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Related Concept Videos

Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

263
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
263
Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

154
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
154
Oral Hypoglycemic Agents: α-Glucosidase Inhibitors01:19

Oral Hypoglycemic Agents: α-Glucosidase Inhibitors

175
α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
175
Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

204
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
204
Oral Hypoglycemic Agents: Sulfonylureas01:17

Oral Hypoglycemic Agents: Sulfonylureas

209
Sulfonylureas are oral hypoglycemic agents utilized in treating type 2 diabetes. They are characterized by their unique sulfonylurea chemical structure. The family of sulfonylureas is divided into generations. First-generation sulfonylureas, including tolbutamide (Orinase), chlorpropamide (Diabinese), and tolazamide (Tolinase), trigger insulin release from pancreatic β cells and enhance peripheral tissues' insulin sensitivity. The second-generation members, such as glipizide...
209
Dipeptidyl Peptidase 4 Inhibitors01:23

Dipeptidyl Peptidase 4 Inhibitors

187
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
187

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Improving IV Insulin Administration in a Community Hospital
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Preoperative Patient Evaluation: Newer Hypoglycemic Agents.

Mario Villasenor1, Angela Roberts Selzer1

  • 1Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.

Anesthesiology Clinics
|January 26, 2024
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Summary

New diabetes medications offer benefits beyond blood sugar control. This review covers newer hypoglycemic agents and their perioperative management strategies, even with limited data.

Keywords:
Diabetes mellitusDiabetic medicationsHypoglycemic agentsPerioperative medicine

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Area of Science:

  • Pharmacology
  • Endocrinology
  • Clinical Therapeutics

Background:

  • Diabetes treatment is evolving with novel hypoglycemic agents.
  • Emerging evidence suggests benefits of these drugs beyond glycemic control.
  • Research into new diabetes medications is rapidly advancing.

Purpose of the Study:

  • To review current and emerging classes of hypoglycemic agents.
  • To summarize medications in phase 2 and 3 clinical trials.
  • To provide guidance on perioperative management of these new agents.

Main Methods:

  • Literature review of newer hypoglycemic agents.
  • Analysis of medications in active clinical development (Phase 2 and 3).
  • Synthesis of existing guidelines and pharmacokinetic data for perioperative recommendations.

Main Results:

  • Identification of various classes of novel hypoglycemic medications.
  • Overview of agents progressing through clinical trials.
  • Discussion of perioperative considerations based on available evidence and principles.

Conclusions:

  • Newer hypoglycemic agents present evolving treatment landscapes.
  • Perioperative management requires careful consideration due to limited specific data.
  • Pharmacokinetic properties and general medication management principles guide safe perioperative use.