Glossary of Drugs for Diabetes Mellitus
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- What are hyperglycemic states?
- Type I Diabetes
Type II Diabetes
- What treatments are used in type I Diabetes?
Self-monitoring of blood glucose levels
- What treatments are used in Type II Diabetes?
Insulin/oral hypoglycemic agents
- What is used to monitor Glucose Levels?
- Blood Glucose Monitoring - machines that need to be calibrated.
Urine Glucose Monitoring - Blood sugar must be > 180 before glucose is in urine.
Glycated Hemoglobin (HbA1C) - average of glucose levels over 2-3 months. HbA1c < 7% is good.
- What is insulin used for?
- Manage hyperglycemia by promoting cellular glucose uptake and metabolism.
Mandatory for type 1 diabetes and may be needed in type 2 diabetes.
- How does insulin vary?
- Vary by peak, onset, and duration of action
Recombinant DNA (human) is now the standard source:
Animal sources are still available.
- What are the types of Insulin?
- Classified according to time course
(Rapid acting, Slower acting)
- Name three short acting insulins.
- Lispro (Humalog)
Regular (Short-Acting) Insulin
- What is the onset, peak, and duration for Lispro (Humalog)?
- Onset: 15 – 30 min
Peak: 0.5 - 2.5 hours
Duration: 3 - 6.5 hours
- How is Lispro (Humalog) used?
- Used in continuous subcutaneous insulin infusion pumps
Patient titrates dose delivered depending on their glucose level
Can be administered immediately before eating
- What is the onset, peak, and duration for Aspart (NovoLog)?
- Onset: 10 – 20 min
Peak: 1.0 - 3 hours
Duration: 3 - 5 hours
- What precautions should be taken with Aspart (NovoLog)used?
- Eating should begin within 5 – 10 minutes of injection or immediately after
- What is the onset, peak, and duration for Regular (Short-Acting) Insulin?
- Onset: 30-60 minutes
Peak: 1-5 hours
Duration: 6-10 hours
- How is Regular (Short-Acting) insulin used?
- Only insulin used for IV insulin infusions.
Check your institution policy – insulin adheres to PVC tubing.
Used for sliding scale coverage.
- Name two intermediate acting insulins.
- NPH (Intermediate-Acting) Insulin & Lente (Intermediate-Acting) Insulin
- What is the onset, peak, and duration for NPH (Intermediate-Acting) Insulin?
- Onset: 1 - 2 hours
Peak: 6 - 14 hours
Duration: 16 – 24+ hours
- What is the onset, peak, and duration for NPH/Regular 70/30 insulin?
- Onset: 30-60 min
Peak: 1.5 – 16 hours
Duration: up to 24 hours
- What is the onset, peak, and duration for Lente (Intermediate-Acting)?
- Time course similar to NPH.
- Name 2 long-acting insulins.
- Ultralente (Long-acting) & Lantus (Long-acting) Insulin
- What is the onset, peak, and duration for Ultralente (Long-Acting)?
- Onset: 4-6 hours
Peak: 8-20 hours
Duration: 24-28 hours
- What is the onset, peak, and duration for Lantus (Long-Acting) insulin?
- Onset: 70 minutes
Duration: 24 hours
(Creates a steady rate; usually used to treat type 2 diabetes in PO form)
- What precautions should you take with Lantus insulin?
- Do NOT confuse with Lente. Should not be administered in same syringe with other insulins.
- What are some Patient Teaching points?
- Proper administration - rotate within site.
Testing for Blood Glucose
Storage of Insulin
Disposal of used needles and syringes
Ambulatory Pumps - needle stays in 1-3 days.
- What is the prototype for Sulfonylurea?
- glyburide (DiaBeta)
- What is the therapeutic effect of Sulfonylurea?
- Stimulates insulin release and reduces glucagon levels
- What are the adverse effects of Sulfonylurea?
- Common adverse effects:
Contraindicated in pregnancy
If mixed with alcohol causes nausea (disulfirem)
- What is the prototype for Biguanide?
- metformin (Glucophage)
- What is the therapeutic effect of Biguanide?
- Used in type 2 diabetes.
Suppresses hepatic glucose production, enhances insulin sensitivity in the muscle, and promotes glucose uptake.
- What is the prototype for Thiazolidinediones?
- rosiglitazone (Avandia)
- What are the therapeutic effects of Thiazolidinediones?
- Used in Type 2 diabetes.
Lowers the blood glucose levels by improving the cellular response to insulin.
Monitor liver enzyme function pretherapy and closely throughout the first year of therapy.
- What are the adverse effects of Thiazolidinediones?
- Adverse effect: Fluid retention. Need base liver values. Anorexia, nausea, vomitting, billius urine
- What is the prototype for Alpha Glucosidase Inhibitor?
- acarbose (Precose)
- What are the therapeutic effects of Alpha Glucosidase Inhibitor?
- Delays the digestion of carbohydrates, resulting in a smaller postprandial rise of blood glucose.
- What are the adverse effects of Alpha Glucosidase Inhibitor?
- Adverse Effects: Flatulance, cramps, GI problems, decrease absorption of iron, and long-term therapy can lead to liver disfunction.
- What precautions should be taken with Alpha Glucosidase Inhibitor?
- Use oral glucose tablets if hypoglycemia occurs, because cane sugar found in candy and orange juice will not be absorbed.
- How do you treat hypoglycemia?
- First line - Intravenous Glucose given as a drug therapy to restore consciousness in extreme hypoglycemia.
Glucagon Stimulates glycogenolysis in the peripheral tissues
Given as a drug therapy to restore consciousness in extreme hypoglycemia
- Total distruction of pancreatic cells.
- Type 1 Diabetes
- Usually adult onset; non-insulin dependent; insuin resistance.
- Type 2 Diabetes
- What are possible outcomes from diabetes 1 and 2?
- Heart disease, numbness and tingling, amputation, hypertension.
- What are normal glucose levels before meals and at betime?
- 80-120 before each meal
100-140 at betime
- What constitutes for a diagnosis of diabetes?
- Need 2 positive readings on 2 different dates. Needs to be > 126. If it is an oral glucose tolerance test or a casual plasma glucose test, must be > 200.
- What are the adverse effects of Biguanide?
- Decrease absorption, decrease appetite, patients w/ renal insufficiency can become toxic. Does't cause hypoglycemia.
- What is the prototype of Meglitinides?
- repaglinide (Prandin)
- What nursing administration/Patient education should you do with Meglitinides?
- Patients should eat within 30 minutes
- What is the therapeutic effect of Meglitinides?
- Stimulates insulin release
- What is the adverse effect of Meglitinides?
- What are symptoms of hypoglycemia?
- Flushed, hot, cold sweat, confusion. (Patients of betablockers may not show signs)
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