ORAL HYPOGLYCEMIC

DRUGS
• QUESTION: Which of the following would not indicate the diagnosis of
diabetes mellitus?
• a. Fasting plasma glucose of 120 mg/dL
b. Random plasma glucose of 250 mg/dL with symptoms of hyperglycemia
c. Fasting plasma glucose of 145 mg/dL
d. 2 hour plasma glucose of 220 mg/dL
• Rationale: The correct answer is fasting plasma glucose of 120 mg/dL. Criteria
for diagnosis of DM includes fasting plasma glucose of ≥126 mg/dL. A fasting
plasma glucose of 145 mg/dL would indicate DM because it is greater than the
criteria of ≥126 mg/dL. Criteria for DM for a random plasma glucose with
symptoms of hyperglycemia is ≥ 200 mg/dL. Criteria for DM in a 2 hour plasma
glucose is ≥ 200 mg/dL (McCance & Huether, 2019).
• QUESTION: Which of the following mechanisms does not lead to hyperglycemia in diabetic
patients?
• a. Exogenous administration of insulin
b. Increased hepatic glucose production
c. Decreased insulin secretion
d. Decreased peripheral glucose uptake
• Rationale: The correct answer is exogenous administration of insulin. Administration of
insulin would increase the body’s available insulin and lead to normal or lower blood glucose
levels. Increased hepatic glucose production leads to hyperglycemia because there is more
glucose for insulin to uptake into the cell for excretion. Decreased insulin secretion leads to
hyperglycemia because there is not enough insulin to meet the body’s needs for glucose
uptake into the cell for excretion. Decreased peripheral glucose uptake leads to hyperglycemia
because the glucose isn’t being pulled into the cell for excretion (McCance & Huether, 2019).
 QUESTION : Which of the following cell types is responsible for secreting insulin in
the body in response to elevated glucose in the bloodstream?
a. Alpha pancreatic cells
b. Beta pancreatic cells
c. Kupffer cells
d. Adipose cells
• Rationale: The correct answer is beta pancreatic cells. Beta pancreatic cells are located in the
islets of Langerhans in the pancreas. They are responsible for producing insulin and the insulin
then takes up glucose into the cells for excretion. Kupffer cells are macrophages that are
important for lipid metabolism, bilirubin production, and healing liver damage. Alpha pancreatic
cells are responsible for secreting glucagon. Glucagon is the antagonist to insulin and increased
blood glucose levels. Adipose cells are fat cells that produce adipokines. Increased adipokines in
the blood contributes to decreased insulin production (McCance & Huether, 2019).
• A 46-year-old obese businessman (body mass index - 32 kg/m 2) with
essential hypertension and type 2 diabetes mellitus (T2DM) of 8 years'
duration presented with poor glycemic control (glycated
hemoglobin [HbA1c] - 9.4%). He was on maximal dosage of metformin
and sulphonylureas and has been following his diet and exercise
schedule very strictly. He is also concerned about his weight and
wants advice on which class of oral antidiabetic drug would be best
suited in his case that may provide efficacious glycemic control, weight
loss, and cardiovascular protection. He also wanted to know the side
effects of these drugs and what measures he could follow to prevent
these adverse events.
Assessment
• In view of the underlying obesity and usage of maximal doses of two classes of
oral antidiabetic drugs, this patient will benefit from the addition of sodium glucose
co-transporter-2 (SGLT-2) inhibitors, which are not only efficacious in terms of
glycemic control and weight loss but will also have additional benefits on blood
pressure control and cardiovascular protection. The main adverse effects that this
patient should be briefed about would include a possibility of simple urinary tract
infections, hypoglycemia, and subtle increases in low-density lipoprotein
cholesterol. However, he should also be explained the rare possibility of
normoglycemic ketosis, and that if he gets symptoms such as acute-onset
dyspnea, nausea, vomiting, and abdominal pain, he should stop taking SGLT2
inhibitors and seek medical attention immediately. To prevent recurrent urinary
tract infections, he should be advised to consume adequate fluids, ensure
micturition at regular intervals, and to keep good personal hygiene.