Diabetes Flashcards
________ is the only drug used to treat type 1 diabetes.
Insulin
T/F: Insulin is typically the first drug used to treat type II diabetes.
False
Patients sometimes end up needing insulin but not initially
What is the goal of secretagogues?
Get beta cells to release more insulin
What are the three classes of secretagogues?
- Sulfonylureas
- Meglitinides
- Drugs working on GLP-1 receptors (incretins)
What is the standard of care for treating type II diabetes?
Sulfonylureas and biguanides
T/F: Suflonylureas are good for treating type I diabetes.
False
They will promote beta cell release of insulin but type I diabetics do not produce insulin in the first place
The _______ decides what to do metabolically based on blood glucose levels.
liver
The ________ decide whether to secrete insulin based on blood glucose information.
Beta cells
How do beta cells respond to various levels of blood glucose?
Adjust ratio of ATP/ADP -> changes in K+ channel regulating insulin release
What happens when someone is fasting?
ATP/ADP low -> K+ channel open -> hyperpolarized cell -> Ca+ channels closed -> no insulin secretion
What happens after a meal?
ATP/ADP high -> K+ channel closed -> cell depolarized -> Ca+ channel open -> insulin secreted
What is the duration of action for most sulfonylureas?
12-24 hours
Where do sulfonylureas bind?
To a subunit of the K+ channel on beta cells - closes the K+ channel
________ have a more rapid onset, and shorter duration of action than sulfonylureas.
Meglitinides
_______ are used to generally beat down blood sugar levels. ________ are used specifically before meals.
Sulfonylureas; meglitinides
What is the general mechanism of action for both sulfonylureas and meglitinides?
Work to promote insulin release by inhibiting K+ efflux from ATP/ADP regulated K+ channels
________ act at the GLP-1 receptor on beta cells and stimulate insulin release.
Incretins
What is generally the first line of treatment in type II diabetes?
Biguanides (metformin)
T/F: Biguanides stimulate insulin secretion.
False
What are the two main functions of biguanides?
- Increase glucose uptake and utilization in skeletal muscle
- Reduce hepatic glucose production
T/F: Many patients lose weight with biguanides.
True
What is the general mode of action for metformin (biguanides)?
Opposes glucagon
Attenuates cAMP/PKA signaling in response to glucagon
The popular theory for metformin is that it works through activation of what enzyme?
AMP-dependent protein kinase (AMPK)
____________ decrease insulin resistance, and are agonists of the PPAR-gamma.
Thiazolidinediones
What is the role of PPAR-gamma?
Regulate fatty acid storage and glucose metabolism
What happens when PPAR-gamma is activated?
Stimulate lipid uptake and adipogenesis by fat cells
_________ act by inhibiting the digestion of glucose.
Alpha-glucosidase inhibitors
T/F: Secretagogues will work on type I diabetics.
False
Must have functional beta cells
