Unit 6 Endocrine System Diabetes pt.2

Anti-Diabetic Agents

Nonsulfonylureas (Meglitinides) 💊

What are they?

A medicine used to treat Type 2 Diabetes .

AKA Secretagogues/ Meglitinides

This means:

➡They make the pancreas release more insulin.

How Do They Work? (MOA)

They work on the beta cells of the pancreas.

➡ Calcium (Ca++) enters the cells.

➡This tells the pancreas:

"Release insulin!"

➡ More insulin lowers blood sugar.

Similar to sulfonylureas, but they work faster. ⚡

Side Effects

⬇ Hypoglycemia (low blood sugar)

🤢 GI upset (nausea, stomach problems)

⚖ Weight gain

☀ Photosensitivity (more sensitive to sunlight)

😴 Weakness, fatigue, dizziness

🍺 Alcohol interaction (disulfiram reaction) → avoid alcohol

Patient Education

🍽 Take 15 minutes before a meal

⚡ Works faster than sulfonylureas

Super Easy Memory

Meglitinides = Fast insulin releasers

💊 Stimulate pancreas

💉 Release more insulin

🍬 Lower blood sugar

⏰ Take 15 minutes before meals .

Anti-Diabetic Agents 1

Biguanides (Example: Metformin) 💊

•  (insulin resistance reducers/antihyperglycemics)

What are they?

A medicine for Type 2 Diabetes .

AKA

Insulin resistance reducers

Think:
➡ Help the body use insulin better.

How Do They Work? (MOA)

1. Stops the Liver from Making Too Much Glucose 🫘

(Inhibits gluconeogenesis)

Think:
➡ Less new sugar made by the liver

2. Decreases Glucose Absorption 🍞

The intestines absorb less glucose from food.

Think:
➡ Less sugar enters the blood

3. Makes Cells More Sensitive to Insulin 💉

Muscle and fat cells respond better to insulin.

Think:
➡ Insulin works better

4. Helps Tissues Use Glucose for Energy ⚡

Moves glucose into body tissues to be used.

Think:
➡ More glucose used, less stays in the blood

5. Lowers Blood Sugar After Meals 🍽

(Postprandial blood sugar)

Think:
➡ Keeps blood sugar from spiking after eating

Anti-Diabetic Agents

• Biguanides (insulin resistance

• reducers/antihyperglycemics)
  
  side effects

⚠ Lactic Acidosis (Black Box Warning)

Rare but serious.

Signs:

• Muscle pain (myalgia)

• Trouble breathing

• Abdominal pain

• Fatigue

🤢 GI Side Effects

• Nausea/Stomach upset/ Diarrhea

💨 Flatulence

• Gas

⚖ Weight Loss

May help people lose weight

🪙 Metallic Taste

Food may taste metallic.

♀ PCOS Benefits

Dog:

• Improve ovulation

• Help regulate menstrual cycles

🍽 Take With Food

Helps reduce stomach upset.

Super Easy Memory

Biguanides (Metformin)

✅ Less sugar made by liver
✅ Less sugar absorbed from food
✅ Insulin works better
✅ Lowers blood sugar after meals

Side Effects:
⚠ Lactic acidosis
🤢 GI upset
💨 Gas
⚖ Weight loss
🪙 Metallic taste

📚 Take with food 🍽

Anti-Diabetic agents-Type 2 Diabetes

Biguanides (insulin resistance reducers, anti-hyperglycemics)

metformin                           Glucophage®

Insulin Sensitizers (Thiazolidinediones) 💊

Anti-Diabetic Agents

What are they?

A medicine for Type 2 Diabetes .

How Do They Work? (MOA) 1. Increase Insulin Sensitivity 💉

They help the body's cells respond better to insulin.

Think:
➡ Insulin works better

2. Decrease Insulin Resistance 🚫

The body stops "ignoring" insulin as much.

Think:
➡ Less resistance = lower blood sugar

3. Decrease Hepatic Gluconeogenesis 🫘

The liver makes less new glucose (sugar).

Think:
➡ Less sugar made by the liver

Side Effects

⬇ Hypoglycemia = low blood sugar

⚖ Weight gain

💧 Fluid retention (holds extra water)

• Not good for people with heart failure (HF)

⚠ Hepatotoxicity = liver damage

🤢 Nausea

🚽 Diarrhea

🤕 Headache (HA)

😴 Fatigue

Patient Education

🩸 Monitor LFTs (Liver Function Tests)

Think:
➡ Check the liver regularly because the medicine can affect it.

Anti-Diabetic Agents

Insulin Sensitizers (Thiazolidinediones) 💊

Super Easy Memory

Thiazolidinediones = Make insulin work better

✅ Increase insulin sensitivity
✅ Decrease insulin resistance
✅ Decrease liver glucose production

Watch for:
⚖ Weight gain
💧 Fluid retention (avoid in HF)
⚠ Liver problems

📚 Monitor liver tests (LFTs) 🩸🫘

Anti-Diabetic agents-Type 2 Diabetes

     Thiazolidinediones (insulin sensitizers) drug

rosiglitazone                       Avandia®

pioglitazone                        Actos®

Anti-Diabetic Agents

Alpha-Glucosidase Inhibitors 💊

• (Glucose Absorption Inhibitors, antihyperglycemics)

What are they?

A medicine for Type 2 Diabetes .

AKA

Glucose Absorption Inhibitors

Think:
➡ Slow down sugar absorption from food.

How Do They Work? (MOA)

They slow the digestion of carbohydrates (carbs) in the small intestine.

As a result:

➡ Sugar enters the blood more slowly.

➡ Blood sugar rises gradually instead of spiking quickly.

Think:
🍞 Carbs are absorbed slowly = smaller blood sugar increase

Side Effects

🤢 Stomach discomfort

🎈 Bloating

🚽 Diarrhea

🤕 Abdominal (stomach) pain

💨 Flatulence (gas)

⚠ Malabsorption = body may not absorb nutrients as well

Patient Education

🍽 Take with each meal

This helps the medicine work on the carbohydrates you eat.

Anti-Diabetic Agents

Alpha-glucosidase Inhibitors (Glucose Absorption Inhibitors, antihyperglycemics)

Super Easy Memory

Alpha-glucosidase inhibitors = Slow down carb digestion

🍞 Carbs slower absorbed
📉 Smaller rise in blood sugar

Side effects:
🤢 Stomach upset
🎈 Bloating
💨 Gas
🚽 Diarrhea

📚 Take with every meal 🍽

Anti-Diabetic Agents

Alpha-glucosidase Inhibitors (glucose absorption inhibitors, anti-     hyperglycemics) drug

miglitol                              

acarbose

Anti-Diabetic Agents

GLP-1 Receptor Agonists (Anti-Diabetic Drugs) — EASY VERSION

Big idea:
GLP-1 drugs act like a natural hormone that helps lower blood sugar.

Think: “GLP-1 = Gets Less sugar in the blood”

MOA (How it works):

GLP-1 agonists do 3 main things:

1. ↑ Insulin release

• Tells pancreatic beta cells → “Release insulin!”

• More insulin = glucose moves into cells = lower blood sugar

2. ↓ Glucagon

• Glucagon normally tells the liver to release sugar

• Blocking glucagon = less sugar released

3. Slows stomach emptying

• Food leaves the stomach slower

• Sugar enters the blood more slowly

• Prevents big blood sugar spikes after meals
  

• ⭐ GLP-1 = Insulin UP, Sugar release DOWN, Stomach slows DOWN

Why take it before meals?

Because it helps control the blood sugar rise that happens after eating.

---

Patient Teaching / Side Effects:

Common side effects:

• 🤢 Nausea

• 🤮 Vomiting

• 💩 Diarrhea

• 🤕 Headache

• 😵 Dizziness

Watch for pancreatitis:

• Severe, persistent stomach/abdominal pain → report it

If injectable:

• Rotate injection sites
  (don't inject in the exact same spot every time)

Anti-Diabetic Agents

• GLP-1 (glucagon-like peptide-1) Receptor Agonist. easy memory

GLP-1 = “Gets Less Peaks”

• Gets insulin working ✅

• Less glucagon sugar release ✅

• Less glucose spikes after meals ✅

• Less stomach speed ✅

Examples: semaglutide (Ozempic®), liraglutide (Victoza®), dulaglutide (Trulicity®)

One sentence summary:
GLP-1 agonists copy a hormone that makes the pancreas release insulin, slows digestion, and lowers blood sugar spikes after meals.

• Have seen improvements in patients with heart failure who are on GLP-1 agonists

   Anti-Diabetic Agents

GLP1 (glucagon-like peptide-1)- Receptor Agonist drug

exenatide                             Byetta®, Bydureon®

liraglutide                            Victoza®

dulaglutide                          Trulicity®

semaglutide Ozempic®, Wegovy®

           

Anti-Diabetic Agents

SGLT2 Inhibitors (Anti-Diabetic Drugs)

• SGLT2 (Sodium Glucose CoTransporter-2) Inhibitor drug

Big idea:
SGLT2 drugs make the kidneys get rid of extra sugar through urine.

Think:
⭐ SGLT2 = “Sugar Goes Leaving Through the pee”

MOA (How it works):

Normally:

• Kidneys filter glucose → then put it back into the blood

SGLT2 inhibitors:

• 🚫 Block glucose from being reabsorbed

• ✅ Sugar stays in urine → leaves the body when you pee

Result:
➡ Less sugar in the blood = lower blood glucose

Other effects:

• 💪 Helps muscles use glucose better

• ⬆ Increases insulin sensitivity (body responds better to insulin)

• ⬇ Decreases gluconeogenesis (less new sugar made by the liver)

Patient Teaching / Side Effects:

🚽 Increased urination

• More sugar leaves through urine → more water follows

🦠 ICUs

• Extra sugar in urine can help bacteria grow

🍞 Yeast infections

• Sugar in urine creates an environment where yeast can grow

💩 Constipation

⚠ Monitor kidney function

• Can affect kidney health, so kidney labs are important

Anti-Diabetic Agents

• SGLT2 (Sodium Glucose CoTransporter-2) Inhibitor

Easy memory:

SGLT2 = “Sugar Gets Lost Through the Toilet” 🚽

• Sugar leaves in urine ✅

• More pee ✅

• Watch kidneys, UTIs, yeast infections ✅

One-sentence summary:
SGLT2 inhibitors lower blood sugar by making the kidneys dump extra glucose into the urine instead of putting it back into the blood.

• decreases kidney reabsorption of glucose back into the blood and enhances glucose secretion and excretion via the urine, enhances glucose uptake into muscles, increases insulin sensitivity, decreases gluconeogenesis

Anti-Diabetic Agents

SGLT2 (Sodium Glucose CoTransporter-2) inhibitor

canagliflozin                       Invokana®

dapagliflozin                    Farxiga®

empagliflozin                   Jardiance

DPP-4 Inhibitors (Anti-Diabetic Drugs) — EASY VERSION

Big idea:
DPP-4 inhibitors help your body keep GLP-1 working longer.

Think:
⭐ DPP-4 = “Don't Destroy Peptide-4”
(It stops the breakdown of GLP-1)

MOA (How it works):

Normally:

• An enzyme called DPP-4 breaks down GLP-1

• Less GLP-1 = less insulin release

DPP-4 inhibitors:

• 🚫 Block DPP-4 enzyme

• ✅ GLP-1 stays around longer

• ✅ More insulin gets released

• ✅ Less glucagon is released

Result:
➡Lower blood sugar

GLP-1 = tells pancreas “make insulin”
DPP-4 = destroys GLP-1
DPP-4 inhibitor = saves GLP-1 → more insulin

Side Effects / Patient Teaching:

🤧 Nasopharyngitis

• Stuffy/runny nose, sore throat

🤒 URI (upper respiratory infection)

• Cold-like symptoms

🤕 Headache

Anti-Diabetic Agents

• DPP-4 (dipeptidyl peptidase 4) Inhibitors
  
  One-sentence summary:

DPP-4 inhibitors block the enzyme that destroys GLP-1, allowing GLP-1 to increase insulin release and lower blood sugar. ✅

Quick comparison:

• GLP-1 agonist: acts like GLP-1 directly

• DPP-4 inhibitor: protects your body's GLP-1 so it lasts longer

MOA: suppresses glucagon secretion, increases insulin secretion, inhibits enzyme that breaks down GLP-1, this allows GLP-1 to stimulate insulin secretion 

Anti-Diabetic Agents

DPP (dipeptidyl peptidase)-IV inhibitors

drugs

sitagliptin                            Januvia®

saxagliptin                          Onglyza®