Podcast
Questions and Answers
What is the primary effect of long-acting GLP1-RAs compared to short-acting agents?
What is the primary effect of long-acting GLP1-RAs compared to short-acting agents?
Which side effects are associated with GLP1-RAs?
Which side effects are associated with GLP1-RAs?
When should dose titration of GLP1-RAs be considered?
When should dose titration of GLP1-RAs be considered?
In which scenario can GLP1-RAs be used as monotherapy?
In which scenario can GLP1-RAs be used as monotherapy?
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Which combination of medications poses a risk of hypoglycemia when using GLP1-RAs?
Which combination of medications poses a risk of hypoglycemia when using GLP1-RAs?
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What is the primary mechanism by which acarbose and miglitol lower post-prandial glucose levels?
What is the primary mechanism by which acarbose and miglitol lower post-prandial glucose levels?
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In which patients are acarbose and miglitol most appropriately prescribed?
In which patients are acarbose and miglitol most appropriately prescribed?
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What is a common side effect of using pramlintide in diabetes management?
What is a common side effect of using pramlintide in diabetes management?
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What key action does GLP-1 receptor agonists perform in the management of type 2 diabetes?
What key action does GLP-1 receptor agonists perform in the management of type 2 diabetes?
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What starting dosage of pramlintide is recommended for type 2 diabetes before meals?
What starting dosage of pramlintide is recommended for type 2 diabetes before meals?
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Study Notes
Acarbose and Miglitol
- Used for type-2 diabetes mellitus (DM)
- Inhibit α-glucosidase enzymes, delaying carbohydrate absorption
- Lower postprandial glucose (PPG) levels (40-50 mg/dL)
- Modest A1C reduction (0.3%–1%)
- Beneficial for patients with near-target A1C and normal fasting blood glucose (FBG), but high PPG
- Common side effects: flatulence, abdominal pain, diarrhea; titration can reduce these
- Contraindicated in specific conditions: cirrhosis, colonic ulcers, intestinal disease, inflammatory bowel disease, diabetic ketoacidosis
Amylin Analogs (Pramlintide)
- Synthetic amylin analog (e.g., Symlin)
- Actions: reduce glucagon secretion, slow gastric emptying, increase satiety.
- Lower both PPG and A1C levels.
- A1C reduction: ~0.6% in type-2 DM, 0.4%-0.5% (5-6 mmol/mol Hb) in type-1 DM
- Primarily used as adjunctive therapy in type-1 DM for patients who do not achieve PPG goals with maximizing mealtime insulin.
- May also aid weight loss and facilitate lower mealtime insulin doses.
- Common side effects: nausea, vomiting, anorexia.
- Hypoglycemia risk exists when combined with insulin, but not with pramlintide alone.
- Dosage in type-2 DM: starts at 60 mcg SC before meals, titrating to 120 mcg as tolerated and indicated by PPG
- Dosage in type-1 DM: starts at 15 mcg SC before meals, titrating to 60 mcg as tolerated, in increments of 15mcg
Glucagon-like Peptide 1 Receptor Agonists (GLP1-RAs)
- Incretin hormone: GLP-1
- Used for type-2 DM
- Examples: Dulaglutide, Exenatide, Exenatide XR, Lixisenatide, Liraglutide, Semaglutide
- Actions: stimulate insulin secretion, suppress postprandial glucagon secretion, decrease hepatic glucose output, slow gastric emptying, increase satiety, cause weight loss (1-3 kg avg)
- Short-acting agents (e.g., exenatide, lixisenatide): predominantly lower PPG
- Long-acting agents (e.g., dulaglutide, liraglutide, exenatide XR, semaglutide): lower both FPG and PPG, with substantial effect on FPG
- Common side effects: nausea, vomiting, diarrhea, dose-related; effects usually transient and mild, but discontinuation may be needed.
- Eating slowly and stopping when satiated can lessen effects.
- Injection site reactions and hypersensitivity are possible (anaphylaxis and angioedema)
- Combine with metformin or thiazolidinediones (TZDs) to lower hypoglycemia risk
- Avoid using with sulfonylureas or insulin as they can increase hypoglycemia risk.
- 2nd line agent for patients with established atherosclerosis, CKD and those wanting to avoid hypoglycemia or weight gain/induce weight loss
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Description
This quiz covers the mechanisms and effects of Acarbose and Amylin analogs in managing type-2 diabetes. Learn about their roles in controlling postprandial glucose levels and A1C reduction, as well as their side effects and contraindications. Test your knowledge on these essential pharmacological treatments for diabetes.
