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We make riding to Awaken Weight Loss easy, which is why over million users, including users in Newton, trust Moovit as the best app for public transit. Skip to main content. Info service alert Coronavirus Updates. For more details download the app. For more details Scan QR Code to download the app. Caution should be used in patients with liver or kidney dysfunction or in those who often skip meals. Two drugs are available in this class: Nateglinide and repaglinide; both are available in generics.
The glinides have a similar mode of action as sulfonylureas; however, glinides have a more rapid onset of action and shorter duration, so they are a good option for patients with erratic timing of meals. Also, the hypoglycemia risk is lower than with sulfonylureas; however, glinides have a similar-to-lower risk of weight gain after initiating therapy. Caution must be used in patients with liver dysfunction. Dosing is before meals. This drug class competitively blocks the enzyme alpha glucosidase in the brush borders of the small intestine, which delays absorption of carbohydrates absorbed in the mid and distal portions of the small intestine instead.
They primarily target postprandial hyperglycemia but do it without causing hypoglycemia.
GI complaints, such as bloating, abdominal cramps, flatulence, and diarrhea, are the main side effects. Use should be avoided in patients with severe hepatic or renal impairment. Dosing must occur before carbohydrate-containing meals. Two drug products are marketed, and both are available in generics. Incretin-based therapies are available as injections glucagon-like peptide-1 [GLP-1] receptor agonists or oral formulations dipeptidyl peptidase-4 [DPP-4] inhibitors.
These therapies differ slightly in their mechanisms of actions, as described in the following sections. All incretin-based medications carry an increased risk of acute pancreatitis. Patients must be warned about this risk and be advised to stop taking these medications and to seek medical evaluation if acute abdominal pain develops.
These medications should not be given to individuals who have a history of medullary thyroid carcinomas or have multiple endocrine neoplasia type 2. This restriction is based on increased incidences of thyroid C-cell tumors observed with these medications in murine models. So far, no increased risk in humans has been observed.
Nevertheless, these patients should not use incretin therapies. The GLP-1 agonists are administered by injection and stimulate insulin secretion and suppress glucagon secretion after meals in a glucose-dependent manner. Exenatide is a synthetic form of exendin 4, a hormone found in the saliva of the Gila monster, which mimics GLP GLP-1 is produced in the small intestine.
It stimulates insulin secretion and inhibits glucagon secretion and hepatic glucose production in a glucose-dependent manner. It also delays gastric emptying and suppresses appetite through central pathways. It primarily decreases postprandial blood glucose levels; however, a moderate reduction in fasting blood glucose levels also occurs. Due to its delaying effects on gastric emptying, the major side effects are GI complaints of nausea, vomiting, and diarrhea.
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Hypoglycemia does not occur when exenatide is used as monotherapy or with metformin, but it does occur when exenatide is combined with a sulfonylurea. Benefits include weight loss up to 2 to 3 kg in the first 6 months and up to 5. Dosing is twice daily by subcutaneous SC injection at least 60 minutes before the 2 main meals.
The initial starting dose is 5 mcg. If this dose is tolerated, titrate after 1 month to 10 mcg. It is administered once a day as a subcutaneous injection from its pen device. Timing is independent of meals.
Half-life is about 13 hours. Its beneficial effects and side effects are similar to those of exenatide, but it may be slightly more powerful in its actions. The initial dose is 0. If there are no side effects, the dose is increased to 1. For most patients, the dose will be increased to 1. Liraglutide has shown cardiovascular protection in a clinical study. Exenatide also is available as a once per week SC injection extended-release exenatide.
If a dose is missed, it should be administered as soon as possible, provided that the next dose is scheduled 3 or more days later. Albiglutide is a newer GLP-1 analog that has a half-life of 4 to 7 days. Dulaglutide is another long-acting GLP-1 analog. Dosing is 0. Dipeptidyl peptidase-4 DPP-4 is a cell membrane protein that rapidly degrades GLP-1 and glucose-dependent insulinotropic polypeptide.
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Suppression of DPP-4 leads to higher levels of insulin secretion and suppression of glucagon secretion in a glucose-dependent manner. The DPP-4 inhibitors act primarily on postprandial blood glucose levels, but reductions in fasting glycemia are also seen. These agents are generally well tolerated, with the most common side effect being headache. An increase in nasopharyngitis also has been seen. Benefits include being weight-neutral and not causing hypoglycemia either as monotherapy or when combined with metformin or thiazolidinediones.
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When combined with sulfonylurea or insulin, however, DPP-4 inhibitors increase the risk of hypoglycemia. These agents are indicated for use as monotherapy or in combination with other agents such as metformin, sulfonylureas, thiazolidinediones, or insulin.
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Sitagliptin dosing is mg orally once daily with or without meals. Dose reduction is needed in patients with renal impairment. Saxagliptin dosing is 2. The 2. Linagliptin dosing is 5 mg orally once daily with or without meals. Dose reduction is not needed in patients with renal impairment. Alogliptin dosing is 25 mg orally once daily with or without meals. Pramlintide is a synthetic form of amylin, a hormone secreted by beta cells that acts to suppress glucagon secretion, slow gastric emptying, and suppress appetite through central pathways.
It acts primarily on postprandial blood glucose levels.