Diabetes drugs

Question 1

What does metformin do?

Answer 1

Doesn’t affect insulin, glucagon, GH, cortisol or somatostatin
Reduces hepatic gluconeogenesis
Increases GLP-1 release from intestines
Increases glucose uptake in SM (GLUT4)
Decreases LDL and VLDL
Potentiates insulin action on adipose and skeletal muscle
Stimulates glycolysis

Question 2

Benefits of metformin

Answer 2

Reduces HbA1c
No hypoglycaemia
Doesn’t stimulate appetite or weight gain

Question 3

Side effects of metformin

Answer 3

Diarrhoea, nausea, metallic taste
Rarely lactate acidosis
Reduces B12 and folate absorption

Question 4

What are incretins?

Answer 4

Physiological gut and brain factors which promote insulin release

Question 5

Where is GLP-1 released from

Answer 5

ileum

Question 6

Where is GIP released from

Answer 6

K cells of duodenum

Question 7

Side effects of incretins?

Answer 7

Nausea and vomiting, constipation, diarrhoea
Headache
Acute pancreatitis

Question 8

Benefits of incretins

Answer 8

Stimulate insulin release
Suppress glucagon secretion
Reduce appetite and weight
Slow gastric emptying
Stimulates B cell number
No hypoglycaemia

Question 9

What is the suffix for incretin (GLP-1 analogues)

Answer 9

-tide

Question 10

What do DPP-4 inhibitors do?

Answer 10

Prolong activation of GLP-1

Question 11

What is another name for DPP-4 inihibitors

Answer 11

Gliptins

Question 12

Benefits of DPP-4 inhibitors?

Answer 12

Reduce HbA1c
No effect on weight
No hypoglycaemia

Question 13

Side effects of gliptins?

Answer 13

Possible increased cancer risk

Acute pancreatitis

Question 14

How do SGLUT-2 inhibitors work?

Answer 14

Inhibit glucose re-uptake in kidney

Question 15

Suffix for SGLUT-2 inhibitors?

Answer 15

-liflozin

Question 16

Benefits of SGLUT-2 inhibitors?

Answer 16

Reduce HbA1c
Reduce weight
CV and renal benefit
No hypoglycaemia

Question 17

Side effects of SGLUT2 inhibitors?

Answer 17

Polyuria
Dehydration
UTI
DKA

Question 18

How do sulphonylureas work?

Answer 18

Close to ATP sensitive K+ channels on B cells. Cause depolarisation and increased insulin release. Increase incretin expression in cell membrane

Question 19

Side effects of sulphonylureas?

Answer 19

Largely protein bound so lots of drug interactions
excreted in urine: enhanced effect in elderly and renal disease
Hypoglycaemia -» complication of neuroglycopenia
Weight gain

Question 20

Acute vs chronic effects of sulphonylureas?

Answer 20

Acutely: increase insulin release and decrease hepatic clearance of insulin
Chronically: no acute increase in insulin but decreased plasma glucose does remain, downreg sulphonylurea receptor, chronic hyperglycaemia

Question 21

Names of sulphonylureas

Answer 21

Carbutamide
Tolbutamide
Glibenclamide
Gliclazide
Glimepiride
Glipizide

Question 22

Names of SLGUT2 inhibitors

Answer 22

Dapagliflozin
Canagliflozin
Empagliflozin
Ertugliflozin

Question 23

What inhibits insulin release?

Answer 23

• Adrenaline
• Beta blockers
• Sympathetic nerves
• Alpha adrenergic drugs