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Classification of Oral Hypoglycemic
Drugs Stimulate insulin release
Sulfonylureas
Meglitinides
Increase insulin responsiveness Biguanides Thiazlidinediones
Modify Intestinal absorption of carbohydrate Alpha-glucosidase inhibitors
Newer drugs Amylin analog
DPP-4 Inhibitors
Incretin Mimetics
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Sulfanylureas
Drugs: First generation : Tolbutamide
Shorter duration of action
Second generation:Glyburide Longer duration of action
Are 100 times more potent vs first generation
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Mechanism of Action
Stimulates insulin release from
pancreatic B cells Blocks ATP dependent K+
channel of pancreatic B cellsopening of Ca2+ channels
secretion of insulin
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Uses:
Are used in diabetes mellitus type 2
Are ineffective in absolute deficiency of insulinproduction
In type 1 diabetes or post-pancreatoctomy
Adverse Effects
Weight gain Hyperinsulinemia Hypoglycemia
Contraindications
Hepatic & renal insufficiency
Pregnancy
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Biguanides Drugs
Metformin
Is antihyperglycemic , does not cause hypoglycemia in largedoses
Promotes weight loss in patients with obesity type 2 diabetesmellitus
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Mechanism of Action
Decrease hepatic glucose production (gluconeogesis)
Activating liver enzyme-AMP-activated protein kinase (AMPkinase)
Improve insulin sensitivity in periphery (insulinsensitizer)
Decrease intestinal absorption of glucose
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Uses
Drug of choice for newly diagnosed tyoe 2 diabetics
Prevents the new onset of type 2 diabetes in prediabetic
Middle aged person
Obese persons
Adverse Effects Diarrhea & dyspepsia
Lactic Acidosis
Contraindications:
Heart failure Kidney disoreders
Lung disease
Liver disease
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Management individual nutritional requirements and meal
planning
type and extent of exercise and physical activity
improvements in lifestyle, for example harmful effectsof smoking, obesity and alcohol intake
self-monitoring and significance of results and actions
to be taken Education
how to cope with emergencies (illness, hypoglycaemia)
how to avoid complications and detect them at an early
stage, e.g. how to take care of the feet
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