Pharmacology of diabetic medications

ACEM Primary

Drug	MOA
Insulins	Activates insulin receptor (ligand regulated tyrosine kinase R) Promotes uptake of glucose from blood into tissues and promotes glycogen synthesis	Rapid acting (lispro) Intermediate (protamine) Long acting (detemir/ glargine) Can be given IV/ SC AE = hypoglycaemia, weight gain, lipodystrophy at injection site
Sulfonylurea: Glipizide Glicazide	Insulin secretagogue Inhibition of K+ efflux on beta cells leads to opening of calcium channel Stimulate insulin release Reduce serum glucagon levels	PO Duration of action 10-24 hours AE = hypoglycaemia, weight gain
Biguanides: Metformin	Exact mechanism of action unknown Reduces hepatic gluconeogenesis Does not require functioning beta cells	PO T ½ 1.5- 3 hours Excreted by kidneys as unchanged compound AE = gastrointestinal upset, contraindicated in renal/ hepatic dysfunction, HAGMA
Dipeptidyl Peptidase-4 (DPPV 4) Inhibitors: Sitagliptin Linagliptin	Blocks degradation of GLP-1, raises circulating GLP-1 levels to increase glucose mediated insulin release	PO T ½ 12 hours Toxicity = rhinitis, URTI, headaches, pancreatitis, allergy
Sodium glucose co-transporter 2 inhibitors (SGLT2): Dapagliflozin Empagliflozin	Blocks renal glucose reabsorption, increases glucose excreted in urine	PO T ½ 10-14 hours Toxicity = genital and urinary tract infection, polyuria, pruritis, osmotic diuresis and constipation

Last Updated on August 12, 2021 by Andrew Crofton

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