6I.Sulfonylureas (mechanism of action) : Increase release of insulin Decrease production of glucose in the liverIncrease the number of insulin receptorsEffective only if have functioning beta cellsSide effect is hypoglycemia and weight gainThese drugs include glibenclamide, glipizide, and glimepiride .
7II.MeglitinidesNateglinide and repaglinide are nonsulfonylureas that lower blood sugar by stimulating pancreatic secretion of insulinIn contrast to the sulfonylureas, the meglitinides have a rapid onset and a short duration of actionThey are categorized as postprandial glucose regulatorsMonotherapy or in combination with metforminShould be taken 1 to 30 minutes before a mealSide effects hypoglycemia and weight gain
8III.Biguanides(mechanism of action): increases the use of glucose by muscle and fat cells, decreases hepatic glucose production, and decreases intestinal absorption of glucoseDoes not cause hypoglycemiaMay be used alone or in combinationSide effects include GIT disturbance and lactic acidosisContraindicated in liver or renal impairment. Can result in lactic acidosis.This group include metformin
9IV. Thiazolidinediones (mechanism of action):Decrease insulin resistance. Through binding with PPAR lead to regulation adipocyte production and secretion of fatty acids as well as glucose metabolism, resulting in increased insulin sensitivity in adipose tissue, liver, and skeletal muscleSide effects include weight gain, headache and anemiaContraindicated in patients with liver disease and acute MIMay be used as monotherapy or in combination with insulin, metformin or a sulfonylureaThese drugs include Pioglitazone and rosiglitazone
10Alpha glucosidase Inhibitors Include acarbose and miglitol(mechanism of action): inhibit alpha-glucosidase enzymes in GI tract. Delays absorption of complex CHO and simple sugarsCan be combined therapy with sulfonylureaContraindicated in malabsorption, severe renal impairmentSide effects include bloating and diarrhea