Lecture 13: Disease Process and Treatment: Diabetes Management

What are ways to reduce the risk of diabetes?

Reduce blood sugar, reduce blood pressure, maintain a normal diet, exercise

ABCs of diabetes treatment

A: A1C control, B: Blood pressure control, C: Cholesterol control

Three main types of oral medications for diabetes

Metformin, DPP-IV inhibitors, SGLT-2 inhibitors

How does metformin work?

1. Metformin (drug) enters the mitochondria and binds to complex 1 on the ETC.

2. binding causes an uncoupling of the ETC with ATP synthase.

3. creates an increase in AMP and decrease in ATP --> causes:

a. activation of AMPK: improved insulin receptor function --> improves insulin sensitivity

b. the inhibition of Adenylyl Cyclase: causing the inhibition of

gluconeogenesis.

What do incretins do?

Increase glucose uptake in the muscles and decreases gluconeogenesis in the liver, decreasing blood glucose levels.

How do incretins affect glucose homeostasis?

act on the pancreatic alpha and beta cells to decrease glucagon secretion and increase insulin secretion --> decrease in gluconeogenesis in the liver and an increase in glycolysis in the muscles --> decrease in blood glucose

What DPP-4 inhibitors do

keep the incretins active for longer

How does Ozempic work?

Activates GLP-1 and GIP --> acts on pancreatic beta cells to release insulin --> appetite suppression.

How do kidneys regulate glucose?

contain the SGLT1 which reabsorbs about 10% of the glucose and SGLT2 which absorbs about 90% of the glucose.

What SGLT inhibitors do

Increase insulin sensitivity in the muscle

Increase in insulin sensitivity in liver

Decrease in gluconeogenesis

Blood glucose levels drop

Why are SGLT2 inhibitors preferred over SGLT1 inhibitors?

SGLT2 reabsorbs 90% of glucose vs. SGLT1's 10%, so SGLT2 inhibition leads to greater sugar excretion