Chapter 13 Nutritional Aspects of Diabetes TABLE 13.2 cont. Glucose-Lowering Medications for Type 2 Diabetes Class and Drugs

Alpha Glucosidase Inhibitors Acarbose (Precose) Miglitol (Glyset)

Sodium-Glucose Transport Protein Inhibitors (SGLT2) Canagliflozin (Invokana) Dapagliflozin (Farxiga) Empagliflozin (Jardiance)

Amylin Agonist Pramlintide (Symlin)

Site and Mechanism of Action

Small intestine

Delay carbohydrate absorption

Kidney Reduce the

reabsorption of glucose in the kidneys via sodium glucose cotransporter-2 (SGLT2) inhibition

Liver, gastrointestinal tract, brain

Decrease glucagon production, which decreases mealtime hepatic glucose release and prevents postprandial hyperglycemia

Insulins

See Table 13.3 (see page 183)

Supplements endogenous insulin

Hypoglycemia

Source: Adapted with permission from Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters A, Tsapas A, Wender R, Matthews D. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Diabetes Care. 2015;38:140-149.

Adverse Effects/Nutrition Considerations

Diarrhea, gas, and nausea (effects can be lessened by slowly increasing dose)

Constipation, diarrhea, nausea, urinary frequency, and genitourinary infections

Bladder infections Injection therapy

Concerns in Older Adults

Adverse gastrointestinal effects may be

especially troublesome

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