[Music]
the first of the oral medications that I
want to talk about are the secrete
ACOG's now secreted gags are the oldest
oral class in diabetes they increase
insulin secretion it is associated with
weight gain and hypoglycemia however so
there are some downsides to this
particular medication now the first
generation secrete ACOG's really aren't
used anymore and I don't really
encourage you to learn too much about
them at this point in time the second
generation secreted gags are going to be
the ones that you will be asked about on
your exams so it's important to know or
at least recognize these names the third
generation of insulin-secreting ogz are
very much coming into its own forte in
clinical practice and right now we use
them perhaps five or ten percent of the
time but I think in the future we'll
start to see them being used much more
often so how does the Credo cogs work
well let's take a look at that glue to
glucose porter at the luminal surface of
the cell membrane this glucose
transporter moves glucose into a cell
now the glucose is going to be used for
metabolism obviously and it eventually
gets broken down and converted into ATP
now ATP is going to act on the potassium
channel now when the potassium channel
closes the cell is depolarized
sulfonylurea drugs block and close and
depolarize the cell membrane now when
you have a depolarized membrane you're
gonna have more calcium influx into that
cell the depolarization opens up that
calcium channel and allows lots of
calcium to move in so now you have more
calcium inside the cell when you have
more calcium inside the cell those
calcium ions can form bridges between
the vesicles that contain insulin so you
have calcium mediated exocytosis of
insulin so you have more
insulin secretion now if your beta cells
aren't working and you're not making
insulin in the first place
secrete ACOG's are not going to work
let's move on to the by Guin is now the
by Guin IDEs are the mainstay of
diabetes treatment they are first-line
they're the most important drugs and
they're the most commonly used drugs the
other beautiful thing about by Guin IDEs
is that they're cheap so remember that
they are first-line therapy they're
cheap effective and very safe there is a
couple of advantages to the by Kuhn IDEs
they actually work by increasing insulin
sensitivity so they work really well
with those type two diabetics and when
you get out into clinical practice
you're going to realize that the type 2
diabetics are by far the majority of the
patients that we deal with the other
nice thing about the by Guin IDEs is
that they actually reduce endogenous
insulin production and the reason why
that happens is because you don't need
as much because the insulin is more
efficient remember that insulin itself
has some negative properties to it so
having hyperinsulinemia in diabetes is
not necessarily a good thing it actually
prevents the development of diabetes and
patients who are prone to it so if you
have a person who has moderately
elevated sugars or impaired fasting
glucose and you put them on metformin or
other byegone IDEs you actually reduce
the chance that they will progress to
full-blown diabetes in the future it is
also used to restore fertility in
anovulatory women so it is used in
infertility treatments let's talk about
side effects now normally when I talk
about side effects I talk about bad
things that happen with drugs but I want
to mention something that's really
important with the bike GU and IDEs and
is they do not cause hypoglycemia and
this is an important distinction between
by goo and IDEs and other drugs and in
fact hypoglycemia is a really bad thing
in diabetes I always say to my patients
that hyperglycemia kills in the long
term and hypoglycemia kills in the short
run so it's important that we
avoid hypoglycemia in our patients his
patients have become hypoglycemic are
actually an increased risk of developing
arrhythmia
so by guen Ides do not cause
hypoglycemia now you can get lactic
acidosis in certain patients
particularly those who have renal
disease liver disease and respiratory
disease
[Music]