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Oral Agents for Diabetes Mellitus Type 2 – Treatment of Diabetes Mellitus

by Carlo Raj, MD
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    Let’s take a look at metformin. Mechanism… you’re doing everything in the power these drugs are so that it can properly exhaust the glucose within your circulation. How does it go by doing that? It actually inhibits the liver from releasing glucose, inhibits gluconeogenesis and also peripherally may then increase the uptake of glucose. Metformin, the clinical use, typically first line of treatment in overweight patients. Before you do any of this, what’s your first step of management? I’ve mentioned this over and over again, lifestyle modification, exercise, diet… exercise, diet. It is associated with modest weight loss, no risk of hypoglycemia as monotherapy. But,, there is an interesting side-effect that you want to know from metformin, it’s lactic acidosis. It is also very importantly contraindicated in a renal disease, severe hepatic disease and congestive heart failure. Put liver and kidney together contraindicated when such diseases are concomitantly present. The GI side effects of metformin are the following. Nausea, diarrhoea; minimized by starting low with dose type of titration. Metformin and its complete, complete picture of what you want to know for your boards and wards. Now, we come to a family and this family, well, maybe your uncle’s name is thiazolidine and your aunt’s family’s name is dione, put them together you have thiazolidine-dione. What’s up with that? We have two of them the drugs that you want to know, rosiglitazone and we have pioglitazone. Look for the suffix glitazone. How does this decrease your glucose? Increase in peripheral sensitivity of the receptors for insulin thus enhances and increase the uptake of glucose. Once again, here under monotherapy, no hyperglycemia and reduces the insulin requirement. Remember this is type II diabetic. This is contraindicated in class II and IV CHF or active liver disease… the glitazones are. Monitor liver...

    About the Lecture

    The lecture Oral Agents for Diabetes Mellitus Type 2 – Treatment of Diabetes Mellitus by Carlo Raj, MD is from the course Pancreatic Disease & Diabetes.


    Included Quiz Questions

    1. Lactic acidosis
    2. Liver failure
    3. Hypoglycemia
    4. Increased ICP
    5. Hirsutism
    1. Rosiglitizone
    2. Metformin
    3. Glipizide
    4. Acarbose
    5. Sitagliptin
    1. Glyburide
    2. Metformin
    3. Rosiglitizone
    4. Nateglinide
    5. Acarbose
    1. Alpha-glucosidase
    2. Pancreatic insulin secretion
    3. GLP-1
    4. Dipeptidyl peptidase IV
    5. PPR4
    1. Amylin
    2. Nateglinide
    3. Exenatide
    4. Glimepiride
    5. Sitagliptin

    Author of lecture Oral Agents for Diabetes Mellitus Type 2 – Treatment of Diabetes Mellitus

     Carlo Raj, MD

    Carlo Raj, MD


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    Update for new sGLT2 inhibitors
    By Hamed S. on 25. February 2017 for Oral Agents for Diabetes Mellitus Type 2 – Treatment of Diabetes Mellitus

    good summary. The presentation should be updated to include sodium-glucose transport proteins (SGLT2) inhibitors like dapagliflozin.