Diabetic Meds Flashcards
A complex disorder of carbohydrate, fat,and protein metabolism resulting from the lack of insulin secretion by the beta cells of the pancreas or from defects of the insulin receptors; it is commonly referred to simply as diabetes.
diabetes mellitus
It has exocrine (digestive) and endocrine (secreting hormones into bloodstream) functions.. In relation to diabetes, we will discuss the endocrine function.
pancreas
_____ is released from the pancreas when blood sugar is low. It will raise blood sugar.
If blood sugar is high, the pancreas is signaled to release insulin which causes
Normal blood sugar-
Glucagon
Autoimmune- born with it
Most times diagnosed in childhood
Body isn’t making enough insulin (Insulin dependent)
type I diabetes
Often due to YOU (diet, weight, exercise)
Many times over 40 (but we are seeing even in children)
Body isn’t utilizing insulin appropriately (Insulin resistant)
type II diabetes
The Three P’s (for type I and II)
Polyphagia (excessive hunger)
Polydipsia (excessive thirst)
Polyuria (urinating frequently)
Weight loss (usually ______)
Possible: nausea, dry skin, fatigue, slow wound healing and susceptibility to infections
Hyperglycemia
type 1
S/S of diabetes
Acanthosis Nigrans
dark, thick, velvety skin in body folds and creases. It often appears in the armpits, groin and back of the neck. A sign of insulin resistance and type 2 diabetes- seeing in youth, children some today.
acanthosis Nigrans
Criteria for Diagnosis of Diabetes
Fasting plasma glucose level of ____ mg/dL or higher
HgA1C greater than _____
Symptoms of diabetes + casual plasma glucose 200 mg/dL or higher
Symptoms = classic symptoms of hyperglycemia such as polyuria, polydipsia, unexplained weight loss
Two-hour plasma glucose level of 200 mg/dL or higher during and oral glucose tolerance test (OGTT).
Any positive finding for the above assessments should be confirmed by repeat testing on a different day
126
6.5%
How do we diagnosis diabetes? Fasting plasma glucose level of 126 mg/dL or higher is considered diabetes (Fasting means no caloric intake for at least 8 hours)
OR: Symptoms of diabetes + casual plasma glucose 200 mg/dL or higher. Casual means it is measured at any time of day without regard to time since meal.
OR: Two-hour plasma glucose level of 200 mg/dL or higher during and oral glucose tolerance test (OGTT). The glucose load (also called a dose) should contain the equivalent of 75 gm of glucose dissolved in water. Patient drinks the glucose and their blood glucose level is measured. Note that the OGTT is not recommended for routine clinical use. Any positive finding for the above assessments should be confirmed by repeat testing on a different day.
A person isn’t diagnosed with diabetes based on one result.
What are some causes of hypoglycemia?
too little food
too much insulin or diabetes medicine
extra excercise
What are s/s of hypoglycemia?
shaking
tachycardia
sweating
anxious
dizziness
hunger
impaired vision
weakness fatigue
headache
irritable
symptoms of hyperglycemia
dry mouth
increased thirst
weakness
headache
blurred vision
frequent urination
shaking
tachycardia
sweating
anxious
dizziness
hunger
impaired vision
weakness fatigue
headache
irritable
S/s hypoglycemia
dry mouth
increased thirst
weakness
headache
blurred vision
frequent urination
s/s of hyperglycemia
What is a normal A1C target level?
less than 5.6
What is the prediabetes range with A1C levles?
5.7 -6.4
What is the A1C levels considered to be diabetic?
6.5 and over
Trend of blood glucose levels over last 2-3 months
Hemoglobin A1C
ADA Goal = less than _____ for diabetic
7%
What is the ADA fasting blood sugar goal from the ADA for people already diagnosed with diabetes?
70-130
What is the A1C goal for diabetics according to the ADA?
less than 6.5%
require insulin
type I diabetics
diet, lifestyle, meds other than insulin (may end up requiring insulin)
type 2 diabetics
Rapid acting
regular
NPH, detemir
glargine
acting time in about 15 minutes
take with or right before meal to prevent hypoglycemia
duration of 3-5 hours peaking in an hour
make sure food is there or on the way before you give meds
most often given subQ
rapid acting insulin
What are the rapid acting insulins?
Insulin Lispro
Aspart
This can be given IV, SubQ
act in 30-60 minutes with peak in 2.5 hours
Short acting insulin
It is a cloudy insulin
May see it mixed with regular
rub between hands to mix insulin
warm it up just a bit so it doesn’t hurt as much
isn’t mixed as much with regular in the hospital as much anymore to avoid medication errors
intermediate acting insulin, NPH
work for 24 hours
doesn’t really have a peak, patient will take once a day
long acting insulins, insulin glargine, insulin detemir
onset of rapid acting insulin?
less than 15 minutes
peak of rapid acting insulins?
30 min to 1 hour
duration of rapid acting insulins?
3-4 hours
onset of short acting insulins?
30 min to 1 hour
peak of short acting insulin?
2-3 hours
duration of short acting insulins?
5-7 hours
onset of intermediate acting insulins?
1-2 hours
peak of intermediate acting insulins?
4-12 hours
duration of intermediate acting insulins?
18-24 hours
onset of long acting insulins?
1 hour
peak for long acting insulins?
none
duration of long acting insulins?
10.4 to 24 hours
Could be every 4-6 hours or with meals.
Disadvantages:
insulin administration until hyperglycemia occurs
results in large swings in glucose control
Many institutions are moving away from______
sliding-scale coverage.
Attempt to mimic a health pancreas.
Long acting insulin (Insulin Glargine)
(rapid acting) given by meal _____ and correction (based on meals- carbohydrates taken in)
Preferred treatment method for hospitalized diabetic patients
____ mimics the burst secretions of the pancreas in response to increases in blood glucose levels
this is what they’re trying to do now to mimic the pancreases, preferred treatment method for hospitalization
patient has more stable blood sugar
Basal bolus insulin therapy
- Decreases glucose production in the liver/intestinal absorption of glucose
- Improves insulin receptor sensitivity
- A.E. GI and metallic taste
- Long term effects: b12 and b9 deficiency
- DON’T USE: Iodine containing contrast, if pt is predisposed hypoxia or lactic acidosis
no
weight gain
and significant chance of HYPOglycemia
First line drug and most commonly used drug for type 2 diabetes
biguanide metformin
Most common: GI effects
Nausea, 6-8lbs weight loss, bloating, anorexia, abdominal cramping, diarrhea, metallic taste
Effect of Long Term Use:
Vitamin B12 and Folic acid deficiencyLactic Acidosis
Hyperventilation, myalgia, sluggishness, somnolence
metformin adverse effects
Iodine-containing contrast
D/C metformin 24-48 hours prior to procedure
Resume 48 hours after test (if normal creatinine levels)
Renal disease or dysfunction
Elevated serum creatinine level
Hold dose if higher than 1.5 mg/dL in males, 1.4 mg/dL in females
Conditions that predispose to hypoxia or lactic acidosis
contraindications for metformin
- Bind to receptor sites in pancreas to stimulate the release of insulin
- decrease glucagon
- best in early diabetes 2
- STOP if/when insulin is needed
- only pts with working beta cells in the pancreas- not for type 1 diabetics
- NO: NPO, alcohol, elderly, allergy to sulfonamide, hypoglycemia pts
- A.E. hypoglycemia, weight gain, GI and rash
can be used w? _______
Sulfonylureas, metformin
Advanced diabetes dependent on insulin
Contraindications:
NPO status, alcohol use, advanced age
Cautions:
Allergy to sulfonamide antibiotic- may have cross allergy
Contraindications of sulfonyureas
Hypoglycemia-#1
Weight gain
Skin rash, nausea, epigastric fullness, heartburn
teach them to eat regular meals, if they skipmeals they could have chance for lowered blood sugar, can cause weight gain
GI and other stuff but not as bad as metformin
sulfonyureas adverse effects
Increase insulin secretion from pancreas (similar to sulfonylureas)
Shorter duration than sulfonylureas- given at each meal
Type 2 diabetes
Can be used with metformin (but not sulfonyureas since they function the same way)
glinides (repaglinide)
Advanced diabetes dependent on insulin
NPO status (such as fasting), alcohol use, advanced age
glinides contraindications
Contraindications similar to sulfonylureas
Hypoglycemia- #1
Eat with dose
Weight gain common report
glinides adverse effects
Insulin sensitizing drugs
Decrease insulin resistance by enhancing the sensitivity of insulin receptors
Affect gene regulation= slow onset of action over several weeks- may take months for full effect
Type 2 diabetes
May combine with metformin or sulfonyurea
Can be used with insulin
takes a long time for it to work, will take several weeks for it to really take full affect
pioglitazone
Contraindicated in patients with severe heart failure- black box warning
Caution with liver or kidney disease
Cause peripheral edema and weight gain
Can cause reduced bone mineral density and increased risk of fractures
contraindications with thiazolidinediones such as pioglitazone
Inhibit enzyme alpha-glucosidase in small intestine
It is responsible for changing saccharides to glucose. Blocking it causes glucose absorption to be delayed.
Because of action it must be taken with food
Prevents or reduces postprandial glucose spike
Used in type 2 diabetes
May be used in combination with other oral hypoglycemic
alpha glucosidase such as acarbose
Because of GI effects- not recommended with inflammatory bowel disease, malabsorption syndrome, or intestinal obstruction
alpha glucosidase contraindications
Flatulance
Diarrhea
Abdominal pain
Do not usually cause hypoglycemia or weight gain
adverse/side effects associated with alpha glucosidase
Bioavailability of drugs such as digoxin (lanoxin) and propranolol (Inderal) may be reduced
alpha glucosidase drug interactions
Dipeptidyl peptidase-IV (DPP-IV) inhibitors work by delaying the breakdown of incretin hormones by inhibiting the enzyme DPP-IV
Incretin hormones are released throughout the day and are increased after a meal
By inhibiting the enzyme responsible for incretin breakdown (DPP-IV), the DPP-IV inhibitors reduce fasting and postprandial glucose concentrations.
dipeptyidyl peptidase IV inhibitors (gliptins)
Significant hypoglycemia may occur when the drug is combined with a sulfonylurea
adverse effects associated with stigaliptin
Hyperglycemic agents are used to?
elevate blood sugar
Medications to INCREASE blood sugar
hyperglycemic agents
50% dextroxe
hyperglycemic agent
What are the hyperglycemic agents?
50% dextrose
glucagon
your patient goes into a hypoglycemic state and is conscious and able to eat, what would you do?
fast 15
15g of carbs -4 oz orange juice, 2oz of grape juice, 8 oz of milk, glucose tabs, et
recheck in 15 minutes
provide balanced meal
instruct patients to maintain access to a source of glucose or glucagon at all times
If patient is unconscious or eating is a risk and your patient goes into a hypoglycemic state?
Administer Glucagon (IM, Subcutaneous, or IV) or 50% dextrose (D50) IV
Turn patient to left side
Recheck glucose level
“Fast 15” once patient is aware
Action: Increases glucose levels
Indication: antidote for hypoglycemic crisis/emergency, decrease GI motility
Available subcut., IM, or IV
Hypoglycemia Crisis = less than 50
Still treat symptomatic “normal”low blood glucose levels
you still need to treat symptomatic hypoglycemia even if its like 80 if theyre showing symptoms
glucagon
Contraindication:
Hypoglycemia due to starvation
Use caution in client with cardiovascular disease
Adverse Effects:
GI (nausea, vomiting)
Too high of a dose will causehyperglycemia
glucagon contraindications and adverse effects
A daily journal should be kept
Monitoring glucose levels
Multiple capillary blood glucose checks daily
Periodic A1C lab levels drawn at the office
Education on lifestyle modifications
Avoid skipping meals or skipping medication dosages
30 minutes of daily exercise
Possible nutritional consult
Low fat diet with 160-300 g carbs a day
Strict foot care
patient education and teaching tips for diabetic patients
