6. Treatment for type 2 diabetes - oral and injectable (non-insulin) pharmacological agents

Question 1

what re the oral pharmacological agents for type 2 diabetes treatment ?

Answer 1

2ND GEN SULFONYLUREAS
= increase insulin secretion

BIGUANIDE
metformin / glucophage

MEGLITINIDES - analogous of sulfonylureas = act similar
glinides
eg repaglinde

DIPEPTIDYL PEPTIDASE 4 INHIBITORS
increase incretin levels - block glucagon and increase insulin release
gliptin
eg alogliptins

SODIUM GLUCOSE CO TRANSPORTER 2 inhibitor
reduction of resoprtionof glucose from tubules
agliflozins
eg canagliflozin

PPAR gama agonists =
glitazones
pioglitazone

fibrates
PPAR alpha agonists
promotes uptake, utilization, and catabolism of fatty acids

Question 2

what are the risk for sulfonylureas ?

Answer 2

hypoglycemia when taking meals unregularly = increase insulin secretion even when normal

Question 3

why are glinides taken before meals ?

Answer 3

analogues to sulfonylureas = rapid onset of secretion of insulin and short duration of action

Question 4

what is the action of metformin ?

Answer 4

decrease gluconeogeneisis in liver
and glycogenolysis
inhibits lipolysis

and increases insulin sensitivity

only acts during = HYPERGLYCEMIA so hypoglycemia is uncommon

Question 5

what is the mechanism of action of glitazone ?

Answer 5

used to treate symptoms of metabolic syndrome = increase TAG STORGAE -
lower tag and insulin sensitivity

Question 6

treatmnet algorithm ?

Answer 6

weight reduction exercise

metformin

dual therapy - metformin plus one of the above drugs

triple therapy - metformin +2 other

still not working
metformin
+ basal inulin
+ short acting insulin before meals or GLP-1 receptor agonist