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Insulin and Oral Antidiabetic Drugs - Coggle Diagram
Insulin and Oral Antidiabetic Drugs
Diabetes diagnosis
two hours after glucose load mg/dL (mmol/L) : more than or equal to 200
HbA1C (%) : more than or equal to 6.5
shows level of glucose intake in the past 2-3 months
Type 2 Diabetes
abnormal insulin secretion
resistance to insulin action in target tissues associated with decreased number of insulin receptors
types: 1, 2, secondary, gestational
Insulin
category B (not teratogenic) - can be used in pregnancy
Types of preparations
Ultra-short acting (eg insulin lispro, insulin aspart)
Short-acting (regular) - Novolin R, Humulin R
intermediate-acting (NPH, Lente insulin)
Long-acting
Insulin Glargine
Insulin Detemir
Insulin Degludec
safer than intermediate-acting insulin preparations (reduced risk of hypoglycemia)
constant circulating insulin over 24 hr with no pronounced peak
Complications: severe hypoglycemia - <50mg/dL (life threatening)
hyperglycemia is better
tachycardia, sweating - major signs of hypoglycemic shock
Oral Antidiabetic Drugs
Sulfonylureas
first generation
tolbutamid (short-acting), acetohexamide & tolazamide (intermediate-acting), chlorpropamide (long-acting)
good for patients with renal impairement
second generation
glipizide (short-acting), glibenclamide & glimepiride (long-acting)
mechanism of action
release of insulin from beta-cells (no use in DM 1)
reduction of serum glucagon concentration
potentiation of insulin action on target tissues
Meglitinides
bind to the same K-ATP channel like sulphonylureas to cause insulin release from beta-cells
advantage: patients allergic to sulfur or sulfonylurea
side effect: hypoglycemia
Biguanides (eg Metformin)
activation of AMP-dependent protein kinase
increase peripheral glucose utilization
inhibit gluconeogenesis
impair absorption of glucose from the gut
advantage over sulfonylureas : does not cause hypoglycemia or weight gain
alpha-glucosidase inhibitors (eg acarbose)
inhibit intestinal alpha-glucosidases and delay carbohydrate absorption
reducing post-prandial increase in blood glucose
side effect: flatulence (since food remains longer in the GIS)
thiazolidinedione derivatives
rosiglitazone, pioglitazone
activate PPAR-gamma receptors
increase target tissue sensitivity to insulin by reducing hepatic glucose output and increase glucose uptake and oxidation in muscles and adipose tissues
do not cause hypoglycemia (similar to metformin and acarbose)
glucagon-like polypeptide-1 (GLP-1) receptor agonists
new on the market
analogs of GLP-1 : bind GLP-1 receptors
insulin preferred over oral drugs since long-term side effects can be prevented