Complete Diabetes Medications Table

• Alpha-Glucosidase Inhibitor
• Biguanide (Metformin)
• DPP-4 Inhibitors

• GLP-1 Agonists (Incretin Mimetics)
• SGLT-2 Inhibitors
• Secretagogues

• Thiazolidinediones -TZDs
• Combination Medications
• Insulins  
• Glucagon

 Metformin extended release
Glumetza® (NB) $18-$74

• Monotherapy or in combination with metformin, sulfonylurea, pioglitazone or insulin.
• Use of DPP-4 inhibitors with SGLT-2 inhibitors may not be outlined in the product monograph(s), but is an acceptable combination according to research.

• Monotherapy or in combination with metformin , sulfonylurea, empagliflozin, basal insulin. 
• Use of DPP-4 inhibitors with other SGLT-2 inhibitors may not be outlined in the product monograph(s), but is an acceptable combination according to research.
• Boehringer 6m compassionate supply form for MDs.

• In combination with metformin, sulfonylurea or insulin. 
• Use of DPP-4 inhibitors with SGLT-2 inhibitors may not be outlined in the product monograph(s), but is an acceptable combination according to research.

• Monotherapy or in combination with metformin, sulfonylurea, pioglitazone, dapagliflozin or insulin.
• Use of DPP-4 inhibitors with SGLT-2 inhibitors may not be outlined in the product monograph(s), but is an acceptable combination according to research.

• Monotherapy or in combination with metformin, sulfonylurea, SGLT-2 or insulin. Sept 11, 2020 Health Canada approved to reduce the risk of non-fatal stroke in adults with type 2 diabetes with multiple CV risk factors or established CV disease.

• Monotherapy or in combination with metformin, sulfonylurea or basal insulin. 
• Use of a GLP-1 with an SGLT-2 or bolus insulin may not be outlined in product monographs, but are acceptable combinations in type 2 diabetes according to research. 

• Add-on to metformin or sulfonylurea or glargine.  
• Use of a GLP-1 with an SGLT-2 or bolus insulin may not be outlined in product monographs, but are acceptable combinations in type 2 diabetes according to research.

• Monotherapy or in combination with metformin, sulfonylurea, SGLT-2  or basal insulin. 
• Add on combination in those with established CV disease & type 2 diabetes.
• Use of a GLP-1 with bolus insulin may not be outlined in product monographs, but is an acceptable combination in type 2 diabetes according to research.

• Monotherapy or use with metformin, sulfonylurea, pioglitazone or basal insulin.
• Use of a GLP-1 with an SGLT-2 or bolus insulin may not be outlined in product monographs, but are acceptable combinations in type 2 diabetes according to research.

 0.25, 0.5 mg, 1 mg
(max 1 mg/week) 

• Monotherapy or in combination with metformin, sulfonylurea or basal insulin.
• Use of a GLP-1 with an SGLT-2 or bolus insulin may not be outlined in product monographs, but are acceptable combinations in type 2 diabetes according to research.
• Note: For 1 mg pen about 74 clicks forward is 1 mg; 37 clicks forward is 0.5 mg. 

3mg, 7 mg, 14 mg tablet

• Monotherapy or in combination with other medicinal products for the treatment of diabetes (includes SGLT-2, secretagogues, metformin, insulins). 
• To be taken on an empty stomach, at least 30 min before eating, with no more than 120 mL water. Review rationale here. 

• Monotherapy or in combination with metformin, sulfonylurea, pioglitazone, sitagliptin or insulin
• Use of an SGLT-2 with a GLP-1 or DPP-4 or bolus insulin may not be outlined in product monographs, but each is an acceptable combination in type 2 diabetes according to research.
• As add-on combination in patients with established cardiovascular disease and type 2 diabetes to reduce the risk of major adverse cardiovascular events.
• With type 2 diabetes and diabetic nephropathy to reduce the risk of end-stage kidney disease, doubling of serum creatinine, and cardiovascular (CV) death in adult patients with type 2 diabetes mellitus and diabetic nephropathy with albuminuria (>33.9 mg/mmol). 
• In patients with type 2 diabetes already initiated on treatment for diabetic nephropathy, the use of INVOKANA® 100 mg can be continued in patients with an eGFR <30 mL/min/1.73 m2. INVOKANA® 100 mg should be discontinued if dialysis is initiated. 

• Monotherapy or in combination with metformin, sulfonylurea, sitagliptin or insulin or to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes and CV risk factors or established CV disease. (Additionally, indicated for use in those without diabetes with heart failure.)
• Use of an SGLT-2 with a GLP-1 or other DPP-4 or bolus insulin may not be outlined in product monographs, but each is an acceptable combination in type 2 diabetes according to research.

• Monotherapy or in combination with metformin, sulfonylurea, pioglitazone, linagliptin or insulin or as add-on combination in patients with established cardiovascular disease.
• Use of an SGLT-2 with a GLP-1 or other DPP-4 or bolus insulin may not be outlined in product monographs, but each is an acceptable combination in type 2 diabetes according to research.
• Boehringer 6m compassionate supply form for MDs.

 Alone or in combination with sulfonylurea, pioglitazone or insulin (not premix).

Boehringer 6m compassionate supply form (MDs).

1 unit of Xultophy contains 1 unit of degludec and 0.04 mg liraglutide (fixed ratio)

Starting dose: 16 units
Maximum dose: 50 units

• Type 2 diabetes in combination with metformin, with or without sulfonylurea, when these combined with basal insulin (< 50 units daily) or liraglutide (less than or equal to 1.8 mg daily), do not provide adequate glycemic control.

• Type 2 diabetes, on basal insulin (< 60 units daily and > 15 units per day) alone or in combination with metformin OR inadquately controlled on GLP-1 in combination with metformin.
• Taken before the first meal.
• Starting Doses: 15 units Soliqua  (if current glargine dose < 30 units); 30 units Soliqua (if current glargine dose 30 to <60 units.)
• Take oral contraceptives at least 1 hour before or at least 11 hours after the dose of SOLIQUA.
• Suggested adjustments by fasting glucose of past 3 days:
  > 7.8 mmol/L add 4 units
  > 5.6 to < 7.8 mmol/L add 2 units
  4.4 to 5.6 mmol/L, no change
  < 4.4 mmol/L subtract 2 units

• Bolus
• Basal
• Mixed

Generic name
Brand names (*coverage) Cost/box

10-20 min / 1-3 hrs / 3-5 hrs

• May inject up to 10 minutes before a meal 

5-15 min / 1-3 hrs / 3-5 hrs

• May inject 2 mins before meal and up to 20 mins after starting meal
• Should not be mixed with other insulins
• Onset is 5 mins earlier than insulin aspart
• Time to peak is 11mins faster than insulin aspart
• Offset of effect occurs 12-14 mins earlier than insuilin aspart

• Biosimilar of lispro
• Reusable pen is Star
• Reusable 1/2 unit pen is Junior Star
• Disposable pen is Solostar
• Use in all ages, pregnancy, pumps

30-45 min / 1-3 hr / 3-5 hrs

• Available in 1/2 unit disposable pens with thebrand name "Humalog Junior KwikPen" 

Same as Lispro 100 u/mL 

30-45 min / 1-3 hr / 3-5 hrs

• Reserved for patients using > 20 units per day of rapid insulin.
• Not to be mixed with other insulins
• Not to be administered via SC infusion pump (not tested)

10-15 min / 1-1.5 hrs / 3-5 hrs

• Must not be refrigerated once opened
• Patient can register for product cards at http://www.sanoficares.ca/

Refer to "regular insulin" line in the image Pharmacodynamic Action Profiles of Bolus Insulins 

30-60 min / 2-4 hrs / 6-8 hrs 

Refer to "regular insulin" line in the image Pharmacodynamic Action Profiles of Bolus Insulins 

30-60 min / 2-4 hrs / 6-8 hrs

1 hr / no peak / 42 hrs

• Doses dialed are per one "normal" unit; e,g,  80 units u100 = 80 units u200; the latter is contained in less volume. 
• U100 pen delivers doses in 1 unit increments up to 80 unit per dose
• U200 pen delivers doses in 2 unit increments up to 160 unit increments
• Missed doses may be taken when remembered if at least 8 hrs between doses.
• Steady state serum concentration is reached after 3-4 days. 
• Diabetes Canada titration suggestions: 2 units every 3-4 days or 4 units a week. You may wish to use the  Tresiba titration handout
• Type 2, adult: If "taking once-daily long or intermediate-acting insulin, start TRESIBA® at the same unit dose. For patients transferring from twice daily long or intermediate-acting insulin, or insulin glargine (300 units/mL), it is recommended that the dose of TRESIBA® is reduced by 20% to lower the risk of hypoglycemia."
• Type 1: Reduce by 20% if patient has type 1 diabetes or if switching from bid basal
• Also available as the combination medication  Xultophy® (degludec + liraglutide). See combination medications section. 

 Conversion FROM degludec TO glargine is not standardized. (Eventually, 10-20% more glargine may be required.)  Consider either:

• Delaying the switch for 2 days e.g. no basal insulin for 48 hours to avoid overlap (Reference). 
  
  OR
  
  
• Day 1 of change (24 hr after degludec): Give 50% of basal as glargine (or less if worried about lows)
• Day 2 of change (48 hr after degludec): Give 75%-100% of basal as glargine depending on readings.
• If type 1, consider that the glargine dose may be divided between bedtime and morning. (Reference). 

1.5 hrs /  no peak / 16-24 hrs

15 15 min / 4-8  hrs / 17-24 hrs

• Indicated for those requiring over 200 units insulin/day
• Onset similar to U-100
• Peak slightly lower than Humulin R U100
• Time to peak is delayed (vs. Humulin R)
• Dose 30 minutes before meal
• Given 2-3 times daily
• When switching to Entuzity and HbA1c < 8% reduce TDD by 20%
• Pen delivers 5 unit increments

1-2 hrs / 5-8 hrs / 14-18 hrs

Refer to NPH line in the image Pharmacodynamic Action Profiles of Long-Acting Insulins 

1-2 hrs / 5-8 hrs / 14-18 hrs

1.5 hrs / no peak / 24 hrs

•  Reduce by 20% when switching from Toujeo to Lantus.
• Patient can register for product cards at http://www.sanoficares.ca/

1.5 hrs / no peak / 24 hrs

up to 6 hrs / no peak / up to 36 hrs

• The prescribed dose of TOUJEO should always be expressed in units of insulin.
• See Toujeo dosing handout.
• Pen dials up to 80 units. Dials in one unit increments.
• Patient can register for product cards at http://www.sanoficares.ca/

up to 6 hrs / no peak / up to 36 hrs

• The prescribed dose of TOUJEO should always be expressed in units of insulin.
• See Toujeo dosing handout.
• Pen dials up to 160 units. Dials in two unit increments.

 Regular insulin (%Toronto) / insulin (%NPH)
Novolin® ge 30/70 (B)
vial $24, cartridges $46

Novolin® ge 40/60 (B)
cartridges $46

Novolin® ge 50/50 (B) 
cartridges $46