Paper II — 2024 March (Supplementary) (2010 Scheme) — Q2
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Paper II
2024 March (Supplementary) (2010 Scheme)
Question
A 52-year-old patient visits his doctor with complaints of increased frequency of
urination, increased hunger and thirst. His fasting blood sugar was 150mg/dl
Postprandial blood sugar was 230mg/dl, HbA1c was 8%. A diagnosis of Type 2
diabetes was made….
(a) Classify Oral Anti diabetic drugs with two examples each. 4 mark(s)
(b) Add a note on Biguanides 2 mark(s)
Q26 marksEssays
Answer
a) Classification of oral antidiabetic drugs, two examples each
Class
Examples
Sulfonylureas
Glibenclamide, Glimepiride
Biguanides
Metformin
Thiazolidinediones
Pioglitazone, Rosiglitazone
Alpha-glucosidase inhibitors
Acarbose, Miglitol
DPP-4 inhibitors
Sitagliptin, Vildagliptin
SGLT2 inhibitors
Dapagliflozin, Empagliflozin
b) Note on BiguanidesMOA: metformin → activates AMP-activated protein kinase (AMPK) in hepatocytes → suppresses hepatic gluconeogenesis (its dominant mechanism) and modestly increases peripheral insulin sensitivity/glucose uptake. Critically, metformin does not stimulate insulin release at all, so it carries essentially no hypoglycemia risk as monotherapy — the reason it remains first-line therapy for this patient’s newly diagnosed type 2 diabetes across essentially all major guidelines. Adverse effects: GI upset (nausea, diarrhea), lactic acidosis (rare but serious, risk amplified by renal impairment — the mechanistic reason metformin is contraindicated/dose-adjusted in significant renal impairment and temporarily withheld around iodinated contrast administration).
