Secretagogues and Biguanides – Diabetes Medications

by Pravin Shukle, MD

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    The first of the oral medications that I want to talk about are the secretagogues. Now secretagogues are the oldest oral class in diabetes. They increase insulin secretion. It is associated with weight gain and hypoglycemia however. So there are some downsides to this particular medication. Now the first generation secretagogues really aren't used anymore. And I don't really encourage you to learn too much about them at this point in time. The second generation secretagogues are going to be the ones that you will be asked about on your exams. So it's important to know or at least recognize these names. The third generation of insulin secretagogues are very much coming into it's own forte in clinical practice. And right now we use them perhaps 5 or 10% of the time but I think in the future we'll start to see them being used much more often. So how do secretagogues work? Well let's take a look at that GLUT 2 glucose porter at the luminal surface of the cell membrane. This glucose transporter moves glucose into the cell. Now the glucose is going to be used for metabolism obviously. And it eventually gets broken down and converted into ATP. Now ATP is going to act on the potassium channel. Now when the potassium channel closes, the cell is depolarized. Sulfonlyurea drugs block and close and depolarize the cell membrane. Now when you have a depolarized membrane, you are going to have more calcium influx into that cell. The depolarization opens up that calcium channel, and allows lots of calcium to move in. So now, you have more calcium inside the cell. When you have more calcium inside the cell, those calcium ions can form bridges between the vesicles that contain insulin. So you have, calcium mediated exocytosis of...

    About the Lecture

    The lecture Secretagogues and Biguanides – Diabetes Medications by Pravin Shukle, MD is from the course Endocrine Pharmacology. It contains the following chapters:

    • Secretagogues
    • Biguanides

    Included Quiz Questions

    1. Membrane bound potassium channels
    2. Membrane bound sodium channels
    3. Membrane bound calcium channels
    4. Intracellular receptors
    5. Intranuclear receptors
    1. Calcium mediated exocytosis of insulin
    2. Potassium mediated exocytosis of insulin
    3. ATP mediated exocytosis of insulin
    4. Sodium mediated exocytosis of insulin
    5. Gerlin mediated exocytosis of insulin
    1. 45 year old female with history of diabetes mellitus type 2.
    2. 17 year old male with type 1 diabetes.
    3. 29 year old female with autoimmune pancreatitis.
    4. 21 year old male with cystic fibrosis-related diabetes.
    5. 75 year old female with type 2 diabetes and early stage Alzheimer's disease.
    1. Patients can not become hypoglycemic
    2. Metformin releases an exact amount of insulin
    3. Patients can not become hyperglycemic
    4. Early and effective advertising campaign by Bristol-Myers Squibb
    5. Metformin decreases insulin sensitivity

    Author of lecture Secretagogues and Biguanides – Diabetes Medications

     Pravin Shukle, MD

    Pravin Shukle, MD

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