Insulin homeostasis:
- Under fasting conditions, insulin is released in a ❌ manner every ❌ mins​.
- In response to increased glucose:​
Phase 1:​ insulin release within ❌​, peak at ❌ mins​
Phase 2: more ❌ release with a ❌ peak​

Sulphonylureas stimulate insulin release by binding to a specific site on the beta islet cell's ❌ complex (SUR) and ❌ its activity. Inhibition causes cell membrane ❌ and insulin ❌.
Their effect declines over ❌ because of down-regulation of cell surface ❌ and​ progression of beta islet cell failure​.
Side effects are hypoglycaemia and initial ❌ gain​, less-common side effects include nausea, vomiting, cholestatic jaundice, and agranulocytosis.​

DPP-4 is dipeptidyl peptidase 4, a serine protease that is widely distributed throughout the body​. It ❌ GLP-1​. Inhibiting ❌ cause increase in plasma ❌, resulting in higher insulin secretion.​

Alpha glucosidase inhibitors reduce the intestinal ❌ of starch, dextrin, and disaccharides ​by inhibiting the action of ❌ in the intestinal brush border​.
They are taken ❌ each meal and not absorbed​. They are often used in ❌ with other meds.
Side effects are malabsorption, flatulence, diarrhoea, and abdominal bloating​.

Biguanides include metformin. Metformin reduces ❌ glucose production by ❌ gluconeogenesis.​
It activates ❌ (AMPK), leading to stimulation of:​
- hepatic ❌ oxidation
- ❌ uptake
- non-oxidative glucose ❌
- ❌ of lipogenesis and gluconeogenesis. ​
Side effects are GI: nausea, indigestion, abdominal cramps, bloating, diarrhoea​.

Thiazolidinediones are PPAR-gamma inhibitors that cause insulin sensitisation.
The PPARγ receptor is a ❌ involved in the regulation of genes related to ❌.​ PPARγ receptors are expressed primarily in adipose tissue. They promote uptake of circulating fatty acids into ❌ cells, and glucose uptake into ❌ tissue.​ They ❌ insulin resistance.
Side effects are weight ❌ and oedema​.

SGLT2 is a Na+-glucose cotransporter located in the proximal portion of the ❌ tubule. It reabsorbs ❌. SGLT2 inhibitors ❌ glucose transport thus ❌ blood glucose.​
Side effects:
- A 1%-2% increase in lower ❌ infections.​
- A 3%-5% increase in ❌ mycotic infections. ​
- Mild ❌, which can lead to hypotension. ​
- Effectiveness decreases by 40%–80% in kidney disease (GFR 60–30 mL/min). ​