Diabetes Therapy – First Aid 2025 High-Yield Summary

A comprehensive set of Q&A flashcards covering MOA, indications, and adverse effects of major diabetes medications from First Aid 2025.ables

What is the mechanism of action of rapid-acting insulin analogs (lispro, aspart, glulisine)?

Binds insulin receptors → tyrosine kinase activation → increases glycogen synthesis in liver and muscle, promotes K+ uptake in muscle, and increases fat storage (↑ TG).

When is insulin therapy indicated?

Type 1 DM, Type 2 DM, gestational diabetes, DKA (IV regular), and hyperkalemia treated with glucose.

What is the mechanism of action of metformin (a biguanide)?

Inhibits hepatic gluconeogenesis, increases glycolysis, and enhances peripheral glucose uptake (↑ insulin sensitivity).

What is metformin's role in type 2 diabetes management?

First-line therapy for type 2 DM.

What are the adverse effects and contraindications of metformin?

GI upset; lactic acidosis; contraindicated in renal insufficiency; can cause B12 deficiency.

How do sulfonylureas stimulate insulin release?

Close K+ channels in pancreatic β-cells → depolarization → Ca2+ influx → insulin release.

In which diabetes type are sulfonylureas used?

Type 2 DM (requires some islet function).

What are common adverse effects of sulfonylureas?

Hypoglycemia (↑ with renal failure) and weight gain; 1st-generation have disulfiram-like effects.

What is the mechanism of action of meglitinides (nateglinide, repaglinide)?

Close K+ channels in β-cells (different site from sulfonylureas) → insulin release.

In which diabetes type are meglitinides used?

Type 2 DM.

What are the adverse effects of meglitinides?

Hypoglycemia and weight gain.

What is the mechanism of action of GLP-1 receptor agonists (Exenatide, Liraglutide, Semaglutide, Dulaglutide)?

↑ glucose-dependent insulin release; ↓ glucagon; slows gastric emptying.

What is the indication for GLP-1 receptor agonists?

Type 2 DM.

What are common adverse effects of GLP-1 receptor agonists?

Nausea, vomiting; pancreatitis; weight loss benefit.

What is the mechanism of action of DPP-4 inhibitors (Sitagliptin, Saxagliptin, Linagliptin, Alogliptin)?

Inhibit DPP-4 → ↑ GLP-1 → ↑ insulin, ↓ glucagon.

In which condition are DPP-4 inhibitors used?

Type 2 DM.

What are common adverse effects of DPP-4 inhibitors?

Mild urinary or respiratory infections; weight neutral.

What is the mechanism of action of pramlintide (amylin analog)?

↓ gastric emptying; ↓ glucagon.

What is the indication for pramlintide?

Type 1 and Type 2 DM.

What are the adverse effects of pramlintide?

Hypoglycemia (with insulin) and nausea.

What is the mechanism of action of SGLT2 inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin)?

Block reabsorption of glucose in the proximal tubule → increased urinary glucose excretion.

What are the uses of SGLT2 inhibitors?

Type 2 DM; cardiovascular/renal benefit.

What are common adverse effects of SGLT2 inhibitors?

Glucosuria; UTIs; vaginal yeast infections; hyperkalemia; dehydration; orthostatic hypotension; weight loss; Canagliflozin ↑ risk of amputation.

What is the mechanism of action of α-glucosidase inhibitors (acarbose, miglitol)?

Inhibit intestinal brush-border α-glucosidase → delayed carbohydrate hydrolysis and glucose absorption.

What is the use of α-glucosidase inhibitors?

Type 2 DM.

What are common adverse effects of α-glucosidase inhibitors?

GI upset; diarrhea; flatulence.