• Hypoglycemic agent
• Promote insulin release (independent)
• Inhibit Glucagon secretion

• Hypoglycemic
• Promote insulin release (dependent)

• Non Hyperglycemic
• Inhibit glucose production
• Increase GLUT-4 transporters

• Post receptor effect
• Bind PPAR -> ↑ GLUT-4 synthesis
• (Insulin more effective)

1. Glucose binds cell, GLUT2 transporter lets glucose in
2. Glucose phosphorylated, ↑ATP
3. ↑ATP causes K channel to stop, Ca comes in
4. Ca activates adenylate cyclase (↑cAMP)
5. Microtuble/Microfilament  contracts
6. Insulin exocytosis

B chain

Amino terminus modification

B chain

carboxy terminus modification

B chain

Modification to double activity

Oral-lyn

• Buccal delivery
• Insulin spray composed from soybean lectin + lysalbinic acid
• type I and II diabetes

1. Remove Thr₃₀
2. Lys₂₉ -> C14 fatty acid

• Decrease postprandial spike

1. Insulin binds receptor
2. Signal to stored vessicle
3. GLUT-IV moves & binds with membrane
4. Glucose enters
5. Insulin leaves
6. GLUT-IV moves back

Glucagon MOA

1. Glucagon binds recepter in liver
2. receptor activation coupled to adenylate cyclase: ↑ cAMP
3. Phosphorylase kinase is phosphorylated
4. PPC activated
5. phosphorylase a activated: glycogenolysis

Adenylate cyclase -> cAMP -> protein kinases -> phosphorylase kinase -> phosphophosphorylase kinase (PPC) -> phosphorylase a -> glycogenolysis

Somatostatin

• treat sulfonylurea OD

1. Protamine dissociation*
2. Zn dissociation
3. dimer -> monomer

1. Hypothalamus releases TRH
2. Anterior pituitary releases TSH
3. ATPase pumps I into thyroid hormone
4. I + Tyr -> MIT or I₂ + Tyr -> DIT
5. DIT + DIT-> T₄ or DIT + MIT -> T₃
6. Feedback inhibition

Thyroid Peroxidase (TPO)

• Thyroxine binding globulin
• Thyroxine binding prealbumin

1. Thiazoladinediones
2. Antiepileptics

• ↓ bone breakdown (↓ osteoclast)
• ↓ Vitamin D activation
• ↓ Ca absorption from GI
• ↑ Ca excretion

"when you have a ton of Ca"

• ↑ Ca mobilization by activating adenylate cyclase
• ↑ Synthesis/activation of vitamin D
• ↑ Absorption of Ca from GI
• ↑ Reabsorption of Ca from renal

1. Vitamin D 25 hydroxylase (liver)
2. Vitamin D 1 hydroxylase (kidney)