Sites of Action for T2DM Meds Flashcards
Where do biguanides, aka metformin work?
Liver
Where do SGLT2i (-flozin) work?
Kidneys
How do SGLT2i work?
Decrease SGLT2 transporters to decrease glucose reabsorption from renal filtrate, leading to increased glucose excretion
How does metformin work?
Inhibits mitochondrial GPD –> reduces hepatic glucogenesis and lipogenesis
Where do alpha glucosidase (acarbose, miglitol) inhibitors work?
Gut/GI tract
How do alpha glucosidase inhibitors work?
Delays intestinal reabsorption of glucose by inhibiting glycosidase hydrolasae enzymes, which are required for carbohydrate metabolism
Where do sulfonylureas work?
Pancreatic beta cells
How do sulfonylureas work?
Inhibit Ca ATPase channels on beta cells –> increase in Ca2+ intracellularly leads to depolarization and insulin secretion
Where do GLP1 agonists/incretin mimetics (Ozempic, Trulicity) work?
Pancreas
How do GLP1 agonists/incretin mimetics work?
Bind GLP1 receptors and resist DDP4 degradation –> increases insulin secretion, decrease glucagon secretion, and delays gastric emptying POSTPRANDIALLY ONLY
Where do DDP4 inhibitors (-gliptin, Januvia) work?
Pancreatic beta cells
How do DDP4 inhibitors work?
Stop DDP4 from breaking down GLP1, increased circulating GLP1 delays gastric emptying, decreases circulating glucagon and increases insulin
Where do thiazolidinediones work?
Adipose tissue primarily, also in the muscle
How do thiazolidinediones work?
Decrease insulin resistance by increasing transcription of genes that increase insulin sensitivity by increasing glucose and lipid metabolism
What are the insulinotropic medications (require some functioning beta cells to be effective)?
GLP1 agonists
DDP4i
Meglitinides
Sulfonylureas
