4.1 Diabetes Drug Therapy Flashcards
Goals of Medication
- Keeping blood glucose normal
- Promote normal metabolism
- Prevent acute/chronic complications (micro/macro)
- Prevent hypoglycemia (side effect of treatment)
Type 1 Diabetes
- Exogenous Insulin
Type 2 Diabetes
- Oral Medications
- Used when diet and exercise don’t control hyperglycemia
- Antidiabetic agents
Insulin
- High alert, high risk med
- Must be verified by 2 healthcare providers before given
- Categorized as rapid acting, short acting, intermediate acting, long acting.
- Injections can vary between people from 1-4 injections a day
- Injections are usually a combination of short and long acting
- Usually given subQ
Conventional Insulin Therapy
- Meals scheduled to match anticipated peaks in insulin profiles.
Rapid Acting Insulin
- Lispro, Humalog, Novolog
- Given with patient meals
- Must eat within 5-15 minutes of the injection
- Rapid onset, short duration. Do not give to NPO patients
Short Acting Insulin
- Regular insulin, Humulin R, Novolin R
- Clear solution
- Given 15 minutes before a meal
- Only one given as IV
- Covering someone during mealtime
- Works slightly longer than rapid acting insulin
Intermediate Insulin
- Humulin N, Novolin N
- Cloudy Insulin
- Basal (Background Constant Effect)
- When mixing, draw clear insulin first then cloudy
Long Acting Insulin
- Lantus Levemir
- Continuous Insulin Action (Controls blood sugar between meals)
- Does not control spikes after meals
- Rapid acting and long acting cannot be given in combination (must be separate)
Complications of Insulin Therapy
- Local reaction at injection site
- Lipodystrophy (fatty pads)
Dawn Phenomenon - Exhibits hyperglycemia in the morning but looks different at night
Oral Agents of Type 2 Diabetes
- Works on insulin resistance
- Works on decreased insulin production
- Works on increased hepatic glucose production
- Works on GI absorption of Glucose
- Can be used in combination with insulin
- Used when diet and exercise not enough
- Risk of hypoglycemia
Sulfonylureas
- Prototype is DiaBeta
- Stimulates pancreas to create more insulin
Alpha-Glucosides
Precose
- Often given with sulfonylureas and it delays digestion of complex carbs and decreases increase in blood sugar after meals.
- Does not lower blood sugar but decreases spike after meals
Biguanide
- Metaformin (Most widely used Oral Agent)
- Glucophage
- Risk of Lactic Acidosis
- Decreases hepatic glucose production
- Increase insulin sensitivity
Thiazolidinediones/Glitazones
- Avandia
- Decreases insulin resistance by stimulating insulin receptors
Meglitinides
- Prandin
- Stimulating Insulin Production
- Avandia
- Decreases insulin resistance and stimulates insulin receptors
Amylin Analogs
- Symlin (Not as common) (Newer Drugs)
- Suppress Postprandial Glucagon Secretion
Incretin Mimetics
- Byetta
- Stimulate pancreas to secrete right amount of insulin based on food intake
Endogenous Insulin
(Produced in the body)
- Lowers blood sugar
- Clears from blood in 10-15 minutes
- Opens cell receptors to allow glucose into cells
- Glucose regulates insulin
- Growth hormone, cortisol, stress inhibit insulin
- Human insulin is only made in pigs and cows
Exogenous Insulin
- Genetic Engineering
- Insulin Analog (Mimics Human Physiology)
Insulin Syringe
- Orange tip measured in units NOT CC
- Usually comes in 100 unites per mL
- SubQ injection rotated between abdomen, upper arm, thigh, buttox
Dipeptidyl Peptidase
Januvia
- Increase and lengthen release of insulin and decrease hepatic glucose production
Sodium Glucose Co-Transporter 2 (SGLT2 Inhibitors)
- Invokana
