Oral Hypoglycemics
Action
Adverse Effects
Nursing Implications
• Inhibit production of
• Lactic acidosis
• Monitor for lactic acidosis and for
glucose by liver
• Drug-drug interaction: iodinated
effectiveness on serum glucose levels
• Increase body tissue
• Monitor renal, liver, cardiovascular and
contrast; decrease in vitamin B 12,
sensitivity to insulin
folic acid absorbed
respiratory function
• Decrease hepatic synthesis
• GI irritation
• Stop drug 48 hours prior and after
of cholesterol
• Contraindicated in patients with
administration of iodinated contrast
• Decreases glucose
• Monitor for other drug-drug interactions
impaired renal or liver function,
absorption in the
respiratory insufficiency, severe
intestines
infection, or alcohol abuse
• Used in DM II to control
• Heart failure/cardiovascular event
serum glucose level
Sulfonylureas: 2nd
• Stimulates beta cells to
• Hypoglycemia
• Monitor for hypoglycemia
generation
secrete insulin; may
• Mild GI symptoms
• Monitor blood glucose and urine ketone
(glimepiride,
improve binding of
• Weight gain
levels to assess effectiveness
glipizide, glyburide)
insulin and insulin
• Patients at high risk for hypoglycemia:
• Drug-drug interactions (NSAIDs,
receptors; may increase
elderly, renal insufficiency
warfarin, sulfonamides, cimetidine)
the number of insulin
• Instruct patients to avoid use of alcohol
receptors
• Contraindicated with sulfa allergy
• Used in DM II to control
serum glucose level
• May be used in
combination with
metformin or insulin
Meglitinides: Non• Stimulate pancreas to
• Hypoglycemia/weight gain (less likely
• Monitor serum glucose levels to assess
sulfonylurea insulin
secrete insulin
than with sulfonylureas)
for effectiveness of therapy and
secretagogues
• Used in DM II to control
• Drug-drug interactions (ketoconazole,
hypoglycemia
(Repaglinide)
• Has rapid action and short half life
serum glucose
fluconazole, erythromycin, rifampin,
• May be used alone or in
isoniazid, gemfibrozil)
• Should be taken only if able to eat
combination with
immediately
metformin or
• Educate patients about hypoglycemia
thiazolidinediones
• Monitor patients with impaired liver
and/or renal function
• Has no effect on plasma lipids
• Is taken before each meal
• Check for interactions with other
medications
Thiazolidinediones
• Sensitizes body tissue to
• Anemia
• Monitor blood glucose levels to assess
(rosiglitazone,
insulin; stimulates insulin
• Weight gain, edema
effectiveness of therapy
pioglitazone)
receptor sites to lower
• Monitor liver function tests
• Decreases effectiveness of oral
blood glucose and
• Dietary education about weight control
contraceptives
improve action of insulin
• May cause liver dysfunction
• Instruct patient on oral contraceptives
• May be used alone or in
• Drug-drug interactions (gemfibrozil)
about increased risk of pregnancy
combination with
• Hyperlipidemia (use pioglitazone in
sulfonylurea, metformin
patients with hyperlipidemia)
or insulin
• Impaired platelet function
• Black Box Warning: HF, MI
Drug
Biguanides
(metformin)
Alpha-Glucosidase
Inhibitors
(acarbose)
• Delays absorption of
complex carbohydrates in
the intestine and slow
entry of glucose into
systemic circulation
• Does not increase insulin
secretion
• Used in DM II to control
serum glucose levels
• Can be used alone or in
combination with
sulfonylureas, metformin
or insulin)
• GI side effects (abdominal discomfort
or distention, diarrhea, flatulence)
• Must be taken with first bite of food to
be effective
• Monitor for GI side effects
• Monitor for serum glucose levels to
assess effectiveness of therapy
• Monitor liver function studies q 3 mo x 1
y and then periodically
• Contraindicated in patients with GI or
kidney dysfunction, or cirrhosis
• Alert: Hypoglycemia must be treated
with glucose and not sucrose
Dipeptidyl
Peptidase-4 (DPP4)Inhibitors
(sitagliptin)
• Increase and prolong the
action of incretin, a
hormone that increases
insulin release and
decreases glucagon
levels, with the result of
improved glucose control
• Upper respiratory infection
• Stuffy or runny nose and sore throat
• Headache
• Stomach discomfort and diarrhea
• Hypoglycemia, if used with
sulfonylurea
• Administer q day
• Used alone or with other oral
hypoglycemics
• Instruct patient about signs and
symptoms of hypoglycemia and other
adverse effects to report
• Monitor kidney function
• Contraindicated in pancreatitis
SGLT – 2 Inhibitors
(canagliflozin)
• Limits the rise of glucose
postprandial
• Excretes glucose through
the urine
• Promotes weight loss
• Used in combination with
insulin for DM I
• Cystitis, candidiasis, polyuria
• Dizziness, hypotension
• Drug - drug interactions (phenytoin,
rifampin, phenobarbital can decrease
effectiveness of SGLT-2 inhibitors;
SGLT-2 inhibitors increase the effect
of thiazide and loop diuretics)
• Educate patient on signs and symptoms
of cystitis, yeast infection
• Teach patient safety measures to manage
orthostatic hypotension
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