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Recent advances have resulted in a dramatic increase in the number and types of drugs used to manage diabetes. These agents can be divided broadly into parenteral and oral drugs. Table II–8 lists the various available antidiabetic agents. Other drugs and poisons can also cause hypoglycemia (see Table I–25).

Table II-8 Antidiabetic Drugsa

  1. Mechanism of toxicity

    1. Parenteral agents

      1. Insulin. Blood glucose is lowered directly by the stimulation of cellular uptake and metabolism of glucose. Cellular glucose uptake is accompanied by an intracellular shift of potassium and magnesium. Insulin also promotes glycogen formation and lipogenesis. All insulin products are given by the parenteral route (a nasal formulation was discontinued in 2007), and all produce effects similar to those of endogenous insulin; they differ in antigenicity and in onset and duration of effect.

      2. Amylin analogs. Pramlintide is a synthetic analog of amylin, a peptide hormone synthesized by and excreted from pancreatic beta cells along with insulin during the post-prandial period. Amylin slows gastric emptying and suppresses glucagon secretion.

      3. Incretin analogs. Incretins are hormones, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), that are released from the intestines in response to oral ...

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