Diabetic Medications Flashcards
How is blood glucose lowered by?
Insulin
How is blood glucose raised?
- Glucagon
- Adrenaline
- Growth Hormone
- Cortisol
How does adrenaline raise blood glucose?
stimulating your liver to release glucose so it can be used in an emergency
How does the growth hormone increase blood glucose?
by stimulating lipolysis so that lipids are available for growth leaving glucose to be available for the brain
How does cortisol raise blood glucose?
Cortisol raises blood sugar by releasing stored glucose so it can be used within stressful situations
What are the 4 types of insulin?
- rapid acting
- short acting
- Intermediate acting
- long acting
What is the indicator for use of insulin?
- Type 1 DM
- Type 2 DM - co-administered with oral hypoglycaemic agents in management of DM
- Hyperglycaemia: in emergencies & stress, infection, surgery, during pregnancy, Treatment of hyperkalaemia
What caution/contra-indicators is there for someone who is on insulin?
in patients with liver or kidney disease, fever, infection, hyperthyroidism, GI upset, recent surgery. Interact with corticosteroids, beta blockers, ACE inhibitors and thiazide diuretics (beta blockers may mask symptoms of hypoglycaemia)
What are the pharacokinetics of insulin?
onset, peak action and duration varies due to type and properties of insulin being used. Metabolised and inactivated rapidly in most tissues of the body.
What are some adverse drug reactions of insulin?
Hypoglycaemia, Weight gain, Allergy-rare, injection site reactions
What patient education would you provide for someone on insulin?
lifestyle management through exercise, eating healthy diet, rotate injection sites (subcutaneous injection – stomach is ideal). Ability to recognise signs of hypoglycaemia e.g. blurred vision, confusion, dizziness, faintness, and headache, how to store insulin, how to administer insulin.
What are some monitoring requirements with insulin?
Monitor BGL levels (4-8 mmol/L), monitor BP, monitor blood for lipid levels, monitor kidney function, eye, and foot care. Instruct appropriate administration and storage
How does each form on insulin work eg. duration and onset?
Rapid acting = rapid onset & short duration of action
Short acting = quick onset & moderate duration of action
Intermediate acting = longer onset of action & longer duration
Long acting = longest onset of action & longest duration
What is the Basal dose regimen?
basal dose is given when there are low levels of insulin present between meals and overnight to “mop up” glucose that is still breaking down between meals. The body needs basal insulin to maintain a steady blood glucose level. Intermediate and longer acting insulins are used.
What is the bolus dose regimen?
bolus dose of insulin is given to cover sharp rise as a result of eating (meal-times) called ‘post prandial’ rise, approx. 90 -120 mins after eating. Bolus insulin provides you with extra insulin on top of your basal insulin. Rapid acting and shorter acting insulins are used.
What are some lifestyle managements/ monitoring with someone on insulin?
Risk of long term complications requires careful monitoring of:
- Renal function
- Vision
- Peripheral circulation
- Cardioprotective measures
- Weight management
- Health eating
- Healthy activities
- Cardiovascular risk assessment
What is used in the treatment of Type 2 diabetes?
- Oral hypoglycaemic agents
- Lifestyle changes: food, physical activity, and behavioural strategies
- Oral monotherapy: one drug
- Combination oral therapy: multiple drugs
- Oral drug plus insulin
- Insulin only
What are Biguanides and give an example
Oral diabetic medication. For example, Metformin. Metformin is the only one used in NZ
What is the indication of use for Biguanides (Metformin)?
Type 2 diabetes
What is the MOA of Biguanides?
Increase glucose uptake & utilisation in skeletal muscle (reduces insulin resistance). Reduce glucose production in the liver (gluconeogenesis). Increase insulin sensitivity
Reduces low and very-low density lipoproteins
what is the pharmacokinetics of Biguanides?
Metformin is well absorbed from small intestine, does not bind to plasma proteins, does not undergo hepatic biotransformation, excreted unchanged in urine.
Half life of Metformin is 1.5 - 4.5 hours, taken in three doses with meals
What are some adverse drug reactions of Biguanides?
GI upset nausea, vomiting, anorexia, diarrhoea, abdominal discomfort, metallic taste. Rare but fatal—lactic acidosis
What are some symptoms of Lactic Acidosis?
dizziness, sleepiness, chills, muscle pain, weakness, diarrhoea, low BP, decreased HR, dyspnoea
What are some contraindications of Biguanides?
- Patient with severe renal or hepatic impairment
- History of lactic acidosis, HF, recent MI, chronic lung disease.
-Elderly and those taking alcohol
