Diabetic Meds Flashcards by Glen McCormick

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

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It has exocrine (digestive) and endocrine (secreting hormones into bloodstream) functions.. In relation to diabetes, we will discuss the endocrine function.

pancreas

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_____ 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

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Autoimmune- born with it
Most times diagnosed in childhood
Body isn’t making enough insulin (Insulin dependent)

type I diabetes

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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

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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

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Acanthosis Nigrans

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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

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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%

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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.

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What are some causes of hypoglycemia?

too little food
too much insulin or diabetes medicine
extra excercise

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What are s/s of hypoglycemia?

shaking
tachycardia
sweating
anxious
dizziness
hunger
impaired vision
weakness fatigue
headache
irritable

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symptoms of hyperglycemia

dry mouth
increased thirst
weakness
headache
blurred vision
frequent urination

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shaking
tachycardia
sweating
anxious
dizziness
hunger
impaired vision
weakness fatigue
headache
irritable

S/s hypoglycemia

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dry mouth
increased thirst
weakness
headache
blurred vision
frequent urination

s/s of hyperglycemia

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What is a normal A1C target level?

less than 5.6

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What is the prediabetes range with A1C levles?

5.7 -6.4

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What is the A1C levels considered to be diabetic?

6.5 and over

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Trend of blood glucose levels over last 2-3 months

Hemoglobin A1C

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ADA Goal = less than _____ for diabetic

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What is the ADA fasting blood sugar goal from the ADA for people already diagnosed with diabetes?

70-130

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What is the A1C goal for diabetics according to the ADA?

less than 6.5%

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require insulin

type I diabetics

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diet, lifestyle, meds other than insulin (may end up requiring insulin)

type 2 diabetics

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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

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 onset in 1-2 hours peak in 4-8 hours duration 10-18 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 Decreases intestinal absorption of glucose Improves insulin receptor sensitivity Increase peripheral glucose uptake and use Decreased production of triglycerides and cholesterol by liver Doesn’t stimulate insulin secretion so it isn’t associated with weight gain and significant chance of HYPOglycemia First line drug and most commonly used drug for type 2 diabetes (Not type 1!) is not going to work for type 1 diabetics

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 specific receptors on beta cells in the pancreas to stimulate the release of insulin secondarily decrease the secretion of glucagon Work best in early stages of type 2 diabetes May be used with ______ Stop if/when insulin is required This should only be given to patients with working beta cells in the pancreas- not for type 1 diabetics

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