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Type 2 Diabetes Mellitus Treatments (Insulin Secretagogues increase…
Type 2 Diabetes Mellitus Treatments
Metformin
Sensitizes both tissue (fat & muscles) and liver to insulin; main effect is by reducing background hepatic glucose release
GI side effects (start at low dose) and care required in chronic kidney disease)
Insulin Secretagogues
increase insulin secretion from the pancreas
by acting on K(ATP) channels
Sulphonylureas
(gliclazide, glimepiride, glyburide)
Meglitinides
(repaglinide)
Can cause hypoglycemia, weight gain; offer less durable glucose lowering
Incretins
a group of hormones that are released in the gut after a meal that increase and augment
the insulin response
DPP-IV inhibitors
slow breakdown of endogenous incretins
relatively mild effect on glucose levels
GLP-1 analogues
analogue of endogenous incretins that are resistant to DPP4
slow gastric emptying; can cause nausea and vomiting;
taken by injection
SGLT2 inhibitors
reduce set point for kidney to remove glucose from the blood
can cause yeast infections in women
can mask DKA, leading to euglycemic DKA
require good renal function
Alpha glucosidase inhibitors
Acarbose
slows digestion of oligosaccharides to monosaccharides
causes lots of gas
TZDs - insulin sensitizers
cause weight gain, should not be combined with insulin
current research says no effect on cardio vascular system, but was subject of a scare in the past