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.

Exenatide ER (Extended Release)
Bydureon® (NB) $123
To be discontinued Mar 31, 2022

• 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. 
• For individuals on insulin +/- other antihyperglycemic agents with HgA1c < 8.0%, consider decreasing the insulin dose by 20% at onset of OZEMPIC treatment.

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 (with eGFR above 45 to impact glycemia). 
• 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.
• As an adjunct to standard treatment of heart failure (with or without diabetes) with reduced ejection fraction (HFrEF) to reduce the risk of cardiovascular (CV) death, hospitalization for heart failure and urgent heart failure visit.
• To reduce the risk of sustained eGFR decline  end-stage kidney disease, and cardiovascular and renal death in adults with chronic kidney disease (CKD, with or without diabetes). Can start if eGFR > 25. Can continue on the dose below this eGFR but discontinued if dialysis. 

• 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.
• For treatment of heart failure with reduced ejection fraction (HFrEF) in adults with an eGFR as low as 20 mL/min/1.73 m²
• 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 insulin 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