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Metformin is an insulin sensitizer in the biguanide class. This class is used for both treatment of diabetes and pre-diabetes. Their action is to reduce liver production of glucose, reducing blood glucose levels. They also act to improve the absorption of glucose into body cells. Other biguanides have been removed from the market due to toxic effects and it is important to note that diarrhea may affect up to a third of patients taking this medication. Lactic acidosis is possible in patients with kidney problems, so is not used in those circumstances.
The chart above shows some of the fixed dose combination medications, which reduce the pill burden and make treatments more convenient for the patient. Side effects for each medication in the combination should be considered when prescribing these.
Above are a couple of examples of alpha-glucosidase inhibitors, which act to slow the digestion of carbohydrates and thus slow the rise of glucose in the blood. Side effects may include diarrhea and flatulence because of the increase in carbohydrates that remain in the intestine. Decreased digestion of carbohydrates can complicate quick treatment of hypoglycemia, and patients taking these medications should be advised to carry glucose tablets as a source of monosaccharides to reverse hypoglycemia.
New classifications and medications should also be mentioned. These include DPP-4 inhibitors, such as Sitagliptin, which lowers glucose by blocking an enzyme; incretin mimetics, such as Pramlintide injection, which helps the pancreas make insulin and slows digestion; and anti-hyperglycemic synthetic analogs, such as Pramlintide injection, which controls postprandial blood glucose. Rick Fields-Gardner |
