Diabetes Medications 💉

Reference guide for diabetes medications. Drug table, dosing, and prescribing for type 2 diabetes and insulin therapy.

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💡 Overview

First-line for type 2 diabetes: metformin (if no contraindications).
Add second-line agent based on comorbidities: SGLT2i/GLP-1 for cardio/renal/weight; DPP-4i if weight-neutral preferred; sulfonylurea if cost/simplicity.
Insulin when oral agents insufficient or in type 1 diabetes. Sliding scale only as per local protocol; prefer basal–bolus where appropriate.

📋 Ward considerations

Hold metformin in acute illness, before contrast, and if eGFR drops (risk of lactic acidosis).
Hold SGLT2i in acute illness, perioperatively, and when fasting (DKA risk).
Sulfonylureas: hypoglycaemia risk; reduce or hold in poor intake or renal impairment.
Review insulin doses when diet poor, on steroids, or if renal/liver function changes.

🔗 Related

DKA Hyperglycaemia Hypoglycaemia

Diabetes Medications

Reference table for diabetes management

Drug	Dose	Frequency	Class	Notes
Biguanides
Metformin (Glucophage)	500 mg – 1 g	BD (with meals)	Biguanide	First-line. Avoid in eGFR <30; caution 30–45. Risk of lactic acidosis in acute illness.
Sulfonylureas
Gliclazide (Diamicron)	40–320 mg	OD or BD	Sulfonylurea	Hypoglycaemia risk. Caution in elderly and renal impairment.
Glimepiride (Amaryl)	1–4 mg	OD	Sulfonylurea	Longer duration. Avoid in severe renal impairment.
DPP-4 inhibitors
Sitagliptin (Januvia)	100 mg (50 mg if eGFR 30–50)	OD	DPP-4i	Weight-neutral. Dose-reduce in renal impairment.
Linagliptin (Trajenta)	5 mg	OD	DPP-4i	No dose adjustment in renal impairment.
Vildagliptin (Galvus)	50 mg BD (50 mg OD if with metformin)	BD or OD	DPP-4i	Caution in heart failure. Dose-reduce if eGFR <50.
SGLT2 inhibitors
Empagliflozin (Jardiance)	10–25 mg	OD	SGLT2i	Cardio/renal benefits. Avoid if eGFR <20. DKA risk if unwell.
Dapagliflozin (Forxiga)	10 mg	OD	SGLT2i	Stop in acute illness (sickness, surgery). Genital infections.
Canagliflozin (Invokana)	100–300 mg	OD	SGLT2i	Similar to above. 300 mg only if eGFR ≥60.
GLP-1 receptor agonists
Dulaglutide (Trulicity)	0.75–1.5 mg	Once weekly	GLP-1 RA	SC injection. Nausea; titrate. Cardio benefits.
Semaglutide (Ozempic)	0.25–1 mg	Once weekly	GLP-1 RA	SC. Avoid in pancreatitis, medullary thyroid Ca.
Liraglutide (Victoza)	0.6–1.8 mg	OD	GLP-1 RA	Daily SC. Similar cautions.
Insulin (ward common)
Short-acting (Actrapid, Humalog, Novorapid, Apidra)	Variable	With meals or sliding scale	Short-acting	Give with meals. Sliding scale for inpatients if prescribed.
Long-acting (Lantus, Levemir, Abasaglar, Toujeo, Tresiba)	Variable	OD or BD	Long-acting	Basal insulin. Usually once daily at same time.
Mixed (Humalog Mix 25, NovoMix 30, Humulin M3)	Variable	BD with meals	Mixed	Pre-mixed; less flexible. Check local protocols.
Other
Pioglitazone (Actos)	15–45 mg	OD	TZD	Avoid in heart failure, bladder Ca. Fracture risk.
Acarbose (Glucobay)	50–100 mg	TDS with first bite	Alpha-glucosidase inhibitor	GI side effects. Rarely used alone.

Biguanides

Metformin (Glucophage)

Biguanide

Dose:500 mg – 1 g

Frequency:BD (with meals)

Notes: First-line. Avoid in eGFR <30; caution 30–45. Risk of lactic acidosis in acute illness.

Sulfonylureas

Gliclazide (Diamicron)

Sulfonylurea

Dose:40–320 mg

Frequency:OD or BD

Notes: Hypoglycaemia risk. Caution in elderly and renal impairment.

Glimepiride (Amaryl)

Sulfonylurea

Dose:1–4 mg

Frequency:OD

Notes: Longer duration. Avoid in severe renal impairment.

DPP-4 inhibitors

Sitagliptin (Januvia)

DPP-4i

Dose:100 mg (50 mg if eGFR 30–50)

Frequency:OD

Notes: Weight-neutral. Dose-reduce in renal impairment.

Linagliptin (Trajenta)

DPP-4i

Dose:5 mg

Frequency:OD

Notes: No dose adjustment in renal impairment.

Vildagliptin (Galvus)

DPP-4i

Dose:50 mg BD (50 mg OD if with metformin)

Frequency:BD or OD

Notes: Caution in heart failure. Dose-reduce if eGFR <50.

SGLT2 inhibitors

Empagliflozin (Jardiance)

SGLT2i

Dose:10–25 mg

Frequency:OD

Notes: Cardio/renal benefits. Avoid if eGFR <20. DKA risk if unwell.

Dapagliflozin (Forxiga)

SGLT2i

Dose:10 mg

Frequency:OD

Notes: Stop in acute illness (sickness, surgery). Genital infections.

Canagliflozin (Invokana)

SGLT2i

Dose:100–300 mg

Frequency:OD

Notes: Similar to above. 300 mg only if eGFR ≥60.

GLP-1 receptor agonists

Dulaglutide (Trulicity)

GLP-1 RA

Dose:0.75–1.5 mg

Frequency:Once weekly

Notes: SC injection. Nausea; titrate. Cardio benefits.

Semaglutide (Ozempic)

GLP-1 RA

Dose:0.25–1 mg

Frequency:Once weekly

Notes: SC. Avoid in pancreatitis, medullary thyroid Ca.

Liraglutide (Victoza)

GLP-1 RA

Dose:0.6–1.8 mg

Frequency:OD

Notes: Daily SC. Similar cautions.

Insulin (ward common)

Short-acting (Actrapid, Humalog, Novorapid, Apidra)

Short-acting

Dose:Variable

Frequency:With meals or sliding scale

Notes: Give with meals. Sliding scale for inpatients if prescribed.

Long-acting (Lantus, Levemir, Abasaglar, Toujeo, Tresiba)

Long-acting

Dose:Variable

Frequency:OD or BD

Notes: Basal insulin. Usually once daily at same time.

Mixed (Humalog Mix 25, NovoMix 30, Humulin M3)

Mixed

Dose:Variable

Frequency:BD with meals

Notes: Pre-mixed; less flexible. Check local protocols.

Other

Pioglitazone (Actos)

TZD

Dose:15–45 mg

Frequency:OD

Notes: Avoid in heart failure, bladder Ca. Fracture risk.

Acarbose (Glucobay)

Alpha-glucosidase inhibitor

Dose:50–100 mg

Frequency:TDS with first bite

Notes: GI side effects. Rarely used alone.

Hypoglycaemia management (PRN)

Treatment options for ward hypoglycaemia. Use as required.

Scenario	Treatment	Dose	Notes
Conscious, able to swallow	Fast-acting oral CHO	15–20 g: 4–5 dextrose tablets, 150–200 mL juice, or 1–2 tubes Glucogel/Hypostop	15–15 rule: recheck BM in 15 min; repeat if <4. Then snack/meal.
Unconscious or unable to swallow	Dextrose 20% IV	50–100 mL (or 10% 100–200 mL)	Flush line; avoid extravasation. Recheck BM in 10–15 min.
Unconscious, no IV access	Glucagon	1 mg IM (0.5 mg if <25 kg)	Onset 5–15 min. Give oral CHO when rousable. Less effective if glycogen depleted.
Recovery	Longer-acting CHO + meal	Snack or meal once BM stable	Document; review insulin/meds. Avoid overtreating.

Conscious, able to swallow

Treatment: Fast-acting oral CHO

Dose: 15–20 g: 4–5 dextrose tablets, 150–200 mL juice, or 1–2 tubes Glucogel/Hypostop

Notes: 15–15 rule: recheck BM in 15 min; repeat if <4. Then snack/meal.

Unconscious or unable to swallow

Treatment: Dextrose 20% IV

Dose: 50–100 mL (or 10% 100–200 mL)

Notes: Flush line; avoid extravasation. Recheck BM in 10–15 min.

Unconscious, no IV access

Treatment: Glucagon

Dose: 1 mg IM (0.5 mg if <25 kg)

Notes: Onset 5–15 min. Give oral CHO when rousable. Less effective if glycogen depleted.

Recovery

Treatment: Longer-acting CHO + meal

Dose: Snack or meal once BM stable

Notes: Document; review insulin/meds. Avoid overtreating.

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