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Drug Table Supplement Contents
Diabetes Medications
Table 2. Glucose-Lowering Activity—Oral Diabetes Agent
Medication |
Blood Glucose Most Affected |
Greatest Risk for Hypoglycemia |
Adapted from © 2002, The Diabetes Center, Old Saybrook, CT, used by permission.
SMBG = self-monitoring of blood glucose |
| Sulfonylureas |
Fasting and postprandial |
Nocturnal, fasting, 4–6 hr after meals |
| Meglitinide or phenylalanine derivative |
Postprandial |
2–3 hr after meals |
| Biguanide |
Fasting and postprandial |
After exercise if prolonged and strenuous |
| Alpha-glucosidase inhibitor |
Postprandial |
None |
| Thiazolidinedione |
Fasting and postprandial |
None |
| Glucovance™ |
Fasting and postprandial |
Nocturnal, fasting, 4–6 hr after meals |
| Metaglip™ |
Fasting |
Nocturnal, fasting, 4–6 hr after meals |
| Avandamet™ |
Fasting and postprandial |
After exercise if prolonged and strenuous |
| Actoplus Met™ |
Fasting and postprandial |
After exercise if prolonged and strenuous |
| Avandryl™ |
Fasting and postprandial |
Nocturnal, fasting, 4–6 hr after meals |
Table 3. Important Insulin Information*
Insulin |
Onset |
Peak |
Effective Duration |
Maximal Duration |
Comments |
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission.
*Site rotation for injections is necessary for all types of insulin. |
Human |
Rapid Acting |
| Lispro (Humalog™) |
< 15 min |
1–2 hr |
2–4 hr |
3–5 hr |
Should be taken just prior to or just after eating. |
| Aspart (Novalog™) |
< 15 min |
1–3 hr |
3–5 hr |
4–6 hr |
Should be taken just prior to or just after eating. |
| Glulisine (Apidra™) |
< 15 min |
0.5–1 hr |
3 hr |
3 hr |
Should be taken just prior to or just after eating. |
Short Acting |
| Regular (Novolin R™,
Humulin R™) |
0.5–1 hr |
2–4 hr |
3–5 hr |
8 hr |
Best if taken 30 min before a meal. |
Intermediate Acting |
| Lente (Novolin™,
Humulin L™) |
3–4 hr |
4–12 hr |
12–18 hr |
16–20 hr |
Limited supplies. |
| NPH (Novolin N™,
Humulin N™) |
2–4 hr |
4–10 hr |
10–16 hr |
14–18 hr |
Bedtime dosing minimizes nocturnal hypoglycemia. |
Long Acting |
Characterized by a “flat” or “peakless” concentration profile. |
Insulin glargine
(Lantus™) analog |
4–6 hr |
None |
24 hr |
24 hr |
Cannot be mixed with any other insulin. Stress site rotation and not to use
same syringe used with other insulins. Not recommended for pre-filling
syringes. |
| Detemir (Levemir™) |
3–4 hr |
50% in 3–4 hr,
lasting up to 14 hr |
5.7–23.2 hr |
Dose dependent-
5.7–23.2 hr |
Cannot be mixed in same syringe with other insulins.
Duration of action is dose dependent: 6 hrs (0.1U/kg), 12hrs (0.2U/kg),
20 hrs (0.4U/kg), 23 hrs (0.8U/kg and 1.6U/kg). |
| Ultralente |
6–10 hr |
Minimal |
18–20 hr |
20–30 hr |
Limited supplies. |
Pre-mixed Human |
Humalog™ 75/25
Novolog Mix™ 70/30 |
<15 min |
1–2 hr |
10–16 hr |
14–18 hr |
75% NPL, 25% Lispro Should be taken just prior to or just after eating
70% NPH, 30% Aspart because of rapid onset. Caution because of name
confusion with Humalog and Novolog. |
Humulin™ 70/30
Novolin™ 70/30 |
0.5–1 hr |
2–10 hr |
10–16 hr |
14–18 hr |
Humalin and Novolin are 70% NPH and 30% regular insulin. |
Animal Source |
| Regular |
0.5–2 hr |
3–4 hr |
4–6 hr |
6–8 hr |
Conversion to human insulin recommended. Dose changes required (usually a 10% reduction in dose when switching to human). |
| NPH |
4–6 hr |
8–14 hr |
16–20 hr |
20–24 hr |
| Lente |
4–6 hr |
8–14 hr |
16–20 hr |
20–24 hr |
Inhaled Insulin |
| Exubera™ |
10–20 min |
30–90 min |
2–6 hr |
6 hr |
Dosed in MG of powder, Available in 1 mg and 3 mg blisters.
1mg approx=3 IU insulin, 3mg approx=8 IU
(Inhalation of 1 mg +1 mg +1 mg does not equal 3mg) |
Table 4. Recommended Insulin Storage
Recommended Insulin Storage |
Refrigerated (36°F - 46°F) |
Room Temperature (59°F - 86°F) |
Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission.
*Suggested, not clinically established |
| Vial |
Opened |
Unopened |
Opened |
Unopened |
| Humalog™, Novolog™, Humulin™, Novolin™, Apidra™ |
28 days |
until expiration date |
28 days |
28 days |
| Lantus™ (10 mL) |
28 days |
until expiration date |
28 days |
28 days |
| Detemir (Levemir™) |
42 days |
until expiration date |
42 days |
42 days |
| Pens/Cartridges |
Not in use |
In use |
| Humalog™ |
Until expiration date |
28 days |
| Humulin R™( available in cartridge only) |
Until expiration date |
28 days |
| Humulin N™ |
Until expiration date |
14 days |
| Humulin 70/30™ |
Until expiration date |
10 days |
| Humalog Mix 75/25™ |
Until expiration date |
10 days |
| Novolog™ |
Until expiration date |
28 days |
| Novolog Mix 70/30™ |
Until expiration date |
14 days |
| Novolin R™ (prefilled and 1.5-mL cartridge) |
Until expiration date |
30 days |
| Novolin R™ (3-mL cartridge) |
Until expiration date |
28 days |
| Novolin N™ (prefilled and 1.5-mL cartridge) |
Until expiration date |
7 days |
| Novolin N™ (3-mL cartridge) |
Until expiration date |
14 days |
| Novolin 70/30™ (prefilled and 1.5-mL cartridge) |
Until expiration date |
7 days |
| Novolin 70/30™ (3-mL cartridge) |
Until expiration date |
10 days |
| Detemir (Levemir™) |
Until expiration date |
42 days |
| Apidra™ |
Until expiration date |
28 days |
| Lantus™ |
Until expiration date |
28 days |
| Self-filled syringes (Note: not recommended for glargine) |
14 days* |
7 days* |
| Inhale Insulin |
Not in use (unopened overwrap) |
In use (unopened overwrap) |
| Exubera™ (insulin blisters) |
Room Temperature (59° F– 86° F) Until expiration date |
Room Temperature (59° F– 86° F) 90days |
| Release Unit |
Do not refrigerate |
Replace every 14 days |
| Inhaler & Chamber |
ReplaceYearly (Wash Weekly) |
Table 5. Incretins and Amylins
Agent |
Primary Action |
How
Supplied/Storage |
Typical Dosage |
Duration
Action |
Side Effects |
Precautions |
Comments |
| Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. *DPP-4-dipeptidyl peptidase -4 GIP- glucose dependent insulinotropic polypeptide GLP-glucose like polypeptide
ESRD-End Stage Renal Disease TZD-Thiazolidinedione |
Exenatide
(Byetta™) |
Decreases post-meal glucagon
production Delays gastric
emptying
Increases satiety, leading to
decreased caloric intake.
Degree of response depends on
plasma glucose levels |
250 mcg/ml:
- 5 mcg/dose prefilled pen
- 10 mcg/dose prefilled pen
If not in use: refrigerate
until expiration date.
If in use: stable at room
temperature
Discard after 30 days. |
5 mcg BID subcutaneous for
first 1 month, then 10 mcg
BID, injected within 60
minutes before morning
and evening meal |
Peak effects
in approx 2
hours with
maximal
duration of 10
hours. |
Nausea and
hypoglycemia most
common; occasional
vomiting, diarrhea,
jitters, dizziness,
headache. |
Not for use in patients with
Type 1 diabetes, severe renal
disease or ESRD*, or severe
GI disease. |
Consider lowering dose of sulfonylurea
to avoid hypoglycemia when starting.
May reduce the rate of absorption of
oral medication.
Medications requiring threshold concentrations
should be taken 1 hour prior to injection.
Approved for use with sulfonylureas
and/or metformin or in combination with a
TZD* alone or with metformin. |
Pramlintide
(Symlin™) |
Decreases post-meal glucagon
production
Delays gastric emptying,
Increases satiety, leading to
decreased caloric intake.
Degree of response depends on
plasma glucose levels |
5 ml vials containing
0.6 mg/ml. Requires U-100
insulin syringe for injection
If not in use: refrigerate
until expiration date.
If in use: room
temperature Discard after
28 days. |
Type 1 diabetes: 15–60
mcg starting with 15 mcg
subcutaneously before
meals of 30gm or more
carbohydrate. Type 2 diabetes:
60–120 mcg starting with
60 mcg subcutaneous before
meals. Titrate as directed by
prescriber. |
Maximum
effect in 20
minutes
with rapid
elimination.
Maximum
duration of 4
hours |
Nausea and
hypoglycemia most
common. Doses are
adjusted based on
presentation of these
side effects. Occasional
vomiting, stomach pain,
dizziness, indigestion. |
Indicated for insulin treated type
2 diabetes or for type 1 diabetes.
Contraindicated in patients with
hypoglycemia unawareness,
gastroparesis. Or poor adherence
Should never be mixed with
insulin and should be injected
separately. Reduce insulin dose
by 50% when starting. |
Requires patient testing of blood sugars
before and after meals, frequent physician
follow up, and thorough understanding of how
to adjust doses of insulin and pramlintide.
May reduce the rate of absorption of orally
administered medication. Medications
requiring threshold concentrations should be
taken 1 hour prior to injection. |
Sitagliptin
(Januvia™) |
DPP-4 inhibitor* Inhibits the
DPP-4 enzyme that degrades
GLP-1 and GIP resulting in 2-3
fold increased levels of these
incretins. Increases insulin
secretion in presence of elevated
plasma glucose. Reduces postmeal
glucagon secretion . |
25mg, 50mg, 100mg
tablets |
100 mg po qD
Moderate renal insufficiency
(CrCl>30 to <50mL/min):
50mg/day
Severe renal insufficiency
(CrCl <30mL/min): 25mg/day |
Approximately
24 hours |
Low incidence of
side effects including
hypoglycemia or
gastrointestinal
symptoms
Headache, upper
respiratory tract infection,
nasopharyngitis |
Not for use in type 1 diabetes
Assessment of renal function is
recommended prior to initiation
and periodically thereafter. |
May be used as monotherapy or in
combination with metformin or TZDs.
Not associated with weight loss |
Table 6. Hypoglycemia Treatment
| Agent |
Primary
Action |
How Supplied/Storage |
Typical
Dosage |
Duration
Action |
Side
Effects |
Precautions |
Comments |
| Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. |
| Glucagon |
Converts liver glycogen to glucose |
1 mg vial with diluent; emergency kit, 1 mg vial with prefilled syringe of diluent. Before reconstitution, room temperature until expiration date. After reconstitution, may be stored for up to 48 hours under refrigeration. |
0.5–2 mg subcutaneous |
15 min, should be followed by carbohydrate snack. |
Occasional nausea and vomiting |
Must be reconstituted prior to injection. Should be followed by carbohydrate snack and blood glucose testing every 15 minutes until glucose level returns to acceptable levels. |
Patient should be instructed to teach colleagues, family, etc. how to give injection. Only use if patient isunconscious or unable to eat or drink. All people taking insulin should receive a prescription for glucagon kit for emergency use. |
Table 7. Recommended Control Measures
Biochemical Index |
Preprandial |
Peak postprandial |
A1C (ADA)* |
Blood pressure |
LDL |
TG |
HDL |
| Adapted from © 2006 The Diabetes Center, Old Saybrook, CT. Used with permission. LDL=low density lipoprotein TG=triclycerides HDL=high density lipoprotein *ADA—American Diabetes Association |
| Goal |
90–130 mg/dL |
<180 mg/dL |
<7% |
<130/80 |
<100 |
<150 |
>40 |
NDEP-54-S
March 2007 |
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National Diabetes Education Program (NDEP) http://ndep.nih.gov
NIDDK, National Institutes of Health, Bethesda, MD
A Joint Initiative of the National Institutes of Health and the
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