Diabetes mellitus (DM) medications

Question 1

Metformin
1) What are the 2 mechanisms of action of metformin?
2) Name a side effects of metformin?

Answer 1

1) Increases insulin sensitivity, decrease liver production of glucose (gluconeogenesis)
2) GI upset (diarrhoea), lactic acidosis

Question 2

Thiazolidinediones/glitazones
1) What is the only drug in this group?
2) What is the mechanism of action?
3) Name 2 potential side effects

Answer 2

1) Pioglitazone
2) Activates PPAR-gamma receptor in adipocytes to increase adipogenesis and fatty acid uptake
3) Weight gain, HF, fluid retention, anaemia, bladder cancer with long term use

Question 3

Sulphonylureas
1) Name a sulphonylurea
2) How do they work?
3) Name 2 side effects

Answer 3

1) Gliclazide (most common), glimepiride
2) Stimulate insulin release from the beta cells of the pancreas
3) Hypoglycaemia, hyponatraemia, weight gain, CVD and MI risk when used as a monotherapy

Question 4

Incretins - GLP-1 mimetics
1) What are incretins?
2) Name 2 effects incretins have to reduce blood sugar
3) How do GLP-1 mimetics work?
4) Name one of these drugs
5) Name 2 side effects

Answer 4

1) Hormones produced by the GI tract which are secreted in response to large meals and act to reduce blood sugar
2) Increase insulin secretions, inhibit glucagon production and slow absorption by the GI tract
3) Mimic the action of GLP-1
4) Exenatide, liraglutide, semaglutide, dulaglutide
5) GI tract upset, weight loss, dizziness

Question 5

Incretins - DPP-4 inhibitors
1) How do these drugs work?
2) What is the commonest example of these drugs?
3) Name a side effect of these drugs

Answer 5

1) DPP-4 enzyme inhibits GLP-1. Inhibiting DPP-4 therefore increases GLP-1, which increases the effect GLP-1 has.
2) Sitagliptin
3) Pancreatitis, GI upset and symptoms of an upper respiratory tract infection

Question 6

SGLT-2 inhibitors
1) Name one of these drugs
2) How do they work?
3) Name 2 side effects

Answer 6

1) empagliflozin, canagliflozin, dapagliflozin
2) SGLT-2 reabsorbs glucose from the urine in to the blood in the proximal tubules of the kidneys. Inhibiting this protein increases urine excretion of glucose
3) Weight loss, increased risk of UTI, glucoseuria

Question 7

Insulin
1) Which patients are given insulin?
2) When does rapid acting insulin start working, and for how long does its effect last?
3) When does short acting insulin start working, and for how long does its effect last?
4) When does intermediate acting insulin start working, and for how long does its effect last?
5) When does slow acting insulin start working, and for how long does its effect last?
6) What other type of insulin can be given?

Answer 7

1) All T1DM, some T2DM
2) 10mins - 4hrs
3) 30mins - 8hrs
4) 1hr - 16hrs
5) 1hr - 24hrs
6) Combination (slow acting and rapid acting)