Know these Anti-Diabetic Meds for the Internal Med Shelf & ABIM Board Exams

Earlier in #EndoWeek, we shared high-yield, ABIM and internal medicine shelf exam-relevant endocrinology pearls, including important information regarding diabetes. Today, we provide a quick review of the important characteristics of diabetic medications:

  • Sulfonylureas (eg. Glipizide, Glimepiride, Glyburide)
    • use cautiously in elderly individuals as can cause hypoglycemia
  • Biguanides
    • Most common medication is Metformin, which is often the initial drug of choice in patients with type 2 diabetes mellitus
    • Avoid in females who have creatinine level of 1.4 mg/dl or higher and males with creatinine of 1.5 mg/dl or higher
    • Can cause nausea, diarrhea and rarely lactic acidosis
  • Thiazolidinediones (a.k.a. “glitazones”) (eg. Rosiglitazone, Pioglitazone)
    • Should be avoided in patients with NYHA congestive heart failure class III or IV
  • Repaglinide
    • oral agent of choice in renal insufficiency patients
  • GLP 1 agonist (e.g. Exanatide)
    • Like metformin, this medication helps in weight loss
  • DPP4 inhibitors (e.g. Sitagliptin or Vidagliptin)
    • Medication to help achieve post prandial glucose control (less than 180 mg/dl)
  • When insulin is required, you should determine if the patient’s creatinine is normal or compromised
    • If creatinine is compromised, total insulin requirement should be 0.3 units/kg
    • With intact creatinine, total insulin requirement should be 0.5 units/kg
    • Once total insulin has been calculated, half should be given as long acting insulin (Glargine) and half as short acting insulin (eg. Lispro). Lispro should be divided into three for each meal the patient eats.
    • If pre-prandial glucose is not at goal of 90-130 mg/dl, then long acting insulin (Glargine) needs to be increased.
    • If post-prandial glucose is not at goal of less than 180 mg/dl, then short acting insulin (like Lispro) needs to be increased.


Given the increasing prevalence of diabetes in internal medicine practices across the nation, knowing these high-yield features of the main diabetes medications will assist in both patient care as well as answering endocrinology questions on the Internal Medicine shelf and ABIM board exams.

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