Nutrition Assessment


Box 2.15 (cont.) Glucose-Lowering Medications for Type 2 Diabetes4,14


• Disadvantages: Genitourinary infections; polyuria; volume depletion/hypotension/dizziness/increase LDL-C levels; in- crease creatinine (transient); high cost


• Usual dosage information


○ Invokana: Starting dose, 100 mg once daily; dose can be increased to 300 mg once daily


○ Farxiga: recommended starting dose, 5 mg taken in the morning, with or without food; dose can be increased to 10 mg once daily


○ Jardiance: 10 mg once daily; if tolerated the dose may be increased to 25 mg


Glucagon-like peptide-1 (GLP-1) agonists


• Examples: ○ Exenatide (Byetta) ○ Exenatide delayed-release (Bydureon) ○ Liraglutide (Victoza) ○ Albiglutide (Tanzeum) ○ Dulaglutide (Trulicity) • Expected decrease


decrease): 0.5%–1.5%


• Principal action: Activates GLP-1 receptors; increases insulin secretion (glucose-dependent); suppresses glucagon release (glucose-dependent); slows gastric emptying; satiety


increases


• Advantages: Weight loss; no hypoglycemia; decreases post- prandial glucose excursions; decreases some CVD risk factors


• Disadvantages: Injectable; frequent GI adverse effects (ini- tially, dosing immediately before meals reduces nausea, with time, increase to 30–60 min); increases heart rate; high cost


• Usual dosage information:


○ Byetta: initially 5 mcg within 60 min of morning and eve- ning meals (never after meal); titrate to 10 mcg twice daily after 1 mo based on tolerability and glycemic control


○ Bydureon: once weekly, extended-release formulation of exenatide injection


Continued on next page.


45


in HbA1c with monotherapy


(unit


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