Chapter 32 Pharmacology Nursing 125

polydipsia

Chronic excessive thirst and intake of fluid (common symptom of uncontrolled diabetes)

Oral Antidiabetic Drugs: Adverse Effects (Alpha-glucosidase inhibitors)

Flatulence, diarrhea, abdominal pain Do not cause hypoglycemia, hyperinsulinemia, or weight gain

Oral Antidiabetic Drugs: Biguanide: Mechanism of Action

Decrease production of glucose by the liver Decrease intestinal absorption of glucose Increase uptake of glucose by tissues Do not increase insulin secretion from the pancreas (does not cause hypoglycemia)

Insulin detemir (Levemir)

Duration of action is dose dependent. Lower doses require twice-daily dosing. Higher doses may be given once daily.

Biguanide

Metformin (Glucophage) First-line drug and is the most commonly used oral drug for the treatment of type 2 DM Not used for type 1 DM

Rapid-acting treatment for types 1 and 2 DM

Most rapid onset of action (5 to 15 minutes) Peak: 1 to 2 hours Duration: 3 to 5 hours Patient must eat a meal after injection Insulin lispro (Humalog) Similar action to endogenous insulin Insulin aspart (NovoLog) Insulin glulisine (Apidra) May be given subcutaneously (SQ) or via continuous SQ infusion pump (but not intravenously [IV])

Hyperosmolar Hyperglycemic Syndrome (HHS)

Serious condition characterized by hyperglycemia, hyperosmolarity and dehydration and the absence of ketoacidosis that may occur in type 2 diabetes

Amylin agonist

-pramlintide (Symlin) decreases glucagon production

Sliding-Scale Insulin Dosing

- SQ rapid-acting (lispro or aspart) or short-acting (regular) insulins are adjusted according to blood glucose test results. - Typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings - SQ insulin is ordered in an amount that increases as the blood glucose increases - Disadvantage: delays insulin administration until hyperglycemia occurs; results in large swings in glucose control

Insulin Dosing and Syringes

U100 Standard for most (100 units/mL) U200 Insulin pen U300 Insulin pen U500 Newer concentration for those patients needing very high doses of insulin 500 units/mL

Oral Antidiabetic Drugs DPP-IV inhibitors (Adverse Effects)

Upper respiratory tract infection, headache, and diarrhea Hypoglycemia can occur and is more common if used in conjunction with a sulfonylurea.

Oral Antidiabetic Drugs: Alpha-Glucosidase Inhibitors

Acarbose (Precose), miglitol (Glyset) Indication: type 2 DM Contraindications Adverse effects

C) Never guess whether a drug was given. Taking the drug out of the machine does not mean it was given. The nurse should ask the night nurse what was done.

After the 0700 report, the day shift nurse notices that a patient has a 0730 dose of insulin due and goes to the automated dispensing machine to retrieve the insulin. The nurse sees that the night shift nurse had removed the 0730 dose of insulin, but the medication administration record has not been signed by the nurse. The patient is confused and says she "thinks" the night nurse gave her the insulin. The patient's blood glucose level is 142 mg/dL. What will the day shift nurse do? A) Give the insulin because it was not signed off. B) Hold the insulin because the patient thinks she received it, and it is recorded in the machine. C) Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given. D) Report this to the nursing supervisor.

Screening for Diabetes

All adults older than age 45 at least every 3 years for type 2 Individuals with risk factors should be screened earlier or more frequently No screening requirements for type 1

Nursing Implications (Oral antidiabetic drugs)

Always check blood glucose levels before giving Usually given 30 minutes before meals Alpha-glucosidase inhibitors are given with the first bite of each main meal Metformin is taken with meals to reduce GI effects Metformin will need to be discontinued if the patient is to undergo studies with contrast dye because of possible renal effects - check with the prescriber

Nursing Implications (Hypoglycemia)

Assess for signs of hypoglycemia If hypoglycemia occurs: if the patient is conscious, give oral form of glucose: give the patient glucose tablets or gel, corn syrup, honey, fruit juice, or non-diet soft drink or have the patient eat a small snack such as crackers or a half sandwich if the patient is unconscious, give D50W or glucagon, intravenously Monitor blood glucose levels

Glucagon

A protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.

Insulin glargine (Basaglar)

Biosimilar insulin U100

Fixed-Combination Insulins

Contains one immediate acting and one intermediate acting or one short acting type Each contains two different insulins, fixed combinations One intermediate-acting type Either one rapid-acting type (Humalog, NovoLog) or one short-acting type (Humulin) Combinations: Humulin 70/30 Humulin 50/50 Novolin 70/30 Humalog Mix 75/25 Humalog 50/50 NovoLog 70/30

Oral Antidiabetic Drugs:Thiazolidinediones (Glitazones) Mechanism of Action

Decrease insulin resistance "Insulin sensitizing drugs" Increase glucose uptake and use in skeletal muscle Inhibit glucose and triglyceride production in the liver

Diabetes mellitus signs and symptoms

Elevated fasting blood glucose (higher than 126 mg/dL) or a hemoglobin A1C (HbA1C) level greater than or equal to 6.5% -Polyuria -Polydipsia -Polyphagia -Glycosuria -Unexplained weight loss -Fatigue -Blurred vision

Long-Acting Insulins

Glargine (Lantus) Detemir (Levemir) Degludec (Tresiba)

Hypoglycemia reverse treatment

Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a non-diet soft drink or other quick sources of glucose, which must always be kept at hand. The patient should not wait for instructions from the physician, nor delay taking the glucose by resting.

Glycemic Goal of Treatment

HbA1C of less than 7% HbA1C diagnostic criteria; <5.7 = Normal 5.7 to 6.4 = Prediabetes >6.5 = Type 2 diabetes Fasting blood glucose goal for diabetic patients of 70 to 130 mg/dL Estimated average glucose

Intermediate-Acting Insulins

Insulin isophane suspension (also called NPH) Cloudy appearance Often combined with regular insulin Onset—1 to 2 hours Peak—4 to 8 hours Duration—10 to 18 hours

Nursing Implications (Overall Concerns)

Keep in mind that overall concerns for any patient with DM increase when the patient: -Is under stress -Has an infection -Has an illness or trauma -Is pregnant or lactating

Major Long-Term Complications of Both Types of Diabetes

Macrovascular (atherosclerotic plaque) & Microvascular (capillary damage)

Type 2 diabetes mellitus (Several comorbid conditions)

Obesity Coronary heart disease Dyslipidemia Hypertension Microalbuminemia (protein in the urine) Increased risk for thrombotic (blood clotting) events These comorbidities are collectively referred to as metabolic syndrome, also known as insulin-resistance syndrome, or syndrome X.

Oral Antidiabetic Drugs:Thiazolidinediones (Glitazones)

Pioglitazone (Actos) Rosiglitazone (Avandia) Only available through specialized manufacturer programs Insulin-sensitizing drugs Indication: type 2 DM

Basal-Bolus Insulin Dosing

Preferred method of treatment for hospitalized diabetic patients Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus Basal insulin is a long-acting insulin (insulin glargine) Bolus insulin (insulin lispro or insulin aspart)

Oral Antidiabetic Drugs: Biguanide: Adverse Effects

Primarily affects gastrointestinal (GI) tract: abdominal bloating, nausea, cramping, diarrhea, feeling of fullness May also cause metallic taste, reduced vitamin B12 levels Lactic acidosis is rare but lethal if it occurs. Does not cause hypoglycemia

Afrezza (inhaled insulin)

Rapid-acting insulin that is inhaled Peak of 12 to 15 minutes Short duration of action of 2 to 3 hours Administered within 20 minutes before each meal Must be given in conjunction with long-acting insulins or oral diabetic agents (for type 2 DM) Side effects: hypoglycemia, cough, and throat pain Contraindicated: smokers and those with chronic lung diseases Black box warning regarding the risk of acute bronchospasms

Short-Acting Insulins

Regular insulin (Humulin R) Routes of administration: IV bolus, IV infusion, intramuscular (IM), SQ Onset (SQ route): 30 to 60 minutes Peak (SQ route): 2.5 hours Duration (SQ route): 6 to 10 hours

Glinides (Meglitinides)

Repaglinide (Prandin), nateglinide (Starlix) Indication: type 2 DM Action similar to sulfonylureas Increase insulin secretion from the pancreas

Oral Antidiabetic Drugs: Alpha-Glucosidase Inhibitors (Mechanism of Action)

Reversibly inhibit the enzyme alpha glucosidase in the small intestine Result in delayed absorption of glucose Must be taken with meals to prevent excessive postprandial blood glucose elevations (with the "first bite" of a meal)

hypoglycemia treatment

Mild sx (sweating, tremor, incr HR, hunger, nausea, weakness): 15g glucose-3/4cup juice or reg soft drink, 6 Lifesavers) Severe sx (confusion, altered behaviour, difficulty speaking, disorientation, seizures and coma): 20g glucose tablets Unconscious: glucagon IM/SC in BG temp to take oral glucose. (glucagon not effective in alcohol-induced hypoglycemia or malnourished pts...need IV 50% dextrose in water)

Amylin agonist mechanism of action

Mimics the natural hormone amylin Slows gastric emptying Suppresses glucagon secretion, reducing hepatic glucose output Centrally modulates appetite and satiety Used when other drugs have not achieved adequate glucose control SQ injection

human insulin

therapy for diabetes; better tolerated than insulin extracted from animals; produced by E. coli -Derived using recombinant DNA technologies -Recombinant insulin produced by bacteria and yeast Goal: tight glucose control To reduce the incidence of long-term complications

Oral Antidiabetic Drugs: Glinides Adverse Effects

headache, hypoglycemic effects, dizziness, weight gain, joint pain, upper respiratory infection, or flu-like symptoms

hyperglycemia

high blood sugar level of 126mg/dL or higher or nonfasting blood glucose level of 200mg/dL or higher

polyuria

increased frequency or volume of urination (common symptom of diabetes)

Humulin 70/30

onset 0.5 hr peak 2-12 hrs duration 24 hrs used for client not needed to mix Looks at hemoglobin A1C (2-3 month sugar review)

type 2 diabetes mellitus

diabetes in which either the body produces insufficient insulin or insulin resistance (a defective use of the insulin that is produced) occurs; the patient usually is not dependent on insulin for survival -Most common type: 90% of all cases -Caused by insulin deficiency and insulin resistance -Many tissues are resistant to insulin: -Reduced number of insulin receptors -Insulin receptors less responsive

Alogliptin (Nesina)

dipeptidyl peptidase-4 inhibitor

Rosiglitazone (Avandia), Pioglitazone (Actos)

Thiazolidinediones Oral hypoglycemic. Rosiglitazone (Avandia) and pioglitazone (Actos). Decreases insulin resistance. There is high risk of CHF due to fluid retention. Pregnancy contraindication. pioglitazone is contraindicated with a history of heart failure

Nursing Implications (Education)

Thorough patient education is essential regarding: -Disease process -Diet and exercise recommendations -Self-administration of insulin or oral drugs -Potential complications

treatment for diabetes

Type 1 Insulin therapy Type 2 Lifestyle changes Oral drug therapy Insulin when the above no longer provide glycemic control

Nonpharmacologic Treatment Interventions

Type 1: always requires insulin therapy Type 2 Weight loss Improved dietary habits Smoking cessation Reduced alcohol consumption Regular physical exercise

Nursing Implications (Insulin)

-Check blood glucose level before giving insulin -Roll vials between hands instead of shaking them to mix suspensions -Ensure correct storage of insulin vials -Only use insulin syringes, calibrated in units, to measure and give insulin -Ensure correct timing of insulin dose with meals -When drawing up two types of insulin in one syringe, always withdraw the regular or rapid-acting insulin first *** -Provide thorough patient education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucose levels, and injection site rotations

Repaglinide (Prandin) Nateglinide (Starlix)

•Stimulate insulin release by closing K+-channels at pancreatic beta cells (Short acting) Do NOT increase insulin sensitivity at target cells. •Take w/ each meal Starlix promotes a *more rapid but less sustained* secretion of insulin, reducing the potential for postprandial hypoglycemia

C) Glucagon, a natural hormone secreted by the pancreas, is available as an SQ injection to be given when a quick response to severe hypoglycemia is needed. Because glucagon injection may induce vomiting, roll an unconscious patient onto his or her side before injection. Glucagon is useful in unconscious hypoglycemic patients without established IV access. The patient is at risk for aspiration, so nothing should be administered by mouth. CPR is not indicated.

The nurse enters the patient's room to complete the discharge process and finds the patient to be lying in bed unresponsive and breathing. The patient has a blood glucose reading of 48 mg/dL. 4. What is the most appropriate response by the nurse? A) Place a packet of table sugar in the patient's mouth. B) Start cardiopulmonary resuscitation (CPR). C) Roll the patient to the side and administer the ordered glucagon. D) Have the patient drink orange juice.

D Lispro insulin onset of action is 15 minutes. It is essential that a patient with DM eat a meal after injection. Otherwise, profound hypoglycemia may result.

The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next? A) Inform the patient of the delay. B) Check the patient's blood glucose levels. C) Call the dietary department to send a tray immediately. D) Give the patient food, such as cereal and skim milk, and juice.

D) The rapid-acting (clear) and then the intermediate-acting (cloudy) insulins should be mixed in the syringe after the appropriate amount of air has been injected. Insulin is stored at room temperature when it will be used within the month. The injection should be administered at a 90-degree angle for patients who have adequate body fat and at a 45-degree angle for patients who are very thin. Insulins should be rolled before administration and not shaken.

The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). 3. Which information does the nurse include when providing discharge teaching to the patient? A) Store the insulins in the refrigerator. B) Shake the insulins for 1 full minute before use. C) Administer the injection at a 30-degree angle to your skin. D) Draw up the insulin aspart (NovoLog) first and then draw up the insulin isophane suspension (NPH) into the same syringe.

Insulin degludec (Tresiba)

Ultra long acting Once daily U100 or U200

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

Nursing Implications (Drawing up Insulin)

When drawing up two types of insulin in one syringe, always withdraw the regular or rapid-acting insulin first. Provide thorough patient education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucose levels, and injection site rotations.

Nursing Implications (Insulin orders)

When insulin is ordered, ensure: -Correct route -Correct type of insulin -Timing of the dose -Correct dosage Insulin order and prepared dosages are second checked with another nurse.

Types of Antidiabetic Drugs

-Insulins -Oral hypoglycemic drugs Both aim to produce normal blood glucose states -Some new injectable hypoglycemic drugs may be used in addition to insulin or antidiabetic drugs

incretin mimetics adverse effects

-Nausea, vomiting, and diarrhea -Rare cases of hemorrhagic or necrotizing pancreatitis -Weight loss

Prediabetes

a condition in which the blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes Categories of increased risk for DM -HbA1C of 5.7% to 6.4% -Fasting plasma glucose levels higher than or equal to -100 mg/dL but less than 126 mg/dL -Impaired glucose tolerance test (oral glucose challenge)

Gestational Diabetes

a form of diabetes mellitus that occurs during some pregnancies -Hyperglycemia that develops during pregnancy -Insulin must be given to prevent birth defects. -Usually subsides after delivery -30% of patients may develop type 2 DM within 10 to 15 years.

diabetes mellitus

a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

antidiabetic drug

any of several agents used to control blood sugar levels in treatment of diabetes mellitus

Hypoglycemia Symptoms Early

confusion, irritability, tremor, sweating

Diabetic Ketoacidosis (DKA)

A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available. -Hyperglycemia -Ketones in the serum -Acidosis -Dehydration -Electrolyte imbalances -Approximately 25% to 30% of patients with newly diagnosed type 1 DM present with DKA.

Metabolic Syndrome (Syndrome X)

A genetic metabolic disorder characterized by diabetes, hypertension, atherosclerosis, centrally distributed obesity, and elevated blood lipids

C) HbA1C is a good indicator of the patient's compliance with the therapy regimen for several months previously.

A male patient who has a history of type 2 DM is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about HbA1C. 1. What can the nurse inform the patient about the use of HbA1C in diabetes mellitus? A) Helps to identify which type of DM the patient has B) Will identify if he has an infection C) Will aid in monitoring patient compliance with treatment regimen for several months previously D) Represents current fasting blood glucose level

D) Corticosteroids antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose.

A patient with type 1 DM is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease. He is placed on IV piggyback antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastroesophageal reflux disease. He takes a dose of glargine insulin every evening. This evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? A) The albuterol B) The antibiotics C) The proton pump inhibitor D) The corticosteroid

Insulin

A protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues -Direct effect on fat metabolism -Stimulates lipogenesis and inhibits lipolysis -Stimulates protein synthesis -Promotes intracellular shift of potassium and magnesium into the cells -Cortisol, epinephrine, and growth hormone work synergistically with glucagon to counter the effects of insulin.

C) Oral antidiabetic medications are generally not recommended for pregnant patients because of a lack of firm safety data. Insulin therapy is the currently recommended drug therapy for pregnant women.

A woman who has type 2 DM is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive? A) She should continue the antidiabetic medication at the same dosage. B) The antidiabetic medication dosage will be increased gradually throughout her pregnancy. C) She will be switched to insulin therapy while she is pregnant. D) She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely.

Humalog 50/50

50% Insulin Lispro Protamine 50% Insulin Lispro

Humulin 50/50

50% NPH 50% Regular Generic: isophane injection susp. and insulin injection injectable hypoglycemic/Indication: Diabetes Duration of Action: intermediate

Hypoglycemia Symptoms Late

hypothermia, seizures, coma and death will occur if not treated

Sodium Glucose Cotransporter (SGLT2) Inhibitors Results

improved glycemic control, weight loss, and a low risk of hypoglycemia

pancreas

located partially behind the stomach in the abdomen, and it functions as both an endocrine and exocrine gland. It produces digestive enzymes as well as insulin and glucagon

Sodium Glucose Cotransporter (SGLT2) Inhibitors Other Effects

may increase insulin sensitivity and glucose uptake in the muscle cells and decrease gluconeogenesis

Incretin mimetic mechanism of action

mimics the incretin hormone, enhances glucose-driven insulin secretion from beta cells of the pancreas, only used for type 2 DM, exenatide: injection pen device

Microvascular (capillary damage)

retinopathy, neuropathy, nephropathy

Glycogenolysis

the breakdown of glycogen into glucose by the liver, releasing it back into the circulating blood in response to a very low blood sugar level

Glucose

the form of sugar that circulates in the blood and provides the major source of energy for body tissues. When its level is low, we feel hunger.

Types of Diabetes Mellitus

type 1 and type 2

Sodium Glucose Cotransporter (SGLT2) Inhibitors Mechanism of Action

work independently of insulin to prevent glucose reabsorption from the glomerular filtrate, resulting in a reduced renal threshold for glucose and glycosuria

Polyphagia

excessive hunger; common symptom in uncontrolled diabetes

Macrovascular (atherosclerotic plaque)

Coronary arteries Cerebral arteries Peripheral vessels

Injectable Antidiabetic Drugs

-Amylin agonist -Pramlintide (Symlin) Incretin mimetics -Exenatide (Byetta) -Dulaglutide (Trulicity) -Liraglutide (Victoza) -Albiglutide (Tanzeum) -Lixisenatide (Adlyxin) -Combo agent: -Soliqua (insulin glargine and lixisenatide) -Xultophy (insulin degludec and liraglutide)

Oral Antidiabetic Drugs

-Used for type 2 DM -Effective treatment involves several elements -Careful monitoring of blood glucose levels -Therapy with one or more drugs -Treatment of associated comorbid conditions such as high cholesterol and high blood pressure

Novolin 70/30

70% NPH, 30% regular human insulin isophane suspension and regular, human insulin injection (rDNA origin)

NovoLog 70/30

70% aspart protamine, 30% aspart; insulin aspart protamine/insulin aspart

Humalog Mix 75/25

75% insulin lispro protamine, 25% insulin lispro insulin lispro protamine suspension mixed with soluble insulin lispro

Glycogen

An extensively branched glucose storage polysaccharide found in the liver and skeletal muscle of animals; the animal equivalent of starch.

Nursing Implications- Assessment

Before giving drugs that alter glucose levels -Assess the patient's ability to consume food. -Assess for nausea or vomiting. Hypoglycemia may be a problem if antidiabetic drugs are given and the patient does not eat. If a patient is NPO for a test or procedure, consult the primary care provider to clarify orders for antidiabetic drug therapy.

Nursing Implications (Documenting)

Before giving drugs that alter glucose levels, obtain and document: A thorough history Vital signs Blood glucose level, HbA1C level Potential complications and drug interactions

Nursing Implications (Monitor for therapeutic response)

Decrease in blood glucose levels to the level prescribed by physician. Measure HbA1C to monitor long-term compliance with diet and drug therapy. Monitor for hypoglycemia and hyperglycemia.

Sitagliptin (Januvia)

DPP 4 Inhibitor stimulated ^ insulin production when high BS lowers glucose production when high BS

Saxagliptin (Onglyza)

DPP-4 Inhibitor T2DM 2.5-5 mg QD regardless of meals

Linagliptin (Tradjenta)

DPP-4 inhibitor, increase GLP-1, hepatically metabolized, ADEs include nasopharyngitis, diarrhea, and cough

Oral Antidiabetic Drugs: DPP-IV inhibitors (Mechanism of Action)

Delay breakdown of incretin hormones by inhibiting the enzyme DPP-IV. Incretin hormones increase insulin synthesis and lower glucagon secretion. Reduce fasting and postprandial glucose concentrations.

insulin function

Function as a substitute for the endogenous hormone Effects are the same as normal endogenous insulin. Restores the diabetic patient's ability to: -Metabolize carbohydrates, fats, and proteins -Store glucose in the liver -Convert glycogen to fat stores

Dulaglutide (Trulicity)

GLP-1 Agonist MOA: (3-prong)- binds GLP-1 receptor to restore activity -> lowers glucagon production, increases beta cell size, lowers gastric emptying to lower glucagon release

Liraglutide (Victoza)

GLP-1 Agonist MOA: (3-prong)- binds GLP-1 receptor to restore activity -> lowers glucagon production, increases beta cell size, lowers gastric emptying to lower glucagon release

Lixisenatide (Adlyxin)

GLP-1 Agonist New to market, daily dosing

Albiglutide (Tanzeum)

GLP-1 agonist

Exenatide (Byetta)

Incretin mimetic (hypoglycemic, subQ) Lowers fasting and postprandial blood glucose Promotes insulin release, decreases glucagon, slows gastric emptying Do NOT use w/ insulin Can cause N/V/D, pancreatitis Oral medication absorption is delayed, esp. oral contraceptives and antibiotics (stagger one hour before or 2 hours after)

Sodium Glucose Cotransporter (SGLT2) Inhibitors

Inhibition of SGLT2 leads to a decrease in blood glucose caused by an increase in renal glucose excretion. new class of oral drugs for the treatment of type 2 DM Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance)

New-onset type 2 DM treatment

Lifestyle interventions Oral biguanide drug metformin If lifestyle modifications and the maximum tolerated metformin dose do not achieve the recommended HbA1C goals after 3 to 6 months, additional treatment should be given with a second oral agent, GLP-1 agonist (liraglutide, exenatide, albiglutide, lixisenatide) or insulin.

type 1 diabetes mellitus

Little or no insulin is produced of defective insulin Affected patients need exogenous insulin. Fewer than 10% of all DM cases are this type. Complications Diabetic ketoacidosis (DKA) Hyperosmolar hyperglycemic syndrome (HHS)

amylin agonist adverse effects

Nausea, vomiting, anorexia, headache

Glucose-Elevating Drugs

Oral forms of concentrated glucose Buccal tablets, semisolid gel 50% dextrose in water (D50W) Glucagon

Ketones

Organic chemical compounds produced through the oxidation of secondary alcohols (e.g., fat molecules), including dietary carbohydrates.

Sulfonylureas

Second generation: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta) Stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels Beta cell function must be present. Improve sensitivity to insulin in tissues Result in lower blood glucose level

Oral Antidiabetic Drugs: Dipeptidyl Peptidase-IV (DPP-IV) Inhibitors

Sitagliptin (Januvia) Saxagliptin (Onglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)

C) The nurse should inform the patient that timing of meals with insulin and oral antidiabetic therapy is important to prevent hypoglycemia and to obtain the most optimal results from the antidiabetic therapy. Whereas insulin detemir (Levemir) is a long-acting insulin, insulin glulisine (Apidra) is a rapid-acting insulin. Insulin isophane suspension (NPH) is an intermediate-acting insulin, and regular insulin (Humulin R) is a short-acting insulin.

The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. 2. Which drug will the nurse tell the patient is a long-acting insulin? A) Insulin glulisine (Apidra) B) Insulin isophane suspension (NPH) C) Insulin detemir (Levemir) D) Regular insulin (Humulin R)

Hypoglycemia

abnormally low level of sugar in the blood less than 70mg/dL or above 50mg/dL) Mild cases can be treated with diet—higher intake of protein and lower intake of carbohydrates—to prevent rebound postprandial hypoglycemia.

Oral Antidiabetic Drugs: Sulfonylureas Adverse Effects

hypoglycemia, hematologic effects, nausea, epigastric fullness, heartburn, many others