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Questions and Answers
What mechanism do alpha-glucosidase inhibitors primarily use to manage blood glucose levels?
What mechanism do alpha-glucosidase inhibitors primarily use to manage blood glucose levels?
Which of the following adverse effects is most commonly associated with the use of amylin analogs?
Which of the following adverse effects is most commonly associated with the use of amylin analogs?
For which type of diabetes is pramlintide primarily indicated?
For which type of diabetes is pramlintide primarily indicated?
Which of the following statements about glucagon-like peptide 1 receptor agonists (GLP1-RAs) is true?
Which of the following statements about glucagon-like peptide 1 receptor agonists (GLP1-RAs) is true?
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What is the average reduction in A1C levels when using pramlintide for type 2 diabetes?
What is the average reduction in A1C levels when using pramlintide for type 2 diabetes?
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What is a common side effect of GLP1-RAs that is dose related?
What is a common side effect of GLP1-RAs that is dose related?
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Which GLP1-RA is primarily effective in lowering postprandial glucose levels?
Which GLP1-RA is primarily effective in lowering postprandial glucose levels?
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When using GLP1-RAs, why is it recommended to eat slowly and stop when satiated?
When using GLP1-RAs, why is it recommended to eat slowly and stop when satiated?
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In what situation is hypoglycemia likely to occur when using GLP1-RAs?
In what situation is hypoglycemia likely to occur when using GLP1-RAs?
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Which condition does NOT recommend GLP1-RAs as first-line agents?
Which condition does NOT recommend GLP1-RAs as first-line agents?
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Study Notes
Alpha-glucosidase Inhibitors
- Used for type 2 diabetes mellitus (DM)
- Examples: Acarbose, Miglitol
- Mechanism: Inhibit the enzyme alpha-glucosidase, which breaks down starches and disaccharides into glucose.
- Effect: Delays carbohydrate absorption, reducing post-prandial glucose (PPG) levels.
- PPG reduction: Approximately 40-50 mg/dL.
- Fasting blood glucose (FBG) change: Relatively unchanged
- A1C reduction: Modest, 0.3%–1%.
- Ideal candidates: Patients with near-normal FBG and high PPG levels.
- Side effects: Flatulence, abdominal pain, diarrhea; can be minimized with slow dose titration.
- Contraindications: Cirrhosis, colonic ulcers, intestinal disease/obstruction, inflammatory bowel disease, diabetic ketoacidosis.
Amylin Analogs
- Example: Pramlintide (Symlin)
- Synthetic amylin analog.
- Actions:
- Reduces glucagon secretion
- Slows gastric emptying
- Increases satiety.
- Effect: Lowers PPG levels and A1C.
- A1C reduction:
- Type 2 DM: ~0.6%
- Type 1 DM: 0.4%–0.5% (5–6 mmol/mol Hb).
- Use: Primarily adjunctive therapy for type 1 DM, not achieving PPG goals despite mealtime insulin.
- Also useful for weight loss and lower mealtime insulin doses.
- Side effects: Nausea, vomiting, anorexia.
- Hypoglycemia risk: Minimal when used alone; increased risk with insulin.
- Dose reduction (30-50%) of mealtime insulin is recommended when initiating pramlintide.
- Dosing (type 2 DM): Begin with 60 mcg SC before meals, titrate to maximum 120 mcg SC as tolerated and needed based on PPG.
- Dosing (type 1 DM): Begin with 15 mcg SC before meals and titrate up to 60 mcg SC before each meal, if tolerated.
Glucagon-like Peptide 1 Receptor Agonists (GLP1-RAs)
- Mechanism: Incretin hormone (GLP-1) agonists.
- Action:
- Stimulates insulin secretion.
- Suppresses glucagon secretion.
- Decreases hepatic glucose production.
- Slows gastric emptying, increases satiety, causing weight loss (1–3 kg).
- Types: Dulaglutide, Exenatide, Exenatide XR, Lixisenatide, Liraglutide, Semaglutide
- Short-acting agents (exenatide, lixisenatide): Primarily lower PPG levels.
- Long-acting agents (dulaglutide, liraglutide, exenatide XR, semaglutide): Lower both FPG and PPG, more impact on FPG.
- Side effects: Nausea, vomiting, diarrhea; dose-dependent, usually transient.
- Eating slowly and stopping when satiated can lessen side effects.
- Other adverse effects: Injection site reactions and potential hypersensitivity reactions (including anaphylaxis and angioedema).
- Hypoglycemia risk: Lower risk with metformin or thiazolidinediones (TZDs); increased risk with sulfonylureas or insulin.
- Use: Not typically first-line therapy. Suitable for patients with established cardiovascular disease (atherosclerosis) or chronic kidney disease, hypoglycemia avoidance, weight loss needs.
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Description
Explore the functions and mechanisms of alpha-glucosidase inhibitors and amylin analogs in managing type 2 diabetes mellitus. Understand their effects on glucose levels, ideal candidates for use, and potential side effects. This quiz will enhance your knowledge of these important diabetes medications.
