drugs for diabetes mellitus Flashcards
untreated diabetes can lead to
- heart disease
- kidney disease
- eye disease
- erectile dysfunction
- nerve damage
- immunosuppression
- poor wound healing
symptoms of diabetes
- unusual thirst
- frequent urination
- weight change
- fatigue or lack of energy
- blurred vision
- frequent infections
- cuts/bruises slow healing
- tingling or numbness in hands or feet
- trouble getting or maintaining an erection
- asymptomatic
type one diabetes mellitus
lack of insulin production
- need exogenous insulin
production of defective insulin
- need exogenous insulin
complications: retinopathy, nephropathy, neuropathy, diabetic ketoacidosis (DKA)
drug therapy for T1DM
insulin
- and certain oral antihyperglycemic agents can be used as adjunctive agents
type 2 diabetes mellitus
most common (90%)
caused by insulin deficiency and/or insulin resistance
many tissues are resistant to insulin
- reduced number of insulin receptors
- insulin receptors are less responsive
gestational diabetes
hyperglycemia onset during pregnancy and resolves at end of pregnancy
- insulin usually medication of choice (metformin may be used)
testing for diabetes mellitus
- blood glucose measurement
- glucose tolerance test
- %HbA1c (glycated hemoglobin)
measuring HbA1C
glycated Hb = glucose + Hb
- non diabetic proportion over lifetime of RBC 3 months: 4-5.9%
- diabetic > 6.5%
measure of the average blood glucose over the past 3 months
target for patients with diabetes is 7%
treatment of diabetes mellitus
insulins: recombinant human insulins
non-insulin drugs
- oral
- injectables
DM medication sites of action
- liver
- muscle and fat cells
- pancreas
- intestine
insulins info
function as a substitute for endogenous hormone
- effects are the same as normal endogenous insulin
improves ability to: take glucose into cells, make proteins and triglycerides, make glycogen from glucose in liver, convert glucose to fatty acids in adipose tissue
types of insulin
- rapid acting
- short acting
- intermediate acting
- long acting
rapid acting insulins
- onset: 10-15 minutes
- peak of action: 60-90 minutes
- duration:3-5 hours
insulin lispro
- taken with each meal
short (fast acting)
- onset: 30-60 minutes
- peak 2-3 hours
- duration 6-7 hours
regular insulin (humulin R)
- SC, IV infusion pump
intermediate acting
- onset 1-3 hours
- peak 5-8 hours
- duration. 10-18 hours
NPH
- cloudy
basal therapy
long acting insulin
- onset 90 minutes
- no pronounced peak
- duration 24 hours
insulin glargine (lantus)
basal therapy
combination insulin products
some com premixed in one solution
- basal insulins and rapid acting insulins together achieve best glycemic control
basal bolus insulin therapy
3 components:
- basal insulin (long acting)
- bolus insulin (short acting)
- correction insulin
target range of 5-10mmol/L
- prevents blood sugar highs and lows
hypoglycemia (too much insulin)
alert value of <3.9 mmol/L
- level 1: 3-3.0 mmol/L
- level 2: <3.0 mmol/L
- level 3 (need assistance to treat
- CNS effects
- SNS activation (give early symptoms)
- possible coma and death
hypoglycemia symptoms
- trembling
- palpitations
- sweating
- anxiety
- hunger
- nausea
- tingling
- difficulty concentrating
- confusion, weakness, drowsy, vision changes
- slurred speech, headache, dizziness
interactions with insulins
increase hypoglycemic effect so will lower blood glucose levels
- b blockers (propranolol): reduce glycogenolysis, can mask signs of SNS activation
- alcohol: reduces liver glycogenolysis
reduce effect of insulin so will increase blood glucose levels:
- glucocorticoids
- epinephrine
- furosemide and thiazide diuretics
insulin client care implications
ensure:
- right route
- right type
- timing of dose
- correct dosage
insulin orders always second checked with another nurse
drugs for diabetes indications
lower blood glucose levels in patients with T2DM
- alone or in combination
- in addition to diet and lifestyle changes
insulin secretagogues
target the pancreas
- act on beta cells
- increase insulin production in T2DM
2 classes of insulin secretagogues
1) sulfonylureas
- glyburide
2) non-sulfonylureas (mealtime drugs, short half life)
same drug target but different duration of action
other diabetes drugs
biguanides
- metformin
thiazolidinediones
- rosiglitazone
diabetes drugs: incretin pathway and others
gliptins (DPP-4 inhibitors)
- sitagliptin
incretin mimetic
- exenatide
SGLT-2 inhibitors
biguanides
metformin
- decrease hepatic production of glucose
- increase tissue sensitivity to insulin = increase uptake of glucose
- does not increase insulin secretion from the pancreas (doesn’t cause hypoglycemia)
- net weight loss
biguanides AE
- GI disturbances: nausea, diarrhea, increased appetite (taken 2-3/day with means to reduce GI disturbances)
- lactic acidosis: rare but 50% mortality (concern in renal insufficiency)
sulphonylureas
glyburide
- stimulate insulin secretion from pancreatic beta cells = increasing insulin levels (beta cell function must be present)
- improves sensitivity to insulin in muscles, liver and fat so they can take up and store glucose more easily
- decrease rate of insulin metabolism and breakdown by the liver
sulphonylureas AE
hypoglycemia (mild-severe)
taken with breakfast (1/day)
what are incretins
- released by intestinal contents
- GLP and GIP
- stimulat insulin release
incretins broken down by enzyme DPP-4
- dipeptidyl-peptidase 4
incretin mimetic
exenatide
- synthetic form of a saliva proteins of the gila monster (synthetic GLP)
- SC administration
incretin AE
decreases appetite
- useful in obesity linked diabetes
- weight loss drug
major adverse effect
- GI upset
DPP-4 inhibitors
reduce incretin metabolism
- higher plasma incretin level
- sitagliptin
- sometimes used with metformin
- only for T2DM
- oral once daily with or without food
Na glucose transporter inhibitors
- newest type of T2DM drugs
- inhibit glucose transporter in nephron (PT)
- loss of glucose (& water) in urine
- canagliflozin
SGLT2 inhibitors adverse effect
-increased urination (possible hypotension/dizziness)
- UTIs
thiazolidinediones
- rosiglitazone
- decrease insulin resistance
- insulin sensitizing agents
- increase glucose uptake and use in skeletal muscle
- inhibit glucose and triglyceride production in the liver
thiazolidinediones AE
increased risk of angina, MI, heart failure
pramlintide
- amylin mimetic
- amylin co released with insulin: delays gastric emptying and inhibits glucagon secretion
- supplement to insulins (T1 and 2DM)
- SC injetion
medication interactions with oral/non-insulin agents
glucocorticoids
- decrease effect of hypoglycemic medication
- cortisol life drugs cause increased blood glucose
antihyperglycemic agents: client care implications
- assess for signs of hypoglycemia
- if hypoglycemia occurs: give glucagon if required, have alert client eat 12-200 mL of clear fruit juice, glucose tablets/gel, teaspoon of corn syrup, or honey, non-diet soft drink, after liquid snack have client eat meal soon or give snack of carbs and protein
- monitor blood glucose levels
