1. Stimulates peripheral glucose uptake
2. Inhibits hepatic glucose production
3. Inhibits lipolysis
4. Inhibits proteolysis
5. Enhances protein synthesis
6. Acts on the liver to increase storage of glucose as glycogen
7. Decreases urea production, protein catabolism, and CAMP in the liver
8. Tryiglyceride synthesis
9. Increases k+ and phosphate uptake by the liver

1. Ax to sulfonamids, thiazides
2. Nursing mothers
3. Type I DM
4. DKA, uncontrolled infection, burns, trauma, pts w/ adrenal or pituitary insufficiency

1. Increases peripheral glucose uptake and utilization
2. Decreases hepatic glucose production
3. Decreases intestinal absorption of glucose
4. Does NOT stimulate insulin release from pancreatic beta cells so the risk for hypoglycemia is minimal **

1. Renal dz
2. Metabolic acidosis
3. Deyhdration
4. Chronic alcoholism
5. Lactic acidosis

1. Type I DM
2. Weight loss

1. Warn about nausea & GI disturbance
2. Warn about s/sx lactic acidosis
3. Hypoglycemia NOT common
4. Warn about potential metallic taste in mouth

1. Acarbose (Precose)
2. Miglitol (Glyset)

Inhibit and delay absorption of carbs from the small bowel

1. Intestinal flatus & abd distention
2. Hypoglycemia NOT issue.

Do NOT use in pts w/ IBD, bowel obstruction, chronic intestinal dz

*Pregnancy cat B (but we never use in pregnancy)*

1. Take w/ 1st bite of meal
2. Usual tx for hypoglycemia DOES NOT work! (Treat w/ 8 oz milk or lactose tabs. If severe, tx w/ glucose or glucagon.)

1. Improve insulin action in cell which leads to increased utilization of available insulin
2. Decrease hepatic glucose production
3. No hypoglycemia

1. Advise pt to report STAT any s/sx hepatocellular injury: N/V, abd pain, fatigue, anorexia, jaundice, dark urine
2. Advise about cardiac risk: CP, SOB, peripheral edema
3. Females using OCP should use an additional form of BC, consider IUD, or increase their dose

Short acting insulin secretagogues

*Dosed TID no more than 20 mins before meals*

1. Ketoconazole
2. Miconazole
3. EES
4. Repaglinide

All increase risk of hypoglycemia

1. Closely monitor older adults
2. Risk for hypoglycemia increases if given with insulin
3. Pregnancy category C

Black box warning w/ amylin agonists:

Start @ 15 mcg & go up 15 mcg increments as tol to 30 to 60 mcg

*If nausea: reduce back to 30 mcg*

1. Initiate @ 60 mcg
2. Decrease dose of preprandial rapid acting or short acting insulin by 50%
3. Increase to 120 mcg when no clinically sig. N/V has occurred for 3-7 days

1. Administer SQ (NOT in the upper arm)
2. Give STAT AC containing at least 250 kcal or @ least 30 grams carbs
3. Can NOT be mixed w/ any form of insulin
4. Admin @ least 2 inches from site where insulin is administered.

1. Reverse hypoglycemia
2. IM, IV, SQ

1. Levothyroxine (T4)
2. Liothyronine (T3)
3. Litri (4:1 mixture of T4)