Thread by @DIskandarmirza

For Junior Doctors

Do you really know how diabetic medications mechanism of action?

It is really important so that you know what to explain to the patient and thus making them more compliant towards their diabetic medications.

Follow this thread

First you guys need to understand how patient developed diabetes mellitus.

Refer to diagram below

Diabetes mellitus pathophysiology is involving multi-organ involvement

And each diabetic medications will inhibit part of the organs involved.

Now you understand right how hyperglycemia happened in diabetic patient? it took me all night to do all this diagram 😆

now we go to each medications and remember this is simplified version as i only can type few words in twitter

1) Metformin

Metformin decreases
- Hepatic glucose production
- Decreases intestinal absorption of glucose
- Improves insulin sensitivity by increasing peripheral glucose uptake and utilization.

2) Sulphonylurea

Act on pancreatic beta-islet cells to stimulate the release of preformed insulin.

By blocking ATP-dependent potassium channels on beta-islet cells, calcium influx is increased, ultimately resulting in exocytosis of insulin secretory granules.

SGLT2 Inhibitors

Novel mechanism reducing renal tubular glucose re-absorption, producing a reduction in blood glucose without stimulating insulin release.

This is another diagram explaining the SGLT2 inhibitors mechanism of action

4)GLP 1 receptor agonist

GLP-1 exerts its main effect by :

- stimulating glucose-dependent insulin release from the pancreatic islets
- slow gastric emptying
- inhibit inappropriate post-meal glucagon release
- reduce food intake

This is a another diagram on how GLP 1 agonist works

5) DPP4 inhibitors

The classical mechanism for DPP-4 inhibitors is that they inhibit DPP-4 activity in peripheral plasma, which prevents the inactivation of the incretin hormone glucagon-like peptide (GLP)-1 in the peripheral circulation

Another diagram showing how DPP4 inhibitor works

Last one is insulin

Insulin will increase glucose uptakes in the peripheral tissue

Insulin regulates both metabolic enzyme and gene expression.

Another diagram on how insulin works

So easy right?

once you really understand how the medication works, it will make you understand better which medications is the best for the patients.

Hope this thread will help you guys to understand more about diabetic medications