Lecture 18: Medicines for Type 2 diabetes

Question 1

What class of drug is metformin?

Answer 1

A biguanide

Question 2

What is used first line for type 2 diabetes?

Answer 2

Metformin

Question 3

What is the mechanism of action of metformin?

Answer 3

Reduces glucose production in the liver.
1. Inhibits ATP synthesis
2. Increase in AMP
3. Activation of AMPK
4. Phosphorylation and inhibition of CRTC2. This inhibits gluconeogenis, so decreases glucose production in the liver.

Question 4

What are the side effects of metformin?

Answer 4

• GI side effects such as diarrhoea, nausea, vomiting, abdominal bloating, gas, reduced appetite
• Vitamin B12 deficiancy: metformin reduces intestinal absorption of vitamin B12. This can lead to symptoms such as tiredness and tingling in hands and feet
• Lactic acidosis (rare)

Question 5

What is the mechanism of action of sulfonylureas?

Answer 5

Stimulate beta cells to secrete insulin.
1. The drug binds to the receptor on beta cells, the ATP gated potassium channels
2. This causes the channel to close
3. Membrane depolarisation
4. Leads to insulin secretion

Question 6

What are the side effects of Sulfonylureas?

Answer 6

• Hypoglycaemia
• Weight gain

Question 7

What is the mechanism of action of Meglitinides?

Answer 7

Stimulate beta cells to secrete insulin.
1. The drug binds to the receptor on beta cells, the ATP gated potassium channels
2. This causes the channel to close
3. Membrane depolarisation
4. Leads to insulin secretion

Question 8

When do you take meglitinides?

Answer 8

Take before meals to help prevent excessive postprandial blood glucose spikes and promotes better glucose control.

Question 9

What are the generic names for sulfornylureas?

Answer 9

• Glibenclamide
• Gliclazide
• Glipizide
• Glimepiride
• Tolbutamide

Question 10

What are the generic names for meglitinides?

Answer 10

• Repanglinide
• Nateglinide

Question 11

What is the mechanism of action of thiazolidinediones?

Answer 11

They are insulin sensitizers, they increase cells responsiveness to insulin
1. Thiazolidinediones bind to and activate the nuclear receptor PPARg
2. Activation of PPARγ leads to increased insulin sensitivity
3. They promote glucose uptake and utilization in skeletal muscle, leading to lower blood glucose levels.

Question 12

What are the side effects of thiazolidinediones?

Answer 12

• Water retention
• Weight gain

Question 13

What is GLP 1?

Answer 13

Naturally occurring hormone that plays a role in glucose regulation.

Question 14

What are GLP-1 analogues?

Answer 14

Mimic the action of GLP 1

Question 15

What is the mechanism of action of GLP 1 analogues?

Answer 15

1. They bind to and activate GLP 1 receptors, which are primarily located in the pancreas
2. this leads to an increased insulin secretion in a glucose dependnt manner
3. GLP 1 analogues also decrease glucagon secretion, which helps reduce hepatic glucose production

Question 16

What are the generic names for GLP 1 analogues?

Answer 16

• Exenatide (twice-daily injection)
• Exanatide (once-weekly injection)
• Liraglutide (once-daily injection)
• Lixisenatide (once-daily injection)
• Dulaglutide (once-weekly injection)
• Semaglutide (once weekly injection)

Question 17

What is the mechanism of action of DPP 4 inhibitors?

Answer 17

They inhibit the action of DPP 4 enzymes, which leads to an incresed level of GLP 1 and GIP. stimulates insulin secretion from the pancreas in response to elevated blood glucose levels and suppresses glucagon secretion, reducing hepatic glucose production. GIP also stimulates insulin secretion, although its contribution to glucose regulation is less significant compared to GLP-1.

Question 18

What are the generic names of DPP 4 inhibitors?

Answer 18

Sitagliptin
Sitagliptin + Metformin
Vildagliptin
Vildagliptin + Metformin
Saxagliptin
Alogliptin
Alogliptin + Metformin
Linagliptin
Linagliptin + Metformin
Saxagliptin + Metformin

Question 19

How do alpha glucoside inhibitors work?

Answer 19

slows down the absorption of starchy foods by intestine- slows rise in blood glucose after a meal

Question 20

How do SGLT2 inhibitors work?

Answer 20

Act by inhibiting the glucose transporter SGLT2, which functions in the kidney to mediate glucose reabsorption

Question 21

What is the generic name for SGLT2 inhibitors?

Answer 21

Dapagliflozin
Canagliflozin
Empagliflozin