Complete Diabetes Medications Table

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

• GLP-1 Agonists (Incretin Mimetics)
• SGLT 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 or with empagliflozin. 
• Use of linagliptin with insulin may not be indicated in the product monograph, but is an acceptable combination according to research. 
• 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.
• Boehringer 6m compassionate supply form for MDs.

• In combination with metformin, sulfonylurea, 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, 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, pioglitazone, sitagliptin or insulin or as add-on combination in patients with established cardiovascular disease.
• With type 2 diabetes and established cardiovascular disease to reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and nonfatal stroke).
• 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).
• Use of other 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, sitagliptin or insulin. 
• Use of other 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, linagliptin or insulin or as add-on combination in patients with established cardiovascular disease.
• Use of other DPP-4 inhibitors with 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.

• Monotherapy or in combination with metformin, sitagliptin.
• 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.

•  Not yet approved by Health Canada
•  Indications are expected to be with type 1 diabetes first. (Consideration for type 2 diabetes requires completion of cardiovascular outcome trials.)
• 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.

 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
• 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

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

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

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 (during waking hrs). Ensure at least 8 hrs between missed dose and the next dose.
• Steady state serum concentration is reached after 3-4 days. You may wish to use the  Tresiba titration handout. 
• 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. 

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.

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.

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.

 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