Week 8: Antidiabetic Drugs Flashcards
Two types
Type 1—insulin-dependent (IDDM) Affected patients need exogenous insulin
Type 2—non-insulin dependent (NIDDM)
without insulin, the kidneys are unable to absorb the excess glucose in the glomerular filtrate and
lose large amounts of glucose, ketones and other solutes in urine.
normal serum levels are
4- 6 mmol
when blood glucose levels are high but no insulin is present to allow glucose to be used for energy production,
the body may break down fatty acids for fuel, producing ketones as a metabolic byproduct
dka can lead to
coma and death
the two major classes used to treat DM are
insulins and oral hypoglycemic drugs.
the primary treatment for typ1 DM and gestational DM
is insulin therapy for type 2 DM is us. last resort
clear insulins
rapid or short acting
cloudy
intermediate acting insulins.
to maintain constant blood glucose levels both after and between meals …
insulin must be present
type 2 diabetes
is characterzed by insulin resistance and an ongoing reduction in beta cell function. thus glucose levels will worsen over time and necesitate ever-changing treatment.
Most common type, associated with obesity
Caused by insulin deficiency and insulin resistance
Many tissues are resistant to insulin
>Reduced number insulin receptors
>Insulin receptors less responsive
Receptors don’t recognize
the use of submaximal doses of the drugs results
in a more rapid and better glycemic control and fewer adverse effects than with monotherapy at maximal dosages
hypoglycemia
is an abnormally low blood glucose level (generally below 2.8 mmol)
signs of CNS manifestataions of confusion, irritability, tremor, sweating.
insulin should be admind at a 90 degree angle
unless emanciated
mixing insulins
clear withdrawn first. then cloudy.
HBA
monitoring for ppl taking oral antidiabetic drugs.
type 1 DM
Autoimmune Disorder
Lack of insulin producction
Affected patients need exogenous insulin
Complications: Retinopathy, nephropathy, neuropathy
Diabetic ketoacidosis (DKA): Type 1 ONLY, Doesn’t happen in type 2
Oral antidiabetic agents not effective
normal ranges
A1C Glyco Hemoglobin: less than 6%
fasting glucose before meals: 4-6 mmmol
glucose level 2 hrs after eating.
Insulins
substitute for the endogenous hormone—↓ blood glucose levels by stimulating peripheral glucose uptake by skeletal muscle
Facilitates passage of glucose, K+ and Mg+ across cell membranes
»Someone who is kyperkalemic and need to change immediately, insulin is the quickest way to do it (Mix insulin IV with dextrose. Dangerous so not all the time.)
Restores the diabetic patient’s ability to:
» metabolize carbs, fats, and protein (Instead of metabolizing protein specifically)
» store glucose in liver
» Convert glycogen to fat stores
Insulins USES
treatment of type 1 diabetics
Treatment of type 2 diabetics
treatment of anyone with diabetes during acute situations
» Usually cortisol raises blood glucose levels so you wanna check for infection. Maybe that’s making the body release cortisol. Assess lungs, UTI, maybe wound
To control Gestational diabetes
treatment of hyperglycemia in nondiabetic clients induced by IV hyperalimentation solutions
emergency treatment of ketoacidosis
treatment of hyperkalemia (look above)
Insulins Contraindications:
hypoglycemia (level of less than 4)
INSULIN Interactions:
Alcohol may increase the effects of insulin causing hypoglycemia
Insulins admin
Administration
give SC only, in adequate adipose, rotate sites
ONLY REGULAR or RAPID given IV
Check blood sugar, dose is individualized
use at room temp.—stable for 1 mos.—LABEL VIAL
store additional insulin in the refrigerator
when insulin is mixed, draw up regular insulin 1st and administer immediately
Intermediate acting insulins are modified by adding a protein or zinc or both—this prolongs drug action
glargine is acidic and CANNOT be mixed in the same syringe with other insulins
Only some can be mixed. Check to make sure
insulin adverse effects
Adverse Effects
LOCAL—redness, swelling, itching, lipodystrophy
HYPOGLYCEMIA – Cool, wet skin, tremors, headache, anxiety, hunger, tachycardia, diplopia, dizziness – monitor at peak action time of insulin
HYPERGLYCEMIA – polydipsia, polyphagia, polyuria, dehydration, nausea, vomiting, deep rapid breathing, drowsiness
Very similar so ALWAYS CHECK WITH GLUCOMETER CHECK TO BE SAFE. Sometimes no symptoms.
Oral Antidiabetic Drugs
Used to control hyperglycemia in type 2 diabetes
Treatment for type 2 diabetes includes lifestyle modifications
Oral antidiabetic drugs alone may not be effective unless the patient also makes behavioral or lifestyle changes—exercise is very beneficial
Usually check hemoglobin A1C and if not controlled glucose, will give the drug
Gestational diabetes
can only be treated with insulin
Oral Antidiabetic Drugs:Indications
Used alone or in combination with other drugs and/or diet and lifestyle changes to lower the blood glucose levels in patients with type 2 diabetes
Oral Antidiabetic Drugs:Contraindications
Known drug allergy
Hypoglycemia
Severe liver or kidney disease
Pregnancy – goes through the placenta
Keep in mind that overall concerns for any diabetic patient increase when the patient:
Is under stress – release of cortisol will cause blood sugars to go up
Has an infection
Has an illness or trauma
Is pregnant
Nursing Action for Hypoglycemia
Check blood sugar levels
if conscious, give 15 g CHO (i.e. 175 ml of juice/pop, 2 tsp. sugar, 3 glucose tablets/gel, 6 lifesavers – any fast acting sugar
check blood glucose level in 15 min.
(Make sure above 4)
if unconscious, administer IV dextrose (D50W) or glucagon 1mg IM
give client snack or meal to replace glycogen stores
nursing implications for Oral antidiabetic drugs
Always check blood glucose levels before giving
Sulfonylureas given 30 min. ac meals
Alpha-glucosidase inhibitors given TID with the first bite of each main meal
metformin is taken BID with meals to ↓ GI effects
