most common drug given to type 2 diabetics
metformin
pro of metformin
no weight gain , no hypos
how does metformin work
it reduces glucose production by the liver but unsure excact mechanism - linked to inhibition of mitochondrial respiratory chain complex 1
eg. It inhibits ATP synthesis by binding to FOX1 - increasing AMP - this activates AMPK and phophorylates and inhibits CRTC2. This inhibits gluconeogenic gene expression
side effects of metformin
GI effects: eg diarrhoea/nausea/vomiting
lowers absorption of vit b12
lactic acidosis (rare)
example of a sulfonylurea
glicazide or glipizide
How do sulfonylureas work
stimulate insulin secretion from pancreatic beta cells by binding to ATP-gated potassium channel - which causes closure and depolarisation and more calcium enters -> insulin produced
eg of a sodium glucose co transported 2 inhibitor
dapagliflozin, empagliflozin
how do SGLT2 inhibitors work
they inhibit the glucose transporter- stopping the kidneys from reabsorbing glucose so more is excreted
GLP-1 analogues eg
glutides (semaglutide(wegovy), dulaglutide ( trulicity) )
how do increting (GLP-1 analogues) work
they are appetite suppressors which also enhance insulin when eating a meal as they help to degrade the DPP-4 which enhances insulin release
which GLP1 analogue is a daily injection
liraglutide oe lizisenatide
which GLP1 analogue is a twice daily injection
exanatide
example of a DPP-4 inhibitor
Gliptins (sitagliptin, vidagliptin, saxagliptin etc)
Thiazolidinediones eg
pioglitazone
how do thiazolidinediones work
they increase insulin sensitivity by stimulating the expression of insulin- sensitising genes
meglinine eg
repaglinide or nateglinide
how do meglitinides work
they have a similar mechanism of action as sulfonylureas but have a rapid onset and short duration - these are taken before meals
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