Chapter 32- Antidiabetic Drugs

Question 1

Diabetes Mellitus

Answer 1

A complex disorder of carbohydrate, fat, and protein metabolism resulting primarily from the lack of insulin secretion by the B-cells of the pancreas or from defects in the insulin receptors. There are type 1 and type 2 diabetes.

Question 2

Diabetic ketoacidosis (DKA)

Answer 2

Severe metabolic complication of uncontrolled diabetes, which,if untreated, leads to diabetic coma and death.

Question 3

Gestational diabetes

Answer 3

Diabetes that develops during pregnancy. May resolve after pregnancy but may also be a precursor of type 2 diabetes.
Insulin must be given to prevent birth defects.

Question 4

Glucagon

Answer 4

Hormone produced by the a-cells in the islets of Langerhans that stimulates the conversion of glycogen to glucose in the liver

Question 5

Glucose

Answer 5

A simple sugar that serves as a major source of energy

Question 6

Glycogenolysis

Answer 6

The breakdown of glycogen to glucose

Question 7

Hemoglobin A1C (HbA1c)

Answer 7

Hemoglobin molecules to which glucose molecules are bound; blood levels of hemoglobin A1C are used as a diagnostic measurement of average daily blood glucose in the monitoring of diabetics

Question 8

Hyperglycemia

Answer 8

A fasting blood glucose level of 7mmol/L or higher or a non fasting blood glucose level of 11.1mmol/L or higher

Question 9

Hyperosmolar nonketotic syndrome (HNKS)

Answer 9

A metabolic complication of uncontrolled diabetes, similar in severity to DKA but without ketosis and acidosis.

Question 10

Hypoglycemia

Answer 10

Blood glucose level less than 2.8mmol/L.
Mild cases treated with diet.
Early symptoms: confusion, irritability, tremor, sweating. Later symptoms: Hypothermia, seizures, coma and death will occur if not treated.

Question 11

Imparied fasting glucose level

Answer 11

A pre diabetic state defined as a fasting glucose level of at least 6.1mmol/L but lower than 6.9mmol/L; prediabetes

Question 12

Insulin

Answer 12

A naturally occurring hormone secreted by the B-cells of the islets of Langerhans in the pancreas in response to increased levels of glucose in the blood.

Question 13

Ketones

Answer 13

Organic chemical compounds produced through the oxidation of secondary alcohols (fat molecules) including dietary carbohydrates

Question 14

Polydipsia

Answer 14

Chronic excessive intake of water; it is a common symptom of diabetes

Question 15

Polyphagia

Answer 15

Excessive eating; common symptom of diabetes

Question 16

Polyuria

Answer 16

Increased frequency or volume of urinary output; common symptom of diabetes

Question 17

Type 1 diabetes mellitus

Answer 17

Genetically determined autoimmune disorder involving a complete or nearly complete lack of insulin production; most commonly develops in children or adolescents.

Question 18

Type 2 diabetes mellitus

Answer 18

Most commonly presents in middle age. Disease may be controlled by lifestyle modifications, oral drug therapy, insulin, or a combination of these measures, but patients are not necessarily dependent on insulin.

Question 19

Long term complications of Diabetes

Answer 19

Macrovascular: atherosclerotic plaque. Coronary arteries, cerebral arteries, peripheral vessels.

Microvascular: capillary damage. Retinopathy, neuropathy, nephropathy (kidney damage)

Question 20

Acute complications of Diabetes

Answer 20

Diabetic ketoacidosis- Life Threatening!: Extreme hyperglycaemia, presence of ketones in serum, acidosis, dehydration, electrolyte imbalances.

Hypersmolar nonketotic syndrome: Triggered by extreme hyperglycaemia, precipitated by physical or emotional stress. Treated with IV fluids and electrolyte replacement, Insulin therapy.

Question 21

Insulins

Answer 21

Substitute for endogenous hormone and has same effects as normal endogenous insulin.
Restore the diabetics patients ability to metabolize carbs, fats and proteins. Store glucose in the liver and convert glycogen to fat storage
Most now use recombinant DNA technologies
Aim to reduce the incidence of long-term complications

Question 22

Rapid Acting insulins

Answer 22

10-15 minutes. Shorter duration. Given SubQ or infusion pump but not IV.
Ex) Insulin aspart (NovoRapid), insulin lispro (Humalog)

Question 23

Short Acting Insulins

Answer 23

Onset 30-60 minutes. Ex) Regular insulin (Humulin R)-only one given IV and (Toronto)

Question 24

Intermediate Acting Insulin

Answer 24

NPH (Humulin-N)

Cloudy appearance. Slower in onset and more prolonged duration

Question 25

Long acting insulin

Answer 25

Insulin glargine (Lantus), Insulin detemir (Levemir)

Question 26

Combination insulin products

Answer 26

Regular insulin 30% (short acting) and NPH 70% (long acting) - Humulin 30/70; Novolin ge 30/70

Question 27

Sliding scale insulin dosing

Answer 27

SubQ short acting or regular insulin doses are adjusted according to blood glucose test results.
Typically use in hospitalized diabetic PTs on total parenteral nutrition or enteral tube feedings.
Done before breakfast, lunch, and supper

Question 28

Oral Antidiabetic drugs

Answer 28

Used for type 2 diabetes. May not be effective unless PT is making lifestyle and behavioural changes.
Ex) Sulfonylureas: gliclazide (Diamicron), glyburide (Dibeta)
Meglitinides: repaglinide (GlucoNorm)
Biguanides: metformin (Glucophage)
Thiazolidinediones aka glitazones: rosiglitazone (Avandia)
a-Glucosidase inhibitors: acarbose (Glucobay)

Question 29

Oral Antidiabetic Mech of Action

Answer 29

Sulfonylureas: Stimulate insulin secretion from pancreas. Improve sensitivity to insulin in tissues. Lower blood glucose levels.
Meglitinides: Similar to sulfonylureas. Increase insulin secretion from pancreas
Biguanides: Decrease production of glucose. Increase uptake of glucose. Do not cause hypoglycemia.
Thiazolidinediones: Decrease insulin resistance, increase glucose uptake.
a-Glucosidase inhibitors: Must be taken with meals to prevent after meal (postprandial) blood glucose elevations. Take with first bit of a meal.

Question 30

Oral Antidiabetic Indications

Answer 30

Used alone or in combination with other drugs, diet and lifestyle changes.

Question 31

Oral Antidiabetic Contraindications

Answer 31

Active hypoglycemia

Question 32

Oral Antidiabetic Adverse Effects

Answer 32

Sulfonylureas: Nausea, heartburn.
Meglitindies: Headache, hypoglycemic
Metformin: Metallic taste, lactic acidosis, does not cause hypoglycemia
Thiazolidinediones: moderate weight gain, edema, mild anemia, hepatic toxicity.
a-Glucosidase inhibitors: flatulence, diarrhea, abdo pain, do not cause hypoglycaemia or weight gain

Question 33

Oral Antidiabetic Interactions

Answer 33

Sulfonylureas: Hypoglycemic effect increases when taken with alcohol, anabolic steroids, and many others. Allergic cross-sensitivity may occur with loop diuretics and sulphonamide antibiotics.

Question 34

Glucose-Elevating Drugs

Answer 34

50% dextrose in water (D50W) IV. Glucagon

Question 35

Nursing Implications

Answer 35

Concerns increase when PT is: stressed, has an infection, illness or trauma, or is pregnant or lactating.
Insulin: Check blood glucose levels before giving insulin. Roll vials. Store in fridge for 3 months. Store in room temp for 1 month. Ensure correct timing with meals. When drawing up two types of insulin in one syringe, always withdraw the regular or rapid first. Rotate injection sites.
Oral antidiabetic drugs: Always check glucose levels before giving. Give 30 mins before meals. Metformin is taken with meals to reduce GI effects. Stop metformin 48hrs prior to a CT.
Assess for hypoglycemia. If occurs, give glucagon, glucose tablets, or have pt eat a small snack with protein and a carb.
Monitor blood glucose levels.
Monitor for Therapeutic effects: decrease in blood glucose levels. measure hemoglobin A1c.