Miscellaneous hypoglycemics

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Miscellaneous hypoglycemics


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Miscellaneous hypoglycemics

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Acarbose p. 361


Hypoglycemics are used to treat high blood sugar, a condition commonly known as diabetes mellitus.

As a quick review, Type 1 diabetes mellitus, which most commonly affects children and adolescents, arises when certain cells of the pancreas known as beta cells are unable to produce enough insulin to maintain normal blood glucose levels.

This is in contrast to Type 2 diabetes mellitus where the body is able to produce insulin, but the tissues don’t respond as well to it, or in other words, these individuals are insulin resistant.

Many hypoglycemics, like sulfonylureas, promote the release of insulin from the beta cells of the pancreas and therefore are known as insulin secretagogues.

In this video, however, we’ll be focusing specifically on the use of non-secretagogues in the treatment of Type 2 diabetes.

These medications include multiple classes of medications such as biguanides, thiazolidinediones, alpha glucosidase inhibitors, amylin analogues, and sodium glucose transporter 2 inhibitors.

It’s important to note, however, that diet and exercise should always be the first step in managing diabetes before initiating medications, and should generally be continued while on medication as well.

There are two classes of medications that increase insulin sensitivity and decrease the production of new glucose and they include biguanides and thiazolidinediones. Let's start with the biguanides.

Biguanides are the first line of therapy for the treatment of type 2 diabetes. There is one main medication in the biguanide class and that is metFORMIN.


Hypoglycemics are used to treat type II diabetes mellitus. They include drugs like sulfonylureas, biguanides, meglitinides, alpha-glucosidase inhibitors, and thiazolidinediones. Each type of medication works in a different way to lower blood sugar levels.

For example, sulfonylureas and meglitinides are secretagogues, meaning they stimulate the pancreas to produce more insulin. Biguanides inhibit production of new glucose from the liver. Alpha-glucosidase inhibitors prevent starch from being broken down into glucose in the gastrointestinal system, whereas thiazolidinediones make tissues more sensitive to insulin.


  1. "Katzung & Trevor's Pharmacology Examination and Board Review,12th Edition" McGraw-Hill Education / Medical (2018)
  2. "Rang and Dale's Pharmacology" Elsevier (2019)
  3. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  4. "SGLT-2 inhibitors in diabetes: a focus on renoprotection" Revista da Associação Médica Brasileira (2020)
  5. "Combination therapy with GLP-1 receptor agonist and SGLT2 inhibitor" Diabetes, Obesity and Metabolism (2017)
  6. "Thiazolidinediones: the Forgotten Diabetes Medications" Current Diabetes Reports (2019)
  7. "The mechanisms of action of metformin" Diabetologia (2017)

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