Treatment of DM2

Question 1

-is the first line oral agent for the management of type II diabetes

Answer 1

Metformin

(“Skinny Kid on his knee saying a metaphor”)

Question 2

Drug used in treatment of Diabetes Type 2

Answer 2

Biguanides (“Kid saying a metaphor”)
Metformin

Thiazolidinones (“Glitter zone”)

Rosiglitazone
Pioglitazone

Amylin Analogues (“Amy and Lynn”)
Pramlintide

α-Glucosidase inhibitors (“A-Carb wigglers”)
Acarbose
Miglitol

SGLT2 inhibitors (“Flossing teeth man”)

Canagliflozin
Dapagliflozin

Question 3

Metformin MOA

Answer 3

-metformin inhibits the mitochondrial enzyme glycerophosphate dehydrogenase (mGDP)􏰀decreasing hepatic gluconeogenesis
(“Girl eating the mitochondrial candy then puking”)

-metformin activates the enzyme AMP-activated protein Kinase (AMPK)􏰀 decreased gluconeogenesis, increased insulin sensitivity
(“AMPKandy”)

-metformin modulates enzyme function to decrease hepatic gluconeogenesis
(“Girl stopping candy release from liver bag”)

-Metformin increases insulin sensitivity
(valentines mailbox is to simulate “welcome inside”mat)

Question 4

Metformin Side Effects

Answer 4

-most common side effect with metformin use is GI side effects (nausea, anorexia, vomiting, diarrhea)
(“Nauseated girl had too many AMPKyandy”)

-metformin can cause lactic acidosis. This is due to metformin inhibiting lactic acid ability to enter gluconeogenic pathways into the liver
(“Spilled sour milk”)

-renal insufficiency increases the risk of metformin induced lactic acidosis
(“Cracked kidney tray”)

-metformin can cause modest weight reduction
(“Skinny kid saying a metaphor”)

Question 5

Thiazolidinones **MOA

Rosi**
glitazone
Pioglitazone

Answer 5

-thiazolidinones (glitazones) are ligands of peroxisome proliferator activated receptor gamma (PPARy) an intracellular nuclear receptor that regulates gene transcription causing increased insulin sensitivity, found in muscle, fat, and the liver
(“PPARy in circle”)

-PPAR-y upregulates adiponectin
(“Turtle neck”)

--hiazolidinedione’s (glitazones) upregulate GLUT4 in peripheral tissues (increased glucose uptake)
(“4 on open mailbox door”)

-thiazolidinedione’s (glitazones) increase insulin sensitivity
(“Inside open candy box”)

-thiazolidinones (glitazones) increase the differentiation and number of adipocytes
(“Elevated fatty donut jar”)

-thiazolidinones (glitazones) increase triglyceride storage and fatty acid oxidation􏰀 decreased serum triglycerides
(“Eating Fatty donut”)

Question 6

Thiazolidinones Side Effects
(“Glitter zone”)

• *Rosi**glitazone
• *Pio**glitazone

Answer 6

-thiazolidinedione (glitazones) can cause weight gain
(“Fat belly on PPAR-y kid”)

-thiazolidinediones (glitazones) can cause fluid retention and peripheral edema, and decompensation of CHF
(“Baggy pants on PPAR-y kid”)

-thiazolidinones induced fluid retention can exacerbate heart failure
(“Falling heart balloon”)

-thiazolidinediones (glitazones) can increase the risk of atypical extremity fractures in women due to decreased bone mineral density
(“Fractured chair leg”)

Question 7

Amylin Analogues MOA
(“Amy and Lynn”)

Pramlinitide

Answer 7

-Pramlinitide is Amylin Analog , a small peptide hormone that is released into the bloodstream by the β cells of the pancreas along with insulin after a meal.

-amylin analogues (pramlintide) decrease gastric emptying
(“Closed gastric water cooler”)

-amylin analogues decrease glucagon secretion
(“Falling empty glucagon packets”)

Question 8

Amylin Analogues such as Pramlinitide are useful in treating …

Answer 8

-amylin analogues can be useful in the management of type I and type II diabetes
(“1 and 2 fingers being held up by Amy and Lynn”)

-amylin analogues can be used to control the postprandial glucose spike
(“Eaten cupcake”)

Question 9

Amylin Analogues Side Effects
(“Amy and Lynn”)

Pramlinitide

Answer 9

-pramlintide can cause hypoglycemia
(“Fallin candy jar”)

-pramlintide can cause GI side effects
(“Nauseated”)

Question 10

α-glucosidase inhibitors MOA
(“A-Carb wigglers”)

Acarbose
Miglitol

Answer 10

-inhibition of alpha-glucosidase enzymes decreases the conversion of disaccharides into absorbable monosaccharides

• alpha-glucosidase inhibitors decrease the activity of disaccharides on the intestinal brush border
  (“Brush border flags”)
• alpha-glucosidase inhibitors delay carbohydrate absorption
  (“Kid can’t open the bag, delayed bag opening”)

(“monosaccharide free”)

Question 11

α-glucosidase inhibitors are useful in which cases ?
(“A-Carb wigglers”)

Acarbose
Miglitol

Answer 11

-alpha-glucosidase inhibitors can be used to control post prandial glucose spike

(“Eaten cupcake”)

Question 12

α-glucosidase inhibitors Side Effect
(“A-Carb wigglers”)

Acarbose
Miglitol

Answer 12

-alpha-glucosidease inhibitors can cause GI side effects (diarrhea, flatulence, abdominal pain) due to fermentation of the undigested carbs by the gut flora

(“Leaky bathroom puddle”)

Question 13

SGLT-2 inhibitors MOA
(“Flossing teeth man”)

Canagliflozin
Dapagliflozin

Answer 13

• *2nd** or 3rd line drug
• inhibit sodium glucose cotransporter 2
• SGLT2 reabsorbs glucose in the proximal tubule (inhibition leads to urinary glucose loss)

(“Salty Glucose Co”)
(“Pro Cart Track”)

Question 14

SGLT-2 inhibitors Side Effects
(“Flossing teeth man”)

Canagliflozin
Dapagliflozin

Answer 14

-can increase the risk of UTI due to increased urine glucose concentration
(“Bladder cup”)

-can increase the risk of vaginal candidiasis
(“snow hitting crotch” , canadian flag )

-SGLT2 inhibitors can cause hypotension due to osmotic diuresis
(“Fainting blue kid”)

-SGLT2 inhibitors are contraindicated in renal insufficiency
(“Cracked kidney tray”)