Diabetes Medication Choices ( None Insulin ) part #1

Metro Detroit Endocrinology Center🆗▶®

Welcome back dr. holly we’re going to continue our series of talking about type 2 diabetes remember we talked last time about insulin resistance the genetics what does it mean to be diabetic that dudes specifically and we’re going to start talking today about management of time to diabetes in terms of medication we’ll have a whole session on that exercise and

The futures but i want to clarify a few things about medication mechanism action how do they work what medicines are right for me a lot of my patient has okay what this is better than the other there’s no better medicine than the other it is just as medicine that fits a certain person more than the other tatooed iv is a complex disease i’m gonna show here on the

Slide it is not only disease of the pancreas it’s a problem in the liver and the kidney and heart and the muscles and the bone and the fat tissue and so on and so on so in order to tackle type 2 diabetes medication we have to understand how they work where they work what do i expect from them what are the side effects so as we see in this slide we have medication

Work on the liver by decreasing glucose production we have medication work on the fat tissue by decreasing the free fatty acid release into the blood that will affect internal resistance we have drugs that work on the muscles to increase glucose uptake by the muscle to be utilized as energy we have medication that work on decreasing absorption of sugar from the

Gi tract an effective fat absorption we have draw the work on the pancreas that improve insulin secretion and decrease glucagon secretion so just remember we talked about what happened to the beta cells we talked about the effect of insulin resistance so if i want the best medicine for type 2 diabetes then i want medicine that first control my sugar very well

Bring the sugar down fast in postprandial ii i want to bring the a1c down also to preserve my bigger cell we have limited beta cells limited in some stores you know on a medicine that help bees preserve that also a medicine does not cause hypoglycemia there’s now cause weight gain does not worsen heart disease hopefully you protect me from our disease there’s

Not worse than renal failure but improvement get my kidneys better at the same time protect me from cancer and also help prevent hypoglycemia and hypokalemia that can come with diabetes medication so it’s very difficult to pick the right medication and hopefully we’ll start with one after the other to show how do they work on the body what are the expectation

From these medications how can we use them first one out ever came out was a sulfonylurea drug south near probably all of you are familiar with it these are glipizide glyburide a glint lamotta clicks there’s probably 1015 of different drug in that group they all call them the sulfon area because they work on a sulfa neera receptor in the pancreas by improving

Insulin secretion and that will control glucose production i’m gonna show in a slide what are the benefit of that and what are the risk here we see how sulfa near work they are attached to atp sensitive potassium channel attached next to it there was activated potassium influx into the cells bring calcium adventure into the cells and now we’ll depolarize it we’ll

Bring these vesicles or granules that carries insulin this is our storage of insulin inside the beta cell it will be carried to the surface of the cell and be released what does that mean when i take sulfonylurea i’m asking my beta cell to release their storage of insulin into the blood this is good in a way that insulin will help me control my sugar the problem

With that process here first i’m killing my preserve beta cell of insulin i’m increasing insulin secretion in a type-2 diabetic they already have too much insulin this can lead to low sugar the effect on the potassium can cause transit hypokalemia we have all the data on salvatierra by increasing the insulin secretion affecting potassium causing hypoglycemia low

Sugar it can worsen heart disease this also have effect on the weight gain serious hypoglycemia especially in patients where we know failure or liver failure so does few things right but does so many other things wrong in that affect how we select these medication for certain patients the second medicine we’ll talk about is popular medicine it probably everybody

Knows that there’s a probably 25% of the whole population of the world takes it’s called metformin glucophage we really don’t understand how it works everybody use it but we don’t know how it works we have some idea it may have an impact on gluconeogenesis the liver mainly work on the liver to decrease glucose production we tell you sometimes they get at night so

Your morning sugar’s are better it does a lot of things right but some things are wrong so the the good things about metformin it will lower glucose it does not increase pressure on the beta cell so preserve my beta cell does not cause hypoglycemia low sugar unless i have a liver problem or kidney problem it will prevent cancer by decreasing the insulin secretion

And improving insulin resistance not only preserve beta cell decrease low sugar decreases the chance of hypokalemia but also have a good impact on preventing cancer related to insulin resistant is good for the heart we have every study in type 2 diabetes showing they aren’t they use a met form and usually they have less heart disease than anybody else who on any

Other medication we also know the metformin have prevention of complication of diabetes nephropathy retinopathy neuropathy problem with it for men not everybody can tolerate it it can cause gastroenterology problem gi problem nausea vomiting diarrhea bloating that limits its use we use extended releases we start low dose and we build up as tolerated we go from

Half a pill of 200 all the way to a 2,000 milligram there’s no benefit beyond 2000 milligram if you can get to that dose with tolerance then you you you can stay on that dose don’t increase it if you can only take 500 milligram a day there’s no benefit of taking it because it’s not that effective so this particular medicine beside the gi side effects it truly

Does all the good thing for the body there is another bad rep for it because people think it hurts the kidney metformin can increase lactate production in the body so can cause something called lactic acidosis only in people with severe renal failure and severe heart failure but does not cause heart promoting a problem it’s actually good for them it just said

You cannot use it in that scenario so just looking at metformin here you can say it works you see here on the hepatocyte so they mean liver cells so work on the liver by activating they amp a kinase this will decrease hepatic glucose production in a different ways and help with this lactate production and that will make it put patient at risk of lactic acidosis

Decreased glucose production will make it ideal to decrease blood sugar in the morning the other drugs we’ll talk about our thiazolidinediones tz ds complex name so i have to remember that though the tz ds first one that came out was rezulin and in a vein ian actos they were a very exciting drugs when ishe came they work on all the bad issue that diabetes have

They work on the muscle by improving glucose uptake they work on the liver by decreasing gluconeogenesis the work on the adipose tissue by decreasing free fatty acid release and her and became a drugs great for insulin resistance so in terms of t z ds these drugs were great to lowering sugar they preserve the beta cell they don’t cause hypokalemia or hypoglycemia

They supposedly were good for the heart unfortunately when we know there are p bar gamma exists everywhere we find out that they can affect the kidney and causing increased absorption of sodium and water and that caused edema that did not help the kidneys it worse in heart failure the effect on the heart was inconsistent we have study showed they were good and

Study showed they’re not they have effect on the bone cause osteoporosis there were a report of bladder cancer so the effect on the body including also effect on the fatty tissue by increasing fat cells and weight gain limits their use or make them unpopular between diabetes drugs

Transcribed from video
Diabetes Medication Choices (✔ None Insulin ) part #1↩ By Metro Detroit Endocrinology Center