PPAR-γR (involved in carbohydrate metabolism) —> increases target tissue insulin sensitivity (aka insulin sensitizers, EUGLYCEMIC) —> NO increase in release of insulin use: fasting + postprandial hyperglycemia AE: stimulates hepatic P450 (pioglitazone), heart failure (rosiglitazone), anemia, edema

α-glucosidase inhibitors

oligosaccharide analogs -> decrease intestinal absorption of monosaccharides -> limits post prandial rise of glucose, aka "insulin sparing effect" (EUGLYCEMIC)use: used in combination for postprandial hyperglycemiaAE: GI effects

incretin mimetics

activates GLP-1R (overcoming DPP-4 inhibition) -> increasing insulin/decreasing glucagonuse: fasting + postprandial hyperglycemiaAE: hypoglycemia, pancreatic issues, GI effectsroutes: s.c. + semaglutide can be given p.o.

dipeptidyl peptidase-4 inhibitors

inhibit incretin metabolism -> increasing insulin/decreasing glucagon (sitagliptin only activates in the presence of hyperglycemia making it EUGLYCEMIC, all others may cause hypoglycemia)use: fasting + postprandial hyperglycemiaAE: hypoglycemia, pancreatic issues, HA, upper RTI

sodium-glucose co-transporter 2 inhibitors

blocks renal glucose reabsorption -> increasing renal glucose excretion (useful for patients w/ CKD)use: fasting + postprandial hyperglycemiaAE: UTIs, ketoacidosis, eGFR < 25

EUGLYCEMIC DRUGS

BIGUANIDE (metformin)THIAZOLIDINEDIONES𝛼-GLUCOSIDASE INHIBITORSDPP-4 INHIBITORS

postprandial ONLY drugs

meglitinidesα-glucosidase inhibitors

OHAs that decrease insulin resistance

metforminpioglitazone

OHAs that augment release of insulin

glipizideglimepiride