Drugs for Diabetes Flashcards
Fill in the characteristics of type 1 and type 2 diabetes as listed in table 57-1.
Type 1:
childhood or adolescent onset
abrupt onset
frequently negative family history
5% of people with diabetes have type one
autoimmune process
loss of pancreatic beta cells
insulin levels reduced early in disease and completely absent later
insulin replacement is mandatory along with strict dietary control
levels of blood glucose fluctuate wildly in response to infection, exercise, and changes in caloric intake and insulin dose.
THE THREE PS: polydipsia, polyphagia, polyuria, weight loss.
body composition is usually thin and undernourished at time of diagnosis
ketosis is common, especially if insulin dosage is insufficient
Type 2
for onset people are usually older than 40 years
gradual onset
frequently positive family history
90-95% of people with diabetes have type 2 diabetes
primary defect unknown, but heredity is suggested to be a risk factor.
insulin resistance (resistin) and inappropriate insulin secretion
inslulin levels may be low (indicating deficiency, normal, or high (indicating resistance)
treated with an oral antidiabetic or non insulin injectable agent and/or insluin, but always in combination with a reduced calorie diet and appropriate exercise.
blood sugar levels are generally more stable than in type 1 diabetes
may be asymptomatic inintally
frequently obses
ketosis uncommon.
explain the long term complications of diabetes regarding microvascular damage: retinopathy, nephropathy, sensory and motor neuropathy, and amputations
Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye).
Nephropathy is characterized by albuminuria, reduced glomerular filtration, and increased blood pressure. Most common cause of end stage renal disease—requires dialysis.
Sensory and motor neuropathy: nerve degeneration begins early on in diabetes, but symptoms do not show up until later. Sensory and motor nerves are affected (why people don’t know there’s glass or a nail in their foot–they don’t feel it) LOOK AT THEIR FEET.
Amputations: diabetes is responsible for an estimated 60% of all lower limb amputations. The cause is typically a severe infection secondary to local trauma. Diabetes also suppresses immune function so the infection cannot be fought off as well.
define and state expected results of screening blood tests for diabetes: fasting glucose, casual glucose, glucose tolerance tests, self monitoring blood glucose, hemoglobin A1C.
fasting glucose: blood is drawn 8 hours after the last meal. NORMAL: less than 100mg/dL. If higher than 126 mg/dL, diabetes is indicated. 100-125 is prediabetes.
Casual (random) glucose is when blood is drawn at any time, without regard to meals. If plasma glucose levels are at 200 mg/dL
or higher, it is suggestive of diabetes.
Glucose tolerance tests are when you give someone an oral tablet of glucose. Then you draw their blood two hours later. If glucose levels are below 140 mg/dL, then they don’t have diabetes. If glucose levels are 200 mg or higher after two hours, then they do have diabetes. 141-199 is prediabetic.
self monitoring blood glucose: where people check their blood sugar themselves. Specifically, the ADA recommends that preprandial plasma glucose values range from 80 to 130 mg/dl before meals and less than 180 1-2 hours after meals.
hemoglobin A1C
reflects average blood glucose over the last two or three months. A value over 6.5% is considered diagnostic for diabetes.
list ADA goals for diabetic patients for preprandial blood glucose levels.
Specifically, the ADA recommends that preprandial plasma glucose values range from 70 to 130 mg/dl,
describe a teaching plan for a newly diagnosed diabetic regarding: diet, glycemic index, exercise, and use of alcohol.
diet: Include more non starchy vegetables, such as broccoli, spinach, and green beans. Include fewer added sugars and refined grains, such as white bread, rice, and pasta with less than 2 grams of fiber per serving. Focus on whole foods instead of highly processed foods as much as possible.
glycemic index: The American Diabetes Association’s goals for blood sugar control in people with diabetes are 70 to 130 mg/dL before meals, and less than 180 mg/dL after meals
exercise: 30 minutes of moderate-to-vigorous-intensity aerobic exercise at least five days a week, or a total of 150 minutes each week.
alcohol: Despite the potential health perks of drinking alcohol, there are some cautions as well. The biggest concern is hypoglycemia (low blood sugar). When drinking alcohol is combined with the medications most often used to treat diabetes—particularly insulin and sulfonylureas, low blood sugar can result.
list the three mechanisms by which insulin deficiency promotes hyperglycemia.
- increased glycogenolysis
- increased gluconeogenesis
- increased glucose utilization.
list the onset, peak, and duration of 2 insulins, rapid acting insulin Lispro and intermediate acting NPH.
Lispro:
onset 15-30 minutes after subq injection,
peak is at 2 hours after injection
duration is 3-6 hours
NPH:
onset is delayed
peak is 6-7 hours after injection
duration is extended
describe insulin administration via subq injection, pen injections, and portable insulin pumps.
subq injection: don’t use if solutions are cloudy (indicates precipitate). disperse particles evenly by rolling syringe around base of hands for NPH. gentle mixing. swab rubber cap with alcohol. air bubbles should be eliminated. skin should be clean with soap and water or an alcohol swab before injection. rotate sites.
pen injection: clean skin, insert device as taught manually subq.
portable insulin pumps: replace infusion set every 3 days and move the catheter to a new infusion site (at least one inch away from the old one). the pump should stay in place for most of the day.
define tight glucose control and list the benefits and risks.
Tight glycemic control attempts to rigidly control glucose levels (typically an A1C level of 6.5% to 7.0% or lower). Standard control is less rigid and allows higher levels (usually 7.5% to 8.0%).
benefits: can save lives, can help diabetics live a more normalized life, etc.
50% decrease in significant kidney disease, 35-57% decrease in diabetic neuropathy, 76% decrease in serious ophthalmic complications.
risks: can cause hypoglycemia, greater inconvenience, increased complexity, increased cost of therapy, need for greater patient motivation.
list the conditions where insulin would need to be increased or decreased.
conditions where insulin would need to be increased: hypoglycemia
conditions where insulin would need to be decreased:
hyperglycemia
(I think?)
define hypoglycemia including signs and symptoms and treatment
hypoglycemia is clinically defined as a blood glucose below 70 mg/Dl. it occurs when insulin levels exceed insulin needs.
signs and symptoms of hypoglycemia are: tachycardia, palpitations, sweating and nervousness. mild CNS symptoms include headache, confusion, drowsiness, and fatigue.
treatment for hypoglycemia is a fast-acting oral sugar (glucose tabs, orange juice, honey, etc). If swallowing or gag reflex impaired, nothing should be put in the mouth. Instead, give IV glucose as the treatment. parental glucagon.
Regarding oral medications, why would they not work for type one diabetes?
Insulin can’t be taken orally to lower blood sugar because stomach enzymes will break down the insulin, preventing its action. Patients need to receive it either through injections or an insulin pump.
describe metformin including action, uses, side effects, and interactions with alcohol.
MOA: lowers blood glucose in three ways
- inhibits glucose production in the liver
- sensitizes insulin receptors in target tissues (fat and skeletal muscle) and thereby increases glucose uptake in response to whatever insulin might be available.
- reduces glucose absorption in the gut.
uses: glycemic control, prevention of type 2 diabetes, gestational diabetes, polycystic ovary syndrome.
side effects: decreased appetite, nausea, diarrhea. deficiency of vitamin b12.
interactions with alcohol: alcohol can inhibit breakdown of lactic acid and can thereby intensify lactic acidosis caused by metformin. patients should avoid consuming alcohol in excess, and discontinuing alcohol entirely would be even safer.
how is metformin different from the sulfonylureas?
it does NOT cause weight gain.
explain how glucagon is used to treat hypoglycemia from insulin overdose, and contrast this with glucose treatment.
glucagon is given as a treatment for insulin overdose if the patient cannot open their mouth.
glucose treatment is given if the patient is conscious enough to open their mouth.
