Pharmacologic Treatment

Question 0

What are the types of Sulfonylureas?

Answer 0

Glyburide- Micronase, Glynase

Glipizide - Glucotrol, Glucotrol XR

Glimepiride - Amaryl

Question 1

What are the five classes of orally administered agents used for type two diabetes

Answer 1

Sulfonylureas
Meglitinides
A biguanide
Thiazolidinediones
Alpha-glucosidase inhibitors

Question 2

How do Sulfonylureas work?

Answer 2

reduce glucose by increasing insulin secretion from pancreatic beta cells

(In persons with residual beta cell function)

Question 3

How do Meglitinides work?

Answer 3

They are short acting insulin secretagogues

that stimulate insulin release from pancreatic beta cells

Question 4

How do Biguanides work?

Answer 4

Increase sensitivity of insulin by decreasing Hepatic gluconeogenesis (primary effect)

increase in peripheral insulin sensitivity (secondary effect)

they do not increase insulin levels or weight gain

alone they do not cause hypoglycemia

Can cause G.I. upset nausea and diarrhea take with food or milk to minimize G.I. effects

Question 5

What is the action of alpha-glucosidase (carbohydrate digestion) inhibitors?

Answer 5

inhibit action of alpha-glucosidase (carbohydrate digestion)

Delaying and attenuating postprandial blood glucose peaks

Undigested sugars are delivered to the colon where they converted into short chain fatty acids, methane, carbon dioxide, and hydrogen.

Do not increase insulin levels or inhibit lactase; major effect is to lower postprandial glucose levels

Do not cause wt gain and may restore ovulation caused by insulin resistance

CAUTION: may cause G.I. symptoms
Not recommended in significant renal dysfunction

Question 6

What is the action of Thiazolidinediones?

Answer 6

^ peripheral insulin sensitivity

increases transcription of nuclear proteins that help increase uptake of glucose (probably with affects on free fatty acid levels)

Takes about 12 to 16 weeks to achieve maximal effect

May restore ovulation in an anovulation due to insulin resistance

improves target cells response to insulin without increase in insulin secretion from pancreas

decreases hepatic glucose output increases insulin-dependent glucose use in skeletal muscle & possibly liver/adipose tissue