Let's Learn About Diabetes Drugs

Alpha-glucosidase inhibitors are a class of drugs used in both type 2 diabetes (DM2) and type 1 diabetes (DM1). These medications work by slowing down the digestion of carbohydrates in the intestines, which helps to prevent blood sugar spikes after meals. By inhibiting the enzyme alpha-glucosidase, these drugs delay the absorption of glucose, leading to better blood sugar control. This class of drugs can be used in both DM2 and DM1 to help manage blood sugar levels.

Biguanide drugs, such as metformin, are commonly used to treat type 2 diabetes. They work by decreasing glucose production in the liver and improving insulin sensitivity. One of the major side effects of these drugs is gastrointestinal (GI) symptoms. This can include nausea, vomiting, diarrhea, and abdominal discomfort. These symptoms usually occur at the beginning of treatment and can be managed by starting with a low dose and gradually increasing it. It is important for patients to report any persistent or severe GI symptoms to their healthcare provider.

Repaglinide has a faster onset compared to Glimpepiride. This is because Repaglinide is a rapid-acting insulin secretagogue that stimulates insulin release from the pancreas quickly after ingestion. On the other hand, Glimpepiride is a sulfonylurea drug that takes longer to stimulate insulin secretion. Therefore, Repaglinide is the correct answer as it has a faster onset of action.

Glinides and sulfonylureas are classified as insulin secretagogues. Glinides stimulate the release of insulin from the pancreas, particularly after meals, to help control blood sugar levels. Sulfonylureas also work by stimulating the release of insulin from the pancreas. Both classes of drugs are commonly used in the treatment of type 2 diabetes to help increase insulin production and improve glucose control.

Metformin is commonly used to treat polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that affects women of reproductive age. It is characterized by irregular periods, excess androgen levels, and the presence of multiple small cysts on the ovaries. Metformin helps to regulate insulin levels in the body, which can help improve symptoms of PCOS such as irregular periods and insulin resistance. It is not used to treat AIDS, hypertension (HTN), or cancer.

Thiazolidinediones and biguanides are classes of drugs that have the benefit of lowering insulin resistance. Thiazolidinediones work by increasing the sensitivity of cells to insulin, while biguanides decrease the production of glucose by the liver and increase the uptake of glucose by cells. Both of these mechanisms help to lower insulin resistance and improve blood sugar control in individuals with diabetes.

Metformin is the correct answer because it is a medication commonly used to treat type 2 diabetes. While oral contraceptives are effective in preventing pregnancy, there have been instances where metformin has reduced the effectiveness of the contraceptive pills, leading to unintended pregnancies. This can occur due to metformin's effect on hormone levels and its potential to interfere with the metabolism of the contraceptive hormones. Therefore, it is important for individuals taking metformin and oral contraceptives to use additional forms of contraception to prevent unintended pregnancy.

Acarbose and Miglitol are oral medications used to treat type 2 diabetes by slowing down the digestion and absorption of carbohydrates in the intestines. They are contraindicated in individuals with inflammatory bowel disease, such as Crohn's Disease, due to the potential risk of exacerbating gastrointestinal symptoms. In Crohn's Disease, the intestinal lining is already inflamed, and these medications may further irritate the intestines, leading to worsening symptoms. Therefore, the 56-year-old male with Crohn's Disease would be contraindicated for Acarbose and Miglitol.

When a patient is taking Pramlintide, a medication that helps regulate blood sugar levels, it is recommended to decrease their rapid or short-acting insulin dose by 50% before meals. This is because Pramlintide slows down the digestion of food, which can lead to a delayed rise in blood sugar levels. By decreasing the insulin dose, the risk of hypoglycemia (low blood sugar) is reduced while still maintaining adequate blood sugar control.

Metformin is a medication commonly used to treat type 2 diabetes. It is excreted through the kidneys and can potentially cause a rare but serious condition called lactic acidosis, particularly in patients with impaired kidney function. Contrast dye used in CT scans can also affect kidney function. Therefore, it is recommended to temporarily discontinue metformin in patients who are undergoing procedures involving contrast dye, such as a CT scan, to reduce the risk of lactic acidosis. The other two options, a 70-year-old man getting an MRI and a 35-year-old female who just found out she is pregnant, do not require temporary discontinuation of metformin.

Exenatide must be administered subcutaneously (SQ). SQ administration involves injecting the medication into the fatty tissue layer just below the skin. This route of administration allows for slow absorption of the medication into the bloodstream, providing a sustained release of the drug and maintaining its therapeutic effect over a longer period of time. SQ administration is commonly used for medications that need to be absorbed gradually and consistently.

Sitagliptin is the drug that the patient was recently started on. The patient reports that the medication seems to be working well for their diabetes mellitus (DM), but they have noticed an increase in the number of headaches and colds. This suggests that the side effects of sitagliptin may include headaches and an increased susceptibility to colds.

Metformin is a medication commonly used to treat type 2 diabetes. The standard dose of Metformin is usually 500 mg taken before meals. This timing allows the medication to be absorbed properly and helps to control blood sugar levels effectively. Taking the medication before meals helps to prevent a sudden spike in blood sugar levels after eating. Therefore, 500 mg before meals is the correct answer for the standard dose of Metformin.

Repaglinide is not recommended to be given to this patient due to its potential harmful drug interactions with erythromycin. Erythromycin can inhibit the metabolism of repaglinide, leading to increased levels of repaglinide in the body, which can cause hypoglycemia (low blood sugar). Therefore, it is important to avoid giving repaglinide to this patient to prevent potential adverse effects.

This means drug requires frequent injections. In our notes she also mentions a preparation that is injected once weekly, and in that drug's case, this is untrue.

Thiazolidinediones are a class of drugs that are restricted in the US and prohibited in Europe. This means that these drugs have certain limitations on their use in the US and are completely banned in Europe. The reason for these restrictions and prohibitions may be due to safety concerns or lack of sufficient evidence regarding their efficacy and potential side effects.

Glyburide is the only sulfonylurea drug that is considered safe to use during pregnancy. It is commonly prescribed to pregnant women with diabetes to help control their blood sugar levels. The other options, Glipizide, Tolbutamide, and Glimepiride, are not recommended during pregnancy due to potential risks to the fetus. Therefore, Glyburide is the appropriate choice in this situation.

Sitagliptin inhibits DPP-4, an enzyme that breaks down GLP-1. By inhibiting DPP-4, sitagliptin prolongs the activity of GLP-1, an incretin hormone. GLP-1 is known to stimulate insulin release from the pancreas and inhibit glucagon release. Therefore, when the activity of GLP-1 is extended due to sitagliptin, it leads to decreased glucagon release and increased insulin release in response to meals.