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

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Dr.IskandarMirza

Dr.IskandarMirza Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @DIskandarmirza

20 Feb
Anda ada atrial fibrillation?

Anda faham apa itu atrial fibrillation?
Anda faham mengapa anda perlu makan ubat cair darah?

Follow bebenang ini

Atria fibrillation adalah masalah rentak jantung yang tidak sekata dan ianya boleh menyebabkan rasa jantung berdenyut laju, berdebar dan rasa jantung turun-naik dengan cepat.
Simptom Atrial flutter adalah

- Jantung rasa berdebar secara tiba-tiba
- Cepat rasa penat
- Sesak nafas
- Rasa hendak pitam
- atau sesetengah pesakit tidak mempunyai apa- apa simptom
Read 7 tweets
20 Feb
For junior doctors

How to Decide on anticoagulant for Atrial Fibrillation

Follow this steps
You need to calculate the CHA2DS-VASc score first

This is how you calculate a CHA2DS-VASc score
If CHAD2DS-VASc score=

1(male) or 2 (female) = OAC should be considered (Class iia)
>2 (male) or >3 (female) + OAC is recomended (Class 1A)

OAC : oral anticoagulant
Do you understand about the class of recommendation?

Just a little bit about it, because it is important for you guys to know it.

Class 1 means: it is recommended
class II: conflicting evidence or divergent opinion about the usefulness of the given treatment
Read 7 tweets
18 Feb
For Junior Doctors

Have you guys heard of Chiladaiti syndrome?

I'm sharing my case from HTAN, Pilah and how I managed this case.

#MedTweetMY Image
62 y.o guy with
- PTB on intensive phase day 40
- dm
- hypertension
- dyslipidemia

Came with right hypochondriac and epigastric tenderness
- associated with nausea and vomiting
- no fever
- reduced oral intake
- able to pass flatus and BO
- no aggravating or relieving factor
- showed consolidation over right upper zone
- bowel shadow below right diaphragm

Patient was treated for chiladaiti syndrome
- ryles tube free flow
- keep nil by mouth
- lactulose 15 mls tds
- IVD for hydration Image
Read 9 tweets
1 Jan
Anda merupakan pesakit Migraine?
6 cara untuk mengelakkan dari medapat serangan migraine
1)Sentiasa mencatat apa yang dimakan atau minum di dalam diari.
Catatkan apa yang anda makan atau minum sebelum berlakunya migraine. Anda akan mendapat pattern makanan yang menyebabkan anda mendapat migraine dan ini memudahkan anda untuk megelakkan dari memakan makanan tersebut.
2)Makan pada waktunya
Read 6 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!