Antidiabetics Flashcards
Caused by absolute lack of insulin secretion; Due to autoimmune destruction of pancreatic islet cells
Type I Diabetes
Methods of insulin administration
Syringe
Insulin pumps
Insulin pen injectors
Insulin jet injectors
How to mix insulin
Draw up the Clear (Fast acting)
Before the Cloudy (Long acting)
Thickening of tissue around the injection site
Lipohypertrophy
Deep, retracted scar on the skin the results from serious damage to SQ fatty tissue
Lipoatrophy
Why is site rotation important?
Site rotation is important to avoid side effects of lipohypertrophy and lipoatrophy
Only regular insulin can be given intravenously.
True or False
True
Routes of insulin administration
Subq and IV
Onset: 15 min
Peak: 1-2 hrs
Duration: 3-5 hrs
Admin: SQ, within 15 min of meals
Rapid-acting (clear)
Ex: Lispro, aspart, & glulisine
Onset: 30-60 min
Peak: 2.5 hrs
Duration: 6-10 hrs
Admin: SQ, 30-60 in before meals, can be IV
Short-acting (clear)
Ex: Regular (Humulin R, Novolin R)
Onset: 1-2 hrs
Peak: 4-8 hrs
Duration: 10-18 hrs
Admin: SQ, mix (cloudy)
Intermediate acting (cloudy)
Ex: Insulin isophane (NPH)
Onset: Lantus 1-2 hrs, Levemir gradual
Peak: Lantus none, Levemir 6-8 hrs
Duration: Lantus 24 hours, Levemir up to 24 hrs
Admin: SQ, once or twice a day, same time each day
Long acting
Ex: glargine (Lantus) & detemir (Levemir)
Can long acting insulin be mixed with other insulins?
No!
Promote use of glucose by body cells, store glucose as glycogen in muscles
Reduce blood glucose
Insulins
-Adjusted doses dependent on individual blood glucose
-Usually done before eating and at bedtime
-Usually uses rapid or short-acting insulin
Sliding-scale insulin coverage
Adverse effects of insulin
Adverse effects – hypoglycemia (insulin shock)
Can result from:
Insulin overdose
Improper timing of insulin dose
Skipping a meal
Insulin side effects
Hypoglycemia & hyperglycemia
Headache, dizziness, confusion, slurred speech
Nervousness, anxiety, agitation
Tremors, incoordination, sweating, tachycardia, seizures
Sx of hypoglycemia
Extreme thirst, dry mucous membranes
Poor skin turgor, polyuria, fruity breath
Fatigue, tachycardia, Kussmaul respirations
Sx of hyperglycemia
Hyperglycemia upon awakening
Dawn phenomenon
Rapid decrease in blood glucose during night stimulates hormonal release to increase blood glucose
Occurs in predawn hours
Somogyi effect
Insulin resistant
Controlled through lifestyle changes
Type II Diabetes
Drugs used to manage type 2 diabetes
-Two or more different types for best control
-May occasionally need insulin
Goals:
Normal blood glucose levels
Reduced blood fat levels
Normal body weight
Oral antidiabetic drugs
Side effects & adverse effects for oral antidiabetic drugs
Side effects – NVD, rash
Adverse effects – severe hypoglycemia
Drugs that directly stimulate beta cells in the pancreas to secrete more insulin
Indirectly alters sensitivity of peripheral insulin receptors, allowing increased insulin binding
Uses: control hyperglycemia in type 2 DM
Take once or twice a day
2nd gen Sulfonylureas
Ex: glipizide (Glucotrol)
Side effects & adverse effects of glipizide (Glucotrol)
-Hypoglycemia (especially in individuals who drink alcohol while taking)
-GI distress, weight gain
-Drowsiness, dizziness, confusion
-Blood dyscrasias (agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia, pancytopenia) hepatic failure
Drugs that stimulate pancreatic beta cells to release insulin (action similar to sulfonylureas)
Short-acting
Take 15-30 minutes before each meal
Meglitinides
Ex: nateglinide (Starlix) and repaglinide (Prandin)
Meglitinides are contraindicated in pts w/
Liver dysfunction (decrease liver metabolism, more drug in the body, could cause hypoglycemia)
Act on liver to reduce release of glucose from stored glycogen
Increase cell sensitivity to insulin (does not cause hypoglycemia)
Reduce absorption of glucose from intestinal tract
Biguanides
Ex: Metformin (Glucophage)
Iodinated contrast media can increase risk of renal failure and lactic acidosis when taking metformin (Glucophage). How long does the drug need to be held before and after testing w/ contrast?
48 hrs
Drugs that block enzymes in small intestine responsible for release of glucose from complex carbohydrates in the diet
Digestion of glucose is delayed. Carbohydrates must be in monosaccharide form to be absorbed.
Most common side effects are GI related (diarrhea, bloating, flatulence)
Alpha-glucosidase Inhibitors
Ex: acarbose (Precose)
