drug therapy for diabetes mellitus Flashcards
(125 cards)
1
Q
describe glucose
A
-sugar in the blood
-body’s primary energy source (easy to break down)
-brain almost exclusively uses glucose for energy
2
Q
what are the two major hormones that stabilize glucose levels
A
glucagon an insulin
3
Q
what secretes glucagon and unsulin?
A
pancreas - islets of langerhans
has alpha and beta cells
4
Q
describe alpha cells
A
-glucaogn secreting cells
-increase blood glucose levels
5
Q
describe beta cells
A
-insulin secreting cells
-decrease blood glucose levels
6
Q
describe glucagon
A
-glucagon is secreted with low blood glucose
-helps maintain glucose between meals
-works with insulin to maintain levels
glucagon stimulates the liver to convert some stored glycogen to glucose to be usd by the body
7
Q
describe blood glucose levels after a meal and other levels of shit and what happens
A
-increased blood glucose
-pancreas increases insulin secretion and decreases glucagon secretion
-results in cellular uptake of glucose
8
Q
describe blood glucose levels between meals and other levels of shit and what happens
A
-decreased blood glucose
-pancreas decreases insulin secretion and increases glucagon secretion
-results in release of stored glucose and breakdown of fat
9
Q
after a meal, the pancreas recognizes rising glucose… then what happens
A
secretes insulin to lower blood glucose
-without insulin, glucose unable to enter cells
10
Q
what does insulin do?
A
acts as transport to allow cells access to glucose
-glucose can enter cells
-cells store glucose as glycogen
-converts lipids to fat
-increase protein synthesis and stop glucogenesis
11
Q
what are some hormones that increase blood glucose
A
-epinephrine
-thyroid hormone
-growth hormone
-glucocorticoids
12
Q
what are some drugs that increase glucose
A
-phenytoin
-NSAIDS
-diuretics
13
Q
what are some drugs that can decrease glucose
A
-alcohol
-lithium
-ACE inhibitors
14
Q
describe diabetes mellitus
A
chronic metabolic disorder in which there is deficient insulin secretion OR decreased sensitivity of insulin receptors resulting in hyperglycemia
15
Q
what are the two classifications of diabetes mellitus
A
-type 1
-type 2
16
Q
both classification of DM are characterized by…
A
hyperglycemia
17
Q
classifications of DM differ in…
A
-onset, course
-pathology, treatment
18
Q
describe type 1 diabetes mellitus
A
-common chronic disorder of childhood
-autoimmune disorder that destroys panceatic beta cells
-sudden onset between ages 4 and 20
-high incidence of complications
-difficult to control
-requires exogenous insulin administration
19
Q
describe type 2 diabetes mellitus
A
-characterized by hyperglycemia and insulin resistance (insulin is present but unable to work)
-historically, onset after age 40 years (increasing prevalence among children and teens)
-gradual onset with less severe symptoms
-90% of people with diabtees have type 2
20
Q
what aresome risk factors for development of diabetes melltius
A
-obesity
-sedentary lifestyle
-presence of metabolic syndrome
-ethnicities at high risk (african americans 13.3%, hispanics greater than 13.9%)
21
Q
describe metabolic syndrome
A
-abdominal obesity, low HDL
-hypertriglyceridemia
-HTN and/or impaired fasting glucose
22
Q
what are some clinical manifestations of DM
A
-hyperglycemia (fasting blood glucose levels greater then 126mg/dl)
-polyuria
-polyphagia (increased hunger)
-polydipsia (increased thirst)
-glucosuria (sugar in piss)
-weight loss
-fatigue
23
Q
what are some chronic macrovascular complications of DM
A
-HTN
-MI
-stroke
-PVD
24
Q
what are some microvascular chronic complications of DM
A
-nephropathy (damage to kidneys)
-retinopathy (damage to eyes)
-neuropathy (damage to nerves in periphery)
25
what are some other chronic complications of DM
-increased risk for infection
-decreased wound healing r/t poor blood flow
-diabetic foot ulcers
26
what is DKA
-life threatening, severe insulin deficiency, usually type 1
-fat broken down for energy, results in ketones
-ketones reproduce faster than needed, cause drop in pH (acidosis)
27
name some symptoms of DKA
-fruity odor to breath
-ketones in urine
-kussmaul's respirations
-severe hyperglycemia (>240)
-polyuria, polydipsia
-N/V
-coma
28
describe the tx of DKA
-lots of IV fluids
-insulin
29
describe hyperocmolar hyperglycemic nonketotic coma (HHNC)
-life threatning, severe hyperglycemia, usually type 2
-excessive glucose and electrolytes
-severe dehydration
30
what the symptoms of HHNC
-extremely high glucose (>600)
-polyuria
-dehydration
-drowsiness
-confusion
-coma
31
describe the treatment of HHNC
-lots of IV fluid
-give insulin
-may need to treat electrolyte imbalances
32
when are blood sugars generally checked
-check AC and HS ig eating
-Q6 if NPO or tube feeding/TPN
33
what value is abnormal fasting glucose
>126
34
diabetic AC blood sugar goal is...
70-130
| varies per agency and pt
35
what is hemoglobin A1C
-average blood sugar over 3 months
-normal less the 7%
## Footnote
greater than 7% indicates diabetes
36
true or false?
diabetes mellitus is a chronic, systemic disease characterized only by metabolic acidosis
false
*DM is a chronic, systemic disease characterized by metabolic and vascular abnormalities*
37
true or false?
insulin is a hormone secreted by beta cells in the pancreas
true
insulin is a ho**rmone secreted by beta cells in the pancreas that allows rapid entry of glucose into the cells
38
what are the symptoms of hyperglycemia
-three Ps (polyuria, polyphagia, polydipsia)
-fatigue
-weakness
-dry skin
39
what are the symptoms of hypoglycemia
-sweating
-tremors
-tachycardia
-hunger
-confusion
-drowsiness
-seizures
40
what is the goal of drug therapy for diabetes
control glucose levels and prevent complications
41
what does the treatment for DM depend on?
type of DM
42
what drug therapy is used for type 1 DM
insulins
43
what drug therapy is used for type 2 DM
-sulfonylureas
-alpha glucosidase
-biguanide
-thiazolidines
-meglitinides
-DDP 4 inhibitors
-amylin analogs
-incretin mimetics
-SGLT2 inhibitors
44
describe insulin
-human insulines only in the US
-synthetic product is identical to endogenous insulin
-synthesized in laboratories by altering the type or sequence of amino acids
different types differ in onset and duration of action
45
describe administration of insulin
-canno be given orally
-most given sub Q
-regular can also be given IV (this is the only type that can be)
-U100 concentration in US (100units/ml)
-measured with orange tipped syringe or pen
46
name some different type of insulin and describe em a little
-**rapid acting** (rapid onset, shorter duration than reg)
-**short acting** (regular) (short onset, short duration of action)
-**intermediate acting** (slower absorption, prolonged action)
-**long acting** (provide basal insulin over 24hr period similar to normal)
-**ultra long acting **(provide basal insulin over 42hr period)
47
# insulin chart
rapid acting
generic name
-aspart
-lispro
-glulisine
48
# insulin chart
rapid acting
onset
15-30min
49
# insulin chart
rapid acting
peak
30min-2.5hr
50
# insulin chart
rapid acting
duration
3-6hrs
51
# insulin chart
short acting
generic name
regular
52
# insulin chart
short acting
onset
30-60min
53
# insulin chart
short acting
peak
1-5hrs
54
# insulin chart
short acting
duration
6-10hrs
55
# insulin chart
intermediate acting
generic name
-NPH
-isophane
56
# insulin chart
intermediate acting
onset
1-2hrs
57
# insulin chart
intermediate acting
peak
4-12hrs
58
# insulin chart
intermediate acting
duration
16hrs
59
# insulin chart
long acting
generic name
-detemir
-glargine
60
# insulin chart
long acting
onset
3-4hrs
61
# insulin chart
long acting
peak
continuous
62
# insulin chart
long acting
duration
24hrs
63
describe the action of insulin
-increase glucose uptake by cells
-decreases glucose production by liver
64
describe the use of insulin
-lower blood glucose
-regular may be given IM or IV in an emergency
-can be used in children and older adults
65
name a contraindication of insulin
hypoglycemia
66
describe timing with meals for insulin
plan for onset to start with meal
-lispro = 15-30mins before
-regular = 30-60mins before
| snack at peak bc its the most likely time to see hypoglycemia
67
what are some adverse effects of insulin
-hypoglycemia
-local reactions (rotate site)
68
what are some drug-drug interactions with insulin
any drug that affects glucose levels
-**beta blockers**, MAOIs, salicylates, alcohol, herbal preparations
69
what are some nursing implications r/t insulin
-be aware of mealtimes
-rotate injection site (abdomen best)
-monitor for hypoglycemia during sleep
-insulin pumps (provide basal dose, usually reg or rapid, may be allowed in hospital)
-high risk med (know policy, programmed vs SSI, know hypoglycemia protocol)
70
describe programmed insulin orders
-given to regulate levels between meals
-set amount ordered
-watch nutrition status
71
describe sliding scale insulin orders
-dose based on blood sugar levels
-notify MD if NPO
72
describe patient teaching for insulin
-diet, weight control, and exercise
-know s/sx hyper/hypoglycemia
-teach family what to do
-keep follow up appts
-test blood glucose as ordered
-what to do if you are sick
-proper SQ injection technique
73
true or false?
insulin plays a major role primarily in the metabolism of carbs
false
*insulin plays a major role in metabolism of carbs, fat, and protein where the nutrients are broken down to simpler molecules (glucose, lipids, and amino acids)*
74
give and example of sulfonylureas
glyburide
75
what do sulfonylureas do
stimulates pancreas to release insulin
-bind K+ channels on pancreatic beta cells
-increase number of insulin receptors
76
what are some indications of use of sulfonylureas
elevated serum glusoce levels
## Footnote
must have some functioning beta cells (not for type 1)
77
what are some adverse effects of sulfonylureas
hypoglycemia
78
what are some contraindications of sulfonylureas
-sulfa allergy
-renal failure
-liver failure
79
what are some drug-drug interactions with sulfonylureas
-beta blockers
-alcohol
80
give an example of alpha-glucosidase inhibitors
acarbose
81
what do alpha-glucosidase inhibitors do
delays digestion of complex carbs
-decreases the increase in BS after meals
-given in combo with sulfonylureas
82
whats an indication of use for alpha-glucosidase inhibitors
decrease in postprandial glucose
83
what are some adverse effects of alpha-glucosidase inhibitors
-hypoglycemia
-GI upset
84
what are some contraindications of alpha-glucosidase inhibitors
-hepatic disease
-bowel conditions (IBS)
85
name a drug-drug interaction for alpha-glucosidase inhibitors
can decrease digoxin levels
86
name a nursing implication for alpha-glucosidase inhibitors
take at beginning of meal
87
give and example of biguanides
metformin
88
what do biguanides do
-decreases hepatic glucose production
-increases use of glucose by muscle and fat cells
-decreases intestinal absorption of glucose
89
what are some indications for use of biguanides
-insulin resistance
-**commonly first choice for type 2 DM**
-used to treat PCOS
90
what are some adverse effects of biguanides
-lactic acidosis
-GI upset
91
what are some contraindications of biguanides
-older adults (black box warning to avoid over 80 y.o.)
-renal failure
-**hold metformin 48hrs before and after contrast media (CT dye, heart cath) testing to avoid renal failure**
92
what are some nursing implications for biguanides
-take with meals
-increased effects if taken with furosemide, digoxin, vancomyocin
-monitor renal function
93
give an example of thiazolinediones (TZDs)
rosiglitaxone
94
what do thiazolinediones (TZDs) do
-stimulates insulin receptors on muscle, fat, and liver cells
-used in combo with insulin, sulfonylureas, or biguanides
-indications for use: insulin resistance
95
what are some adverse effects of thiazolinediones (TZDs)
-hepatotoxicity
-congestive heart failure
-weight gain
96
what are some contraindications of thiazolinediones (TZDs)
-liver disease
-**CV disease (black box warning of risk of CHF and MI)**
97
what are some nursing implications of thiazolinediones (TZDs)
-take with meals
-monitor liver function studies
-monitor patients for signs of heart failure
-gemfibrozil may increase effects
-may take 12 weeks to reach peak effects
98
give an example of meglitinides
repaglinide
99
what do meglitinides do
-stimulates pancreatic stimulation of insulin (needs working beta cells)
-used in combo with TZDs or biguinides
-indications for use: elevated serum glucose
100
what are some adverse effects of meglitinides
-hypoglycemia less so than sulfonyureas
-GI upset
101
what are some contraindications of meglitinides
-renal disease
-liver disease
-type 1 DM
102
what are some nursing implications for meglitinides
-take just before meals (**if meal is skipped, skip dose. if meal is added, add dose**)
-gemfibrozil and itraconazole increase effects
103
give an example of dipeptidyl peptidase 4 inhibitors (DPP-4)
sitagliptin
104
what do dipeptidyl peptidase 4 inhibitors (DPP-4) do
-balance the release of insulin and linit the release of additional glucose from liver, inhibition of glucagon secretion, delayed gastric emptying, and induction of satiety (need working beta cells)
-may take in combo with TZD or biguanide
-indications for use: elevated serum glucose
105
what are some adverse effects of dipeptidyl peptidase 4 inhibitors (DPP-4)
-upper resp infections
-heart failure
106
what are some contraindications of dipeptidyl peptidase 4 inhibitors (DPP-4)
-type 1 DM
-insulin use
-renal failure
107
what are some nursing implications for dipeptidyl peptidase 4 inhibitors (DPP-4)
one daily - with or without meals
108
give an example of amylin analogs
pramlintide
109
what do amylin analogs do
-suppresses postprandial glucagon secretion, increases sense of satiety
-used in addition to insulin, sulfonyureas, or biguanides
-indications for use: reagulate the postprandial rise in blood glucose
110
what are some adverse effects of amylin analogs
hypoglycemia
**black box warning for severe hypoglycemia if mixed with insulins**
111
what are some nursing implications for amylin analogs
-monitor blood sugars very closely
-avoid giving with anticholinergics
-may promote weight loss
-SQ injection
112
give an example of incretin mimetics and describe them a little
exenatide
-stimulates panreas to secrete the right amount of insulin based on the food that was just eaten
-can be used in combo with oral meds
-indications for use: postprandial glucose elevations
113
what are some adverse effects of incretin mimetics
-hypoglycemia
-GI distress and nausea
-pancreatitis
114
what are some contraindications of incretin mimetics
-liver disease
-**black box warning for risk of thyroid cancer**
115
what are some nursing implications for incretin mimetics
-SQ injection within one hour of breakfast and dinner
-must be refigerated
-some extended release versions available, only need 1 weekly injection
-may promote weight loss
116
give an example of sodium glucose contransporter 2 inhibitors (SGLT2)
canagliflozin
117
what do sodium glucose contransporter 2 inhibitors (SGLT2) do
-blocks reabsorption of glucose in the kidney, promotes excretion of glucose in urine
-used in combo with other ant-diabetics
-indication for use: improved glucose control
118
what are some adverse effects of sodium glucose contransporter 2 inhibitors (SGLT2)
-**dehydration**
-**hypotension**
-electrolye imbalance
-bone loss
-increased risk of leg/foot amputations
119
what are some contraindications of sodium glucose contransporter 2 inhibitors (SGLT2)
renal failure
120
what are some nursing implications for sodium glucose contransporter 2 inhibitors (SGLT2)
-take with first meal of the day
-use caution in combo with meds that decrease BP
-risk for dehydration or syncope
121
name some things to include in general patient education regarding antidiabetics
-consistent diet and exercise = best control
-maintain normal weight
-unopened bottle of insulin stored in fridge
-kow s/sx hyper/hypo glycemia and what to do
-teach friend/family how to treat hypoglycemia
-maintain BS to prevent complications
-complete follow up appts
-dont start new med/herbs without telling MD
-alert MD if BS is greater than 250
122
describe hyperglycemia management
seek MD if:
-BS more than 250
-ketones in urine
-fever above 101
-vomiting/diarrhea
-miss multidose of a med
123
describe hypoglycemia management
-rapidly absorbed sugar (takes 10-20 minutes to work)
-if the patient is alert you can give 4oz of juice, 1 tube glucose gel, or 2-3 glucose tabs)
if the patient is unable to swallow dextrose 5-% half ampule, glucagon IM, SQ
avoid taking so much sugar that you cuase hyperglycemia
124
describe managing sick days as a diabetic
-illness can cause stress response and increase BS
-continue to take anti-diabetic meds
-test for ketones in urine
-check glucose at least 4x daily
-if unable to eat, continue liquids -> 15g carbs every 1-2 hrs, drink 2-3 quarts of fluids
## Footnote
15g carbs = 8oz of gatorade
125
a pt with type 2 DM is scheduled for a heart cath in one week. the nurse instructs the pt to stop taking which med 2 days before the procedure?
metformin
*biguanides like metformin can cause kidney failure if given 48 hours before or after receiving contrast dye*
