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U of A NURS 3313 - Antidiabetic Drugs

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Antidiabetic DrugsDiabetes Mellitus- Diabetes mellitus (DM) actually is not a single disease, but a group of progressive diseases. It is often regarded as a syndrome rather than a disease.- Two typeso Type 1 Fewer in number o Type 2- Signs and symptomso Elevated fasting blood glucose (higher than 126 mg/dL) or a hemoglobin A1C (A1C) level greater than or equal to 6.5% A1C – normal differs with different lab valueso Polyuriao Polydipsiao Polyphagiao Glycosuriao Unexplained weight loss (only type 1)o Fatigueo Blurred vision (elevated blood sugar)Type 1 Diabetes Mellitus- Lack of insulin production or production of defective insulin- Affected patients need exogenous insulin- Fewer than 10% of all diabetes cases are type 1- Complicationso Diabetic ketoacidosis (DKA)o Hyperosmolar nonketotic syndromeo Emergency situations o Must worry about low blood sugar Type 2 Diabetes Mellitus- Most common type: 90% of all cases- Caused by insulin deficiency and insulin resistance- Many tissues are resistant to insulino Reduced number of insulin receptorso Insulin receptors less responsive- Several comorbid conditionso Obesityo Coronary heart diseaseo Dyslipidemiao Hypertensiono Microalbuminemia (protein in the urine)o Increased risk for thrombotic (blood clotting) eventso Tend to be sedentary- These comorbidities are collectively referred to as metabolic syndrome or insulin-resistance syndrome or syndrome XGestational Diabetes- 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 yearsMajor Long-Term Complications of DM (Both Types)- Macrovascular (atherosclerotic plaque)o Coronary arterieso Cerebral arterieso Peripheral vessels- Microvascular (capillary damage)o Retinopathy blindnesso Neuropathy Loss of sensation in the feet Can have pain with thiso Nephropathy Kidney failureScreening for DM- Prediabeteso Categories of increased risk for diabetes  Hemoglobin A1C of 5.7% to 6.4% Fasting plasma glucose (FPG) levels higher than or equal to 100 mg/dL but less than 126 mg/dL Impaired glucose tolerance test (oral glucose challenge)- Valuable in early pregnancy- Screening recommended every 3 years for all patients 45 years and olderTreatment for DM- Type 1o Insulin therapy- Type 2o Lifestyle changeso Oral drug therapyo Insulin when the above no longer provide glycemic controlTypes of Antidiabetic Drugs- Insulins- Oral hypoglycemic drugso Both aim to produce normal blood glucose states - Some new injectable hypoglycemic drugs may be used in addition to insulin or antidiabetic drugsInsulins- Has to be injected - Function as a substitute for the endogenous hormone- Effects are the same as normal endogenous insulin o Weight gain - Restores the diabetic patient’s ability to: o Metabolize carbohydrates, fats, and proteinso Store glucose in the livero Convert glycogen to fat stores- Human insulino Derived using recombinant DNA technologieso Recombinant insulin produced by bacteria and yeast- Goal: tight glucose controlo To reduce the incidence of long-term complications- Rapid-actingo Most rapid onset of action (5 to 15 minutes)o Shorter durationo Patient must eat a meal after injectiono Insulin lispro (Humalog) *** Similar action to endogenous insulino Insulin aspart (NovoLog)***o Insulin glulisine (Apidra)o May be given subcutaneously or via continuous subcutaneous infusion pump (but not IV)- Short-actingo Regular insulin (Humulin R)o Onset 30 to 60 minutes The only insulin product that can be given by IV bolus, IV infusion, or even IM- Intermediate-actingo Insulin isophane suspension (also called NPH)  Cloudy appearance Slower in onset and more prolonged in duration than endogenous insulin- Long-actingo glargine (Lantus), detemir (Levemir) Clear, colorless solution Usually dosed once daily Referred to as basal insulin Works in young population - Fixed combinationso Humulin 70/30o Humulin 50/50o Novolin 70/30o Humalog Mix 75/25o Humalog 50/50o NovoLog 70/30- Insulin use in special populationso Pediatrics Insulin pumps are preferableo Pregnant women  Insulin therapy  Can be difficult to teach pt’s  Need to know that they can live normal healthy lives Just because they have it doesn’t mean their children will have it Sliding-Scale Insulin Dosing- Subcutaneous short-acting or regular insulin doses adjusted according to blood glucose test results- Typically used in hospitalized diabetic patients or those on total parenteral nutrition (TPN) or enteral tube feedingso GLUCOCORTICOSTERIODS & STERIODS INCREASE THE BLOOD SUGAR**- Subcutaneous 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 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- Used for type 2 diabetes- Treatment for type 2 diabetes includes lifestyle modificationso Diet, exercise, smoking cessation, weight loss- Oral antidiabetic drugs may not be effective unless the patient also makes behavioral or lifestyle changes- Biguanides (The best)o metformin (Glucophage)o Start patients on this drug first o If we have to add another medication it will be a sulfonylurea- Sulfonylureaso Second generation: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Micronase)o Don’t give this to pt allergic to sufonamideso Know the drug class - Dipeptidyl peptidase-IV (DPP-IV) inhibitors o sitagliptin (Januvia)o saxagliptin (Onglyza)o linagliptin (Tradjenta) New class, complex - Mechanism of Actiono Biguanides 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)- Also causes weight loss o Sulfonylureas Stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels- Decreases absorption of glucose  Beta cell function must be


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U of A NURS 3313 - Antidiabetic Drugs

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