anti-diabetic drugs Flashcards
what is the major stimulus in the regulation of insulin secretion
glucose
incretin hormones in the GI tract stimulate..
the release of insulin when glucose levels are normal or elevated
cortisol, GH, epinephrine, estrogen and progesterone all..
raise blood glucose levels
excessive prolonged endogenous secretion of insulin can exhaust..
pancreatic beta cells and can cause or aggravate DM
some factors that inhibit insulin secretion are?
hypoxia, hypothermia, surgery and severe burns (ie. stress)
DM type 1:
-autoimmune disorder destroys pancreatic beta cells (life long disease)
DM type 2:
-insulin resistance & hyperglycemia
signs and symptoms of DM
-hyperglycemia, glucosuria, polydipsia, polyruia, dehydration, polyphagia
complications of DM include
-MI, Stroke, blindness, leg amputation and kidney failure
lispro and insulin aspart are _________ insulin’s
short acting
intermediate acting insulin’s have
added protamine and or zinc
insulin glargine is _______
long acting, used to provide basal amount
insulin is not used if _____________
DM is controlled by diet
when mixing insulin’s?
draw up rapid/short acting insulin first, then immediate acting insulin, use immediately
the insulin pump uses _______ acting insulin
rapid acting, others use regular insulin
Oral hypoglycemics and anti-hyperglycemics:
sulfonylureas (glyburide)
increase secretion of insulin
Oral hypoglycemics and anti-hyperglycemics:
alpha-glucosidase inhibitors (acarbose)
delay digestion of complex carbohydrates into glucose
Look at videos in red on powerpoint…
YES
Oral hypoglycemics and anti-hyperglycemics:
-Biguanide (ALSO called Metformin)
Increases use of glucose by muscle and fat, decreases hepatic glucose production and decreases intestinal absorption of glucose
Oral hypoglycemics and anti-hyperglycemics:
-Glitazones (Actos)
-insulin sensitizers decrease insulin resistance by stimulating receptors on muscle, fat, and liver cells
Oral hypoglycemics and anti-hyperglycemics:
-Meglitinides (nateglinide)
-stimulate pancreatic secretion of insulin
Oral anti-diabetic agents can be used in various combinations for…
additive fact
Sulfonylureas and meglitinides may have interactions with
beta blockers and alcohol may have additive hypoglycemic effects with concurrent use
concurrent use of thiazide diuretics and _______ may raise blood glucose levels and thereby counteract the effects of insulin
glucocorticoids
beta blockers may mask..
SNS response to hypoglycemia (tachycardia, tremors), making it difficult for clients to identify hypoglycemia
Insulin dosage may need to be increased in response to ..
- increase in caloric intake
- infection
- stress
- growth spurts
- in second and third trimesters of pregnancy
Insulin dosage may need to be decreased
- in response to level of exercise
- first trimester of pregnancy
Instruct clients to administer subcutaneous insulin in one general area to have consistent rates of absorption. absorption rates from subcut admin__________ from thigh to upper arm to abdomen
increase
oral anti-diabetics: rapidly decrease glucose so
have food available
Hypoglycemia if abrupt onset
client will experience sympathetic nervous system (SNS) effects (tachycardia, palpitations, diaphoresis, shakiness)
Hypoglycemia if gradual onset
client will experience parasympathetic (PNS) manifestations (headache, tremor, weakness)
if Hypoglycemia occurs administer..
snack of 15g carbohydrates, 4 oz orange juice, 2 oz grape juice, 8 oz milk, glucose tablets equal to 15g
what is the best measure of glycemic control?
glycosated hemoglobin (HGB AIC)
what is a good HGB AIC level?
less than 6.5%
Children with type 1 DM high risk for
delayed growth and development
Goals of diabetic education?
- self-management/self care
- good glycemic control
- HBA1C less than 7%
- FBG between 4-7mmol/L
- monitor glucose levels and urine ketones
_____ or _______ when combined with either glyburide or metformin increase blood glucose
-Beta-blockers or alcohol
