Type II Diabetes: Oral Glycaemic Agents

Question 1

Which endocrine gland is not regulated by a hypothalamic-pituitary loop?

Answer 1

Pancreas

Question 2

What does the pancreas directly respond to?

Answer 2

Plasma glucose levels

Question 3

What are the backups for eliciting an insulin-like response?

Answer 3

Sympathetic > adrenal medulla > adrenaline

Anterior pituitary > adrenal cortex > cortisol

Question 4

What are the exocrine cells of the pancreas?

Answer 4

Acinar cells

Question 5

What are the endocrine cells of the pancreas?

Answer 5

Islets of Langerhans

Question 6

What cells in the islets of Langerhans secrete glucagon?

Answer 6

Alpha cells

Question 7

What cells in the islets of Langerhans secrete insulin?

Answer 7

Beta cells

Question 8

What cells in the islets of Langerhans secrete somatostatin?

Answer 8

Delta cells

Question 9

What are the responses to insulin after a meal in someone with a relative lack of insulin?

Answer 9

Can have higher than normal basal rate
Food taken
No initial spike
Second maintained release sub-normal to normal

Question 10

What are the therapeutic lifestyle changes that can be made in type 2 diabetes?

Answer 10

Aim for ideal body weight
- Restrict refined sugars
- Reduce saturated fats
Adequate exercise
Stop smoking
Reduce alcohol
Treat hypertension and lipidaemias

Question 11

What do sulfonylureas do?

Answer 11

Increase insulin secretion from beta cells > restore phase 1 spike in insulin

Question 12

How do sulfonylureas work?

Answer 12

Inhibit ATP-gated K channels

Question 13

What are the pharmacokinetics of sulfonylureas?

Answer 13

Oral absorption
Half-life = 6-24 hours
Excreted via kidneys

Question 14

Why aren’t sulfonylureas used in pregnancy?

Answer 14

Cross placenta

Question 15

What are the adverse effects of sulfonylureas?

Answer 15

Hypoglycaemia

Weight gain

Question 16

What is the drug class of metformin?

Answer 16

Biguanides

Question 17

What does metformin do?

Answer 17

Increases insulin-mediated peripheral glucose uptake
Reduces hepatic glucose production
Decreases carbohydrate absorption
Reduces LDL cholesterol level and triglycerides

Question 18

How does metformin work?

Answer 18

Activation of AMP kinase

Question 19

What are the adverse effects of metformin?

Answer 19

GI disturbances
- Diarrhoea
- Nausea
- Abdominal discomfort
- Anorexia
Lactic acidosis if improperly prescribed
Possible modest weight loss

Question 20

In whom is metformin contraindicated?

Answer 20

Patients with impaired renal function

Question 21

What is the drug class of acarbose?

Answer 21

Alpha-glucosidase inhibitors

Question 22

How does acarbose work?

Answer 22

Doesn’t have to enter bloodstream

Blocks enzymes that digest and promote absorption of starches in small intestine

Question 23

What are the pharmacokinetics of acarbose?

Answer 23

Not absorbed from GIT

Question 24

What are the adverse effects of acarbose?

Answer 24

Flatulence/abdominal discomfort

Loose stools and abdominal pain

Question 25

In whom is acarbose contraindicated?

Answer 25

Patients with - Inflammatory bowel disease - Cirrhosis

Question 26

What are incretins?

Answer 26

Gut hormones release when food is ingested - GLP-1 - GIP

Question 27

What do incretins do?

Answer 27

``` Increase - Insulin release from beta cells - Glucose uptake by muscles Decrease - Glucagon release from alpha cells - Glucose production by liver ```

Question 28

What is the drug class of sitagliptin?

Answer 28

"Gliptins" | Dipeptidyl peptidase-4 (DPP-4) inhibitors

Question 29

What does sitagliptin do?

Answer 29

Increases native GLP-1 levels

Question 30

How is sitagliptin administered?

Answer 30

Orally

Question 31

What are the adverse effects of sitagliptin?

Answer 31

``` URTIs Headaches Hypoglycaemia when combined with insulin Allergic/hypersensitivity reactions Pancreatitis (rare) ```

Question 32

What is the drug class of exenatide?

Answer 32

Glucagon-like polypeptide-1 (GLP-1) receptor agonists

Question 33

How is exenatide administered?

Answer 33

Subcutaneous injection

Question 34

What are the actions of exenatide?

Answer 34

Potentiate glucose-mediated insulin secretion Suppress glucagon release Slow gastric emptying Loss of appetite

Question 35

What are the adverse effects of exenatide?

Answer 35

``` Nausea Vomiting Diarrhoea Weight loss Ab formation Immune reactions Pancreatitis ```

Question 36

What is the approach and drug class for managing a relative lack of insulin?

Answer 36

Stimulate pancreas to make more insulin | Sulfonylureas

Question 37

What is the approach and drug class for managing insulin resistance?

Answer 37

Sensitise body to insulin and/or control hepatic glucose production Biguanides

Question 38

What is the approach and drug class for managing glucose absorption?

Answer 38

Slow absorption of starches | Alpha-glucosidase inhibitors

Question 39

What is the approach and drug class for managing incretins?

Answer 39

Regulate glucagon and insulin | Incretin mimetics and enhancers

Question 40

What is the approach and drug class for managing glucose reabsorption?

Answer 40

Slow renal glucose reabsorption | SGLT2 inhibitors