treatment of type II diabetes Flashcards
hypoglycemic agents
1) insulin secretagues (sulfonourea)
treatment algorithm
1) metformin
2) sulfonylurea, metformin,
3_ basal insulin, pre mix insulin, or glucosidase inhib, GLP-1 agonist
4) basal + meal time insulin, pre-mix insulin consider basal and meal time
sulphonylureas and meglitinides side effects
1) hypoglycemia
2) weight gain
3) cytochrome p450
insulin secretion
1) glucose transported into the beta cells and converted to G6P
2) ATP produced
3) ATP sensitive K+ channel closes
4) depolarization of cell
5) voltage gated Ca2+ channel open
6) exocytosis of insulin
1) incetin analogues
1) bind to incretin receptor
2) minimic incretins
3) exenatide trulicity ozempic, wegovy
dipeptidyl peptidase IV inhibitors
1) sitagliptin blocks DPP-4 enzymes
2) alogliptin, saxagliptin, linagliptin, increases activation of endogenous incretins
side effects of increase incretin
1) beneficial
- reduced gastric emptying
- increased satiety
- weight loss
2) adverse side effects
- nausea
- gastric upset
- increased risk of pancreatitis
alpha glucosidase inhibitors
1) locally acting in GI tract
2) prevents formation of easily absorbed monosaccharides
3) side effects
- gastric distress, diarrhea, flatulence
biguinides
1) mechanisms of action unclear
- inhibits lipogenic enzymes, increase FA oxidation, glucose uptake in tissue, increase insulin dependent uptake, reduces production of glucose, reduce glucose absorption, reduce plasma glucagon levels
2) metformin
- prediabetes, anti cancer, anti aging, neuroprotection, long covid prophylacxis
metformin side effects
1) GI tract distress
2) weight loss
4) increase risk of lactic acidosis
4) water retention
thiasolidinediones
1) insulin sensitizers
2) activate PPAR
3) activation of insulin responsive genes
4) side effects
- increase in HDL and LDL
- weight gain
- cause heart failure
- bladder cancer risk
novel agents in diabetic care
1) oral insulin
2) inhaled insulin
- less control
medically complex patients
