Insulin, metformin and oral hypoglycemic agent pharmacology in details

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This covers the full pharmacology of insulin, metformin, and all major oral hypoglycemic drug classes. Here's a quick orientation to each section:

What's covered above:

PART 1 — Insulin

β-cell physiology and GLUT2/ATP-K⁺ channel/Ca²⁺ mechanism of secretion (with diagram)
Insulin receptor structure → IRS → PI-3K/Akt/GLUT4 signaling
Metabolic actions in liver, muscle, and adipose
All four categories of insulin preparations (rapid, short, intermediate, long-acting) with onset/peak/duration table and pharmacokinetic diagram
Adverse effects (hypoglycemia, weight gain, hypokalemia, lipodystrophy)

PART 2 — Metformin

PART 3 — All Oral Antidiabetics

Sulfonylureas (1st/2nd/3rd gen): SUR1 blockade mechanism, hypoglycemia risk, renal dosing
Meglitinides: rapid prandial secretagogues
TZDs: PPARγ agonism, heart failure/fracture/bladder cancer risks
α-Glucosidase inhibitors: postprandial blunting, flatulence
DPP-4 inhibitors: incretin-based, weight neutral, linagliptin safe in CKD
GLP-1 receptor agonists: CV mortality reduction, weight loss, GI SE, thyroid C-cell warning
SGLT2 inhibitors: insulin-independent glycosuria, heart failure/CKD protection, euDKA risk

PART 4 — Comparative table (HbA1c reduction, hypoglycemia, weight, CV benefit, key risks)

PART 5 — Modern treatment algorithm (ADA/ACC-aligned preferred sequencing)

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