Pancreatic Hormones

Amylin

• ↑ insulin release

• anorexiant

• slows down gastric emptying

Incretins

• GI hormones that are enhanced in response to high CHO lead

• ↑ insulin release

• anorexiant

• slows down gastric emptying

T1DM

• Insulin dependent

• absolute lack of insulin

• beta-cell destruction

• Insulin

• Pramlintide

Tx of type 1 DM

T2DM

• non-insulin dependent

• insulin level: normal, but receptors are resistant

• relative lack of insulin

antidiabetic agents (PO)

Tx of T2DM

T3DM

due to underlying disease

T4DM

gestational DM

Demand

for post-prandial hyperglycemia

Basal

to control normal body glucose for 24hrs.

• hypoglycemia

• weight gain

• lipodystrophy

• allergy

T/E of insulin

• GLP-1 agonist

• Pramlintide

antidiabetic drug PO except for

• inhibit polarization

• Ca²⁺ channel opening

MOA of insulin secretagogues

tolbutamide

elderly, shortest t₁/₂

chlorpropamide

• used with caution in hepatic and renal insufficiency patient

• longest, t₁/₂

meglitinides

for post-prandial hyperglycemia (give 30 minutes before breakfast)

• tremors

• headaches'

• tachycardia

• sweating

• hostility

T/E of biguanides

biguanides

only euglycemic agents

• 1st line T2DM

• management of prediabetes

use of biguanides

• diarrhea

• lactic acidosis

• weight loss

T/E of biguanide

Thiazolidinediones

“insulin sensitizers”

Rosiglitazone

withdrawn due to heart failure (Cardiotoxic)

PPAA-gamma agonists

• enhanced fatty acid metabolism

• ↑ glucose utilization

MOA of thiazolidinediones

• hepatoxicity

• cardiotoxicity

T/E of thiazolidinediones

Alpha-glucosidase inhibitor

prevent alpha-glucosidase

• Flatulence

• Diarrhea

• Weight loss

T/E of alpha-glucosidase inhibitors

• Incretin-based drugs (GLP-1 agonist)

• Dipeptidylpeptidase-IV inhibitors

Incretin-based drugs

• nausea and vomiting

• weight loss

• hypoglycemia

T/E of Incretin-based drugs

• Hypoglycemia

• weight loss

• UTI

SGLT2 inhibitors T/E