8: USMLE and COMLEX Prep: Side Effects of Diabetes Medications

Check out our 25% Black Friday Sale now through 12/1/2025 at https://medicalschoolhq.net including our 1-on-1 advising and MCAT Winter Immersive Course! Session 08 Step 1 and Level 1 love to test the mechanisms or side effects of medications that treat diabetes. Follow along to test your knowledge of diabetic medications and side effects. Once again, we're joined by Dr. Andrea Paul, Chief Medical Officer at Board Vitals. Reminder to everyone is that you may know the diagnosis but the question is not going to be that simple. So be prepared for so many different levels of questions and knowledge that you have to know. Use the promo code BOARDROUNDS to save 15% off their QBanks. [02:00] Diabetes Medications There are lots of medications for diabetes so it makes it extra complicated and they have their own interesting set of side effects and mechanisms of action that you want to know because they're commonly tested. As you're studying medications, first look at the overarching category. You don't have to remember every single medication within that overarching category. But in some cases like insulin, it's helpful to know the different preparation because they may ask about short-acting or long-acting insulin preparation. But generally, other medications have the same mechanisms and side effects so you can combine those together and just remember by the generic names. Most often, what the test is going to be asking about is mechanism or side effect. [05:00] Question of the Week It's a 56-year-old man with adult-onset diabetes who's visiting his primary care physician. He's been on medication while controlled and his glucose levels have improved. But now, he is presenting with his glucose levels trending up over the last 6 months. His A1C trending up and they want to add a second medication. There's a worrisome side effect of the second medication and it's asking you to narrow down, looking at the different options of what you could add to what he's already on. So you need to think about which of those has a worrisome side effect. He's on Sulphonylurea and when you think about that category of medications, you start thinking that glucose normally triggers an insulin release from the pancreatic beta cells. They mimic the action of glucose so they close those channels in the cells and that depolarizes them which leads to insulin release. Then when you think about toxicity, that's the category of drugs where you think about disulfiram reaction and hypoglycemia. With insulin, if you take more than what's necessary, there's a worrisome side effect of hypoglycemia. Then you start thinking through which of the other categories have something that they would categorize as extremely worrisome. That would knock out things like hypoglycemia because that's the side effect of almost every antidiabetic medication. You'd start thinking down the path of severe toxicity and the only medication that has that is the Glitazone category. Those are the medications where their mechanism is they bind receptors that modulate insulin sensitivity. They will increase your insulin sensitivity and decrease gluconeogenesis, increase the number of insulin receptors. They're known for cardiovascular and hepatotoxicity which is something you have to remember about that category. If you look through all of the other diabetic medication categories, none of them have as worrisome or a severe side effect as that category does. [08:20] What's the Worrisome Effect? In this case, the answer is hepatotoxicity. The way you can narrow it down is knowing that he's already on a sulphonylurea and they're adding something that causes a very worrisome side effect. You can immediately narrow it down and find the medication in the list of options that fall into that category. Choices: Hypoglycemia...

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