Diabetes medications - classes and MOA

Question 1

Biguanide

Answer 1

Metformin

decr. hepatic glucose prod
decr. intestinal absorption of glucose

incr. insulin sensitivity

Question 2

Sodium Glucose Co-Transporter 2 Inhibitors

Answer 2

SGLT2i:

-gliflozin (canagliflozin, dapagliflozin, empagliflozin)

INHIBIT: SGLT2 (expressed in proximal renal tubules, reabsorbing filtered glucose)

decr. reabsorption of glucose
incr. urinary glucose excretion

=it’s not being reabsorbed, so it’s being excreted

Question 3

Glucagon-Like Peptide 1 Agonists

Answer 3

GLP1 agonist

-tide (liraglutide, semaglutide, dulaglutide, exenatide, lixisenatide)

analogs of GLP-1

incr. insulin secretion (glucose-dependent)
decr. glucagon secretion = slow gastric emptying/better satiety

Question 4

Insulin Secretagogues

Answer 4

SU - g…ide (glipizide, glyburide, glimepiride)

meglitinides - glinide (repaglinide, nateglinide)

stimulate INSULIN SECRETION from beta-cells of pancreas

decr. postprandial BG

Question 5

Dipeptidyl Peptidase 4 inhibitors

Answer 5

DPP-4i

-gliptin (sitagliptin, linagliptin, saxagliptin, alogliptin)

inhibits DPP-4 from breaking down incretin hormones = hormones (GLP-1 and GIP) are able to

incr. insulin release (beta cells)
decr. glucagon secretion (alpha cells)

Question 6

Thazolidinediones

Answer 6

TZDs… INSULIN SENSITIZER

peroxisome proliferator-activated receptor gamma (PPARy) agonists

• glitazone (pioglitazone, rosiglitazone)
  incr. peripheral insulin sensitivity

Question 7

Alpha glucosidase inhibitor

Answer 7

acarbose, miglitol

inhibit metabolism of intestinal sucrose

Question 8

amylin analog

Answer 8

pramlintide

help control PPG by slowing gastric emptying = decr. glucagon secretion after a meal

Question 9

Basal insulins

Answer 9

1. glargine
2. degludec
3. detemir

onset: 3-4 hours
peak: “peakless”
duration: > 24 hours

Question 10

Rapid-acting

Answer 10

1. aspart
2. lispro
3. glulisine

onset: ~15 mins
peak: 1-2 hours
duration: 3-5 hours

Question 11

Short-acting

Answer 11

= regular

1. Humulin R/Novolin R

onset: 30 mins
peak: ~2 hours
duration: 6-10 hours

Question 12

Intermediate-acting

Answer 12

insulin NPH (Humulin N/Novolin N)

onset: 1-2 hours
peak: 4-12 hours
duration: 14-24 hours

Question 13

order:

Answer 13

rapid-acting (aspart, lispro, glulisine)
regular 
NPH
Detemir
Glargine
Degludec (ultra-long acting)