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Diabetes and medications

Terms in this set (22)

Regulation of BG levels
Hormones and drugs that affect glucose metabolism
*Hormones that cause hyperglycemia include=
-epinephrine (from adrenal medulla)
-thyroid hormone (from thyroid gland)
-growth hormone (from anterior pituitary)
-glucocorticoids (from adrenal cortex)
*Drugs that cause hyperglycemia include=
-Phenytoin (anticonvulsant)
-NSAIDs (anti-inflammatory)
-Diuretics
*Drugs that cause hypoglycemia include=
-alcohol
-lithium (for manic depression)
-ACE inhibitors (for hypertension and CHF)
-Beta- blockers (for hypertension and to decrease BP)
*both types of DM (1 and 2) have same complications= retinopathy, neuropathy, and nephropathy
DM Type 1
-5-10% of all cases
-is the 6th leading cause of death
-was known as the childhood disease but can affect anyone
-diagnoses usually ranges around 11-13 years old
-is insulin dependant
*Causes=
-auto-immune destruction of beta-cells--> results in lack of insulin
*manifestations= Hyperglycemia (FBG >126 on two separate occasions), polyuris, polydipsia, polyphagia, glucosuria, weight loss and fatigue
*complications=DM--> can lead to damaged arteries--> heart disease--> stroke--> kidney disease--> blindness
-lack of circulation to the feet--> causes gangrene--> amputation
-Neuropathy (nerve degeneration)--> causes tingling in the toes and feet--> complete loss of sensation
- lipids utilized as energy--> ketoacids--> decreased pH--> DKA--> coma--> death
Manifestations of hypoglycemia
-happens when too much insulin or not enough food intake or too much exercise
-manifestations are same as DKA
-will be pale, cool, moist skin, with BG <50
-symptoms are sudden --> can lead to death
*memory Mnemonic
Hot and dry= sugar high
cold and clammy= need some candy
emergency treatment for hypoglycemia
if mild then give food or drink with glucose
-a quick way to reverse serious hypoglycemia is to give IV Glucose in Dextrose solution***
-Glucagon can also be used if unable to take IV glucose
-give 1mg glucagon IV, IM, or SubQ. It will reverse symptoms in <20min (depending on route)
DM Type 2
More common in 90-95%
-appears in middle-aged adults (referred to as age-onset DM or maturing onset DM)
-often asymptomatic, takes years before diagnosed
-insulin resistant, defect in insulin receptor function
-pancreas secretes sufficient insulin but target cells don't recognize it--> increases BG--> pancrease increases more insulin--> beta cells exhausted--> beta cell death--> as type 2 progresses--> decreased insulin production and insulin resistance occurs.
HHS (hypersomolar hyperglycemic state) in type 2DM
is a serious, acute condition with mortality rates of 20-40%
*causes= not enough insulin, too much glucose
*Onset= is gradual (hyperglycemia is gradual but hypoglycemia is fast). is sometimes mistaken for CVA
*manifestations= skin flushed, dry, warm, with BG >600 mg/dl
*treatment= fluid replacement, correct electrolyte imbalances, give low-dose insulin (slow) to decrease BG levels to 250-300 mg/dl
-has higher mortality rate than DKA in type 1DM
Human Regular Insulin (Humulin R)
Is a short acting, hypoglycemic agent
-promotes cell uptake of glucose, amino acids, and potassium
-promotes protein synthesis, glycogen formation & storage in the liver. stores fatty acids and triglycerides too.
-conserves energy needs
-inhibits gluconeogenesis from liver
-used in combo with intermediate or long acting insulin
-used as monotherapy in type 1DM or in combination therapy with oral hypoglycemics in type 2DM
-used in emergency DKA treatment since it's short acting
-used in gestational diabetes
*manifestations of hypoglycemia from too much insulin
-tachycardia, confusion, sweating, drowsiness, weight gain
*monitor= hypokalemia since it may worsen it. alcohol intake can increase BG levels at first and then decrease BG levels --> causing hypoglycemia
Insulin
it's important to balance correct insulin with available glucose and must be carefully planned in conjuction with proper meal planning & lifestyle habits
-example= insulin with glucose and heavy exercise can lead to hypoglycemia if glucose uptake increases by the muscles when exercising
-need to eat food or drink sports drinks just before activity to maintain normal BS levels
-without correct insulin dose, glucose increases --> causing hyperglycemia--> coma
*Adverse effects= hypoglycemia, localized allergic reaction at injection site, generalized urticaria, swollen lymph glands, may experience the Somogyi Phenomenon (rapid decrease of BG at night which stimulates the release of hormones [epinephrine, cortisol & glucagon] and will increase BG in the morning)
-rapid rebound hypoglycemia if given additional insulin above the normal dose
Insulin nursing interventions
-insulin need may increase or decrease during illness or stress
-anorexia, nausea, vomiting may decrease need for insulin
-increase physical activity; may need to monito before and after and then 48hrs after activity since hypoglycemic effects may still take place.
-exercise should occur 1hr after a meal or after 10-15g of carbohydrate
Interactions that can cause hypoglycemia or hyperglycemia
*Drugs that can potentiate hypoglycemia=
- alcohol, salicylates, MAOIs, anabolic steroids, guanethidine,
(beta blockers mask hypoglycemia)
*Hormones that counteracts hypoglycemic effects=
- corticosteroids, TH, epinpephrine
*Drugs that can cause hyperglycemia=
-furosemide, thiazide diuretics
Oral Hypoglycemics for type 2DM
for type 2Dm after diet and exercise have failed to decrease BG to normal levels
-may also be temporarily necessary during stress, illness, or loss
*There are 6 primary groups of oral antidiabetic drugs=
1. Sulfonylureas
2. Biguanides
3. Meglitinides
4. Thiazolidinediones (Glitazones)
5. Alpha- glucosidase inhibitors
6. Incretin mimetics
-these oral hypoglycemics are not effective for type 1DM
Sulfonylureas oral hypoglycemic agents
-Causes the islet of langerhans to secretes insulin
-and increases sensitivity to insulin
*Adverse Effects=
-hypoglycemia (Give Dextrose)**
-weight gain, hypersensitivity reaction, GI distress, hepatotoxicity (report yellow skin or sclera, white or clay stool, or dark urine), can cause Disulfiram-like reaction (flushing, palpitations, & nausea) when taken with acohol.
Biguanides oral hypoglycemic agents
*Metformin
-causes the liver to stop secreting glucose (gluconeogenesis)
-decreases insulin resistance
- doesn't promote increase release of insulin from the pancreas
-decreases BG, triglycerides and LDL levels
*Adverse Effects= GI related (anorexia, nausea, diarrhea)
-doesn't cause hypoglycemia or weight gain **
- it increases weight loss
-can decrease respiratory rate (report if lactic acidosis)
Alpha-Glucosidase Inhibitors oral hypoglycemic agents
*Acarbose (Precose)
-blocks enzymes in the small intestines that breakdown carbohydrates into monosaccharides (and then into glucose)
-digestion of glucose is delayed
*Adverse Effects=
-minimal abdominal cramp, diarrhea, & flatulence, liver impairment
-hypoglycemia doesn't occur by acarbose alone (need to be combined with insulin or sulfonylureas to decrease BG)
-Treat hypoglycemia with glucose (not sucrose table sugar because the drug inhibits the absorption of sucrose)**
Thiazolidinediones (Glitazones) oral hypoglycemic agents
-decreases BG by decreasing insulin resistance
- inhibits hepatic gluconeogenesis
-takes 3-4 months of therapy to decrease BG
*Adverse Effects= fluid retention (contraindicated in HF, pulmonary edema), headache, no hypoglycemia, may cause hepatotoxicity, balck box warning for CHF & MI
-end in -zone
Meglitinides oral hypoglycemic agents
Release insulin from pancreatic islet cells
-same as sulfonylureas
-has short duration action of 2-4hrs
*Adverse effects= hypoglycemia
Incretin mimetics
affect the incretin-glucose control mechanism
-Incretins are hormones secreted by the intestine following a meal, when BG is increased--> it signals the pancreas to increase insulin --> and tells the liver to stop producing glucose
-DM can't produce incretins in adequate amounts
Byetta (Exenatide) (incretin mimetic)
decrease BG by increasing insulin --> slows absorption of glucose and decreases glucogan action
-is an alternative to metformin
-give SubQ
-is a miscellanous oral hypoglycemic agent
*Adverse Effect= nausea, vomiting and diarrhea, doesn't cause hypoglycemia
DDP-4 (Dipeptidyl Peptidase ) Inhibitors
*Sitagliptin (Januvia)
-is a miscellanous oral hypoglycemic agent
-the normal function o a DDP-4 enzyme is to break down incretins.
-this drug inhibits the breakdown
Amylin Analog oral hypoglycemic agent
*Pramlintide (Symlin)
-is a miscellanous oral hypoglycemic agent
-Amylin is a small peptide released by the beta cells of the pancreas at the same time as insulin
- acts synergistically with insulin to control glucose
-slows gastric emptying time
-increases satiety to reduce caloric intake
-give immediately prior to meal
-no mix with insulin must be injected in a different site than the insulin site
*Adverse Effect= hypoglycemia
Bromocriptine (Parlodel, clycoset) oral hypoglycemic agent
-is a miscellanous oral hypoglycemic agent
- acts on the CNS to increase dopamine neurotransmitter
-improves glycemic control but is unclear how
*Adverse Effects= nausea, vomiting, fatigue, dizzy and headache
Metformin (Biguanide)
Is preferred for type 2Dm
- approved for > 10 years old
- decreases fasting and postprandial BG
- no hypoglycemia, no weight gain **
-can decrease BG in those who no longer secrete insulin
-can decrease triglyceride and LDL
-promotes weight loss
-causes false positive for ketonuria
-use hemodyalisis for overdose
* Adverse Effects= nausea, vomiting, diarrhea, metallic tatse, anorexia, headache, dizzy, agitation, fatigue, lactic acidosis (must d/c if continues)
* interactions with other drugs= alcohol can increase lactic acidosis and acute renal failure
* Contraindicated= liver, heart failure, history of lactic acidosis, serious infection
-DOn't give 2hrs before or after IV radiographic contrast
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