Drug Treatment Of Type 2 Diabetes Flashcards
Insulin on muscle cells effect?
Increase glucose uptake by translocation of glut 4 onto membrane, glycogen synthesis, amino acid uptake and protein synthesis
Insulin effect on adipocytes?
Increase glucose uptake, increase triglyceride synthesis, decreases FFA and glycerol release
Treatment for beta cell dysfunction?
Sulphonylureas, GLP-1 analogues and DDp-4 inhibitors
treatment for insulin resistance?
Metformin and TZDs (thiazolidinediones)
Treatment for renal glucose absorption?
SGLT-2 inhibitors
Sulfonylureas?
Glicazide, glipizide and glimepiride, orally active- all bound to plasma protein
Sulfonylureas action?
Cause insulin release,
Sulfonyureas bind to ATP K channels, closing it. Hence depolarisation, calcium ions influx, releasing insulin granules
Sulfonylureas secondary action?
Decrease lipolysis, decrease clearance of insulin and sensitize beta cells to glucose
Major side effect of sulfonylureas?
Hyppoglycaemia
Drug interaction: allopurinol, aspirin and alcohol
Consider when prescribing sulfonylureas these drugs ….?
Oral contraceptives and corticosteroids because they decrease glucose tolerance
Biguanides- metformin action?
Increase glucose uptake in muscle and decrease glucose production by liver
Metformin mechanism of action?
Suppression of hepatic glucose production
- Inhibits mitochondrial complex 1- decrease ATP synthesis, and gluconeogenesis needs energy.
Increase in AMP which inhibits fructose 1,6 bisphosphate key enzyme in gluconeogenesis - Activating AMP activated protein kinase- nuclear transcription factors SHP, which inhibits expression of gluconeogenesis genes PEPCK and glucose 6 phosphatatse
Biguanides secondary action?
- Increase insulin sensitivity- by AMPK insulin binding to its receptors
- Increased GLUT 4 translocation
- Pushes heart muscle to use glucose by MAPCK and PKC
- Increase fatty acid oxidation
- Decrease glucose absorption from GI tract
Properties of metformin?
Oraly active
Doesn’t bind to plasma proteins, excreted unchanged in urine.
Half life 1.3 and 4.5 hours
Also used for PCOS
Adverse effect of metformin?
Lactic acidemia
Metallic taste, nausea, abdominal discomfort, diarrhoea, anorexia more common
Decreases absorption of vitamin B12 and folate