March 28, 2023

Insulin Sensitisers – TZDs and biguanides

Hi everyone in second part of this video i’m going to discuss insulin sensitizers as a quick recap in the previous video i’ve mentioned to you there are currently seven classes of oglds available in the market to treat diabetes mellitus and we have covered sulfona ureas and bactinites in this video i’m going to focus on discussing insulin sensitizers which

Include tizo living dions t-sectis and also big one nights so metformin is the currently available available in the market the previous drugs fan for me has been disconnected because it caused fatal lactic acidosis so lactic acidosis is a kind of metabolic acidosis whereby there’s a disturbance in the body ph and also electrolyte levels which can cause serious

Organ dysfunctions in the body insulinary sensitizer how they act is that they actually promote target cell response to the insulin but they do not secrete any insulin meaning they don’t cause any secretions of insulin from the pancreas and by so they actually reduce insulin resistance metformin are currently available the branding that commonly used is actually

Good for glucophage the duration of actions of metformin can last about 18 hours the extended release preparations of course can last longer which often give as one’s daily dosing with the evening meal but for me x to reduce hepatic glucose output by inhibiting gluconeogenesis and it also promote glucose object and utilization in the skeletal muscle and adipose

Tissues it also reduce glucose absorption from the gastrointestinal tract and interestingly metformin also found to reduce some lipid level in the body whereby it is actually very suitable to prescribe metformin for uh patients with type 2 diabetes and also with hyperlipidemia because of the uh effect on reducing hyperlipidemia metformin is the first line drug

For treating type 2 diabetes meaning unless the patient is contraindicated or have ended allergy to metformin metformin should be used when patient is diagnosed with type 2 diabetes and it is particularly suitable for patients who are obese remember in the previous video that we mentioned sulfonylurex is not suitable for patients who are obese because it promotes

Weight gain so in this case metformin can be given for patients who are obese because it does not stimulate appetite and therefore it actually helps to reduce or it does not increase any weight again in patients with type 2 diabetes it is important to note that metformin when the dose exceed 1000 milligram at any one time it can it can cause significant gi side

Effects therefore doses large doses should be given in divide doses or the extended release preparation should be used in patients so the common side effects of metformin include gi disturbances as we mentioned earlier on and particularly diarrhea is the most common gi side effects which affect 30 of the patients and resulted in four percent of the patient which

Need to discontinue the use of metformin lactic acidosis is actually a rare side effects but it can be serious which we need to take note so patients who are with renal or hepatic disease and patients who are with alcohol alcoholisms we usually need to take extra extra questions where they are com they should be contraindicated so metformin should not be given in

This kind of patients because of the risk of lactic acidosis the next class of drug is known as diazolidine dions or t-zactis they are often also called glyphosomes this is another group of insulin sensitizer apart from b guanets or metformin the examples of t sectors include recyclone and also pyoglytosons so the duration of action is also long for both these drugs

Which can last up to 24 hours which is why it’s often given like in daily dosing so it is important to note that the first drug the first example of drug secretarson has been discontinued in malaysia as well as many other countries uh due to the risk of causing high heart failure we will talk about this a bit more in the subsequent slides so how the exactly act is

That it activates the parasyzone proliferated activated receptor gamma whereby it promotes the transcription of insulin responsive genes that control glucose and also lipid metabolism so that actually increased the insulin sensitivity in the fat tissues or adipose tissue liver and also spliter muscles the three factors also increase are good for this is one of the

Glucose transporters in the cell membrane of muscle and also adipose tissues and this actually promote the uptake and neutralizations of glucose in these tissues so things like d is often used in combination with other oral glucose lowering drugs in the treatment of type 2 diabetes they are extensively bound to albumin so because of high risk of developing heart

Failure in patients taking these drugs and this has actually caused rosically rosicletasone discontinued from the malaysian market due to the high incidence of heart failure in patients taking these are prosecutors other common side effects include a cause edema and also high plasma volume and it also promote weight gain most likely is due to the fluid retentions

In the body and it has been shown to reduce both bone mineral density which is a osteopenia pyrogritation also shown to have slightly increased the risk of bladder cancer and other side effects include headache and also anemia

Transcribed from video
2 2 Insulin Sensitisers By DR WONG YUET YEN