There are a number of drugs on the market to manage diabetes. They have different mechanisms of action. Here are a few with a short description of how they work.

Sulfonylureas are drugs that stimulate insulin secretion from beta cells. Tolbutamide is an example of a sulfonylurea, although newer sulfonylureas such as glibenclamide are more commonly used instead.

Metformin (Glucophage) is a drug that is cheap and generally safe and effective. It works to limit 'hepatic glucose production', in part by inhibiting gluconeogenesis.

4a) What metabolic state is typically associated with increased hepatic glucose production?

Absorptive state/post-absorptive state

Thiazolidinediones (TZDs) improve/restore insulin action, or promote the sensitivity of target cells for insulin.

4b) Almost all cells of our body have insulin receptors and can respond to insulin. However, from a whole body perspective, name the 3 organs that are the most important targets of insulin.

Answer

4a) Post-absorptive state

4b)liver, skeletal muscle, adipocytes (fat cells)

Step-by-step explanation

4a) The post-absorptive state, aka the fasting state, occurs when food has already been digested, absorbed, and stored. This commonly occurs when you fast overnight, as well as skipping meals during the day. During this state, the body must breakdown glycogen and produce more glucose. The process of breaking down glycogen is glycogenolysis and the process of forming new glucose is gluconeogenesis.

4b) The primary targets for insulin are liver, skeletal muscle, and adipocytes. Insulin acts on these organs to form fuel storage in the form of glycogen or fat. Glucose enters the circulation either from the diet or from synthesis in the liver and form glycogen in the liver where it will also be stored. Additionally, insulin inhibits breakdown of fat in adipose tissue by inhibiting the intracellular lipase that hydrolyzes triglycerides to release fatty acids. Insulin facilitates entry of glucose into adipocytes, and within those cells, glucose can be used to synthesize glycerol, which is stored in the adipocytes. Simultaneously, insulin stimulates glucose uptake in skeletal muscle, and the increased glucose entry into skeletal muscle, together with the activation of key enzymes in glucose metabolism by insulin, leads to an increase in muscle glucose oxidation.