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
Metformin
What is the indication of use for Biguanides (Metformin)?
Should be initiated at diagnosis unless contraindicated
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, abdominal discomfort, diarrhoea, metallic taste
Lactic acidosis - rare but potentially life threatening.
What are some symptoms of Lactic Acidosis?
.
What are some contraindications of Biguanides?
Conditions predispose to increased lactate production causing lactic acidosis which is fatal.
- patients with significant renal or hepatic impairment, cardiac disease, dehydration, severe burns, severe infections, ketoacidosis, recent major surgery or trauma.
Pregnancy
- not recommended for use in pregnancy or during lactation
Cautions
- acute gastric illness (vomiting and diarrhoea): stop metformin while unwell
- prior to surgery to reduce risk of lactic acidosis.
What patient education would you give to someone on Biguanides (Metformin)?
Take with food or at the end of the meal
Start on low dose to minimize GI effects
Avoid alcohol
Healthy diet & exercise
Regular checks of HbA1C
Why would Sodium glucose co-transported-2 inhibitors be used?
This group of oral hypoglycaemics are considered the second line treatment or used when metformin is contraindicated
Indicated for treatment of type II diabetes in persons with high risk of CVD or renal complications, including all M_ori & Pacific peoples
Give an example of a Sodium Glucose co-transported-2 inhibitor
Empaglaflozin
What is the MOA for sodium glucose co-transported-2 inhibitor?
Acts on the sodium glucose co-transporters in the renal tubules to inhibit reabsorption of glucose (increases excretion of glucose)
What are some contraindications of using a sodium glucose co-transported-2 inhibitor?
T1DM- High risk of ketoacidosis. Caution in older persons due to decreased renal and hepatic function
Avoid in persons with:
Hypersensitivity,
Severe renal or hepatic impairment,
Ketoacidosis or diabetic coma,
Undergoing surgery
Pregnancy & lactation
What are some adverse drug reactions of a sodium glucose co-transported-2 inhibitor?
Urinary tract infection
Hypoglycaemia
Increased urination and increased thirst
Constipation
Puritis
What patient education would you provide for someone taking a sodium glucose co-transported-2 inhibitor?
take with or without food at the same time each day
Seek immediate medical attention if symptoms of diabetic ketoacidosis occur
keep your genitals clean to decrease risk of thrush
stop your empagliflozin if you are unwell- consult sick day plan
avoid a keto diet while on this medication
Healthy diet and exercise.
What is the risk for diabetic patients who drink alcohol?
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Which groups of patients should not take metformin and why?
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Why does Metformin NOT cause hypoglycemia?
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Why would metformin be selected for treatment of diabetic patients who are overweight?
.
What factors determine which oral hypoglycaemic agent is selected?
.
What are the risks for persons with diabetes who are also taking beta blockers?
.
What is the threshold of diagnosis of type 2 diabetes?
.
When administering a sulphonylurea oral hypoglycaemic drug, when should someone take it?
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