Week 7: How do we control hormones?

Scenario 1: Nola is a 37 year old librarian.

Medication and history: Nola suffers from Type 2 diabetes. She has been controlling
her diabetes with diet and an oral hypoglycaemic agent; however she is experiencing
frequent episodes of hypoglycaemia. Her only other medication is the combined oral
contraceptive pill. She has been smoking daily since she was a teenager, and has
recently cut down to 2 packets per week.
Question 1: Drug treatment of diabetes
1. What are the major classes of oral hypoglycaemic agents, and how do these drugs act?
Why are OHAs inappropriate for treatment of T1D?
There are 4 types of OHA, Metformin, Sulphonylureas, Thiazolidinediones, and Incretin
enhancers.
- Metformin acts to improve insulin sensitivity and blood lipids, hende increases glucose
uptake and usage. It also reduces gluconeogenesis.
- Sulphonylureas inhibits ATP-sensitive potassium channels causes depolarization and
stimulate insulin secretion. This increases the availability of insulin to act on the insulin
receptors.
- Thiazolidinediones activate PPAR nuclear receptors that regulate expression of genes in
glucose and lipid metabolism. This helps to increase insulin sensitivity.
- Incretin enhancers such as Gliptins are DPP-4 inhibitors, which is an enzyme that inactivates
incretins. As a result, it increases the concentration of incretins and therefore increase insulin
secretion.
OHA only used for T2DM because they require residual insulin secretion from the pancreas,
which does not exist in T1DM.

b. Given Nolas episodes of hypoglycaemia, which OHA do you think she is likely to be
taking? Justify your answer.
She is likely to taking either Sulphonylureas or Incretin enhancers, which increase
concentration of insulin in the blood that stimulate glucose uptake by the cells that causes the
blood glucose level to decrease.

c. Nolas doctor tells her that her HbA1C levels are elevated. What is HbA1C, and why is it
important?
The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin joins with
glucose in the blood, becoming 'glycated'.
It is important because the measuring of glycated haemoglobin (HbA1c) helps us to get an
overall picture of what our average blood sugar levels have been over a period of time.

For people with diabetes, the higher the HbA1c, the greater the risk of developing diabetesrelated complications.

d. Do you think Nolas treatment plan may be altered? If the answer is yes, what are the
likely alterations?
Yes, It can be combined with Metformin or Thiazolidinediones that increases insulin sensitivity
rather than increasing the total amount of insulin secreted therefore it is less likely to cause
hypoglycaemia.