tyoe 2 diabetes mellitus

type 2 diabetes mellitus

a metabolic disorder of insufficient insulin being produced by the pancreas, impaired cell uptake of insulin, or both; requires therapy of balance of diet, exercise, stress, management, and antihyperglycemic drugs

type 2 DM symptoms

frequent urination day and night, extreme thirst, excessive hunger, drowsiness, nausea, dry skin, blurred vision

retinopathy

DM complication; DM can damage the small vessels that line the retina

nephropathy

DM complication; DM can damage the glomeruli of the kidneys, impairing structure and function

neuropathy

DM complication; DM can damage nerves; early signs include numbness, tingling, prickling, searing or burning of feet or hands; may result in infection or tissue death

DM complications

retinopathy, nephropathy, neuropathy, hypercholesterolemia, hypertension, CVS complications, amputation due to tissue death from impaired circulation

DM modifiable risk factors

diet, sedentary lifestyle, obesity, alcohol/substance misuse, stress

sulfonylureas generic names

glyburide (diabeta), gliclazide (diamicron), glimepiride (amaryl)

sulfonylureas action

stimulates production and release of insulin and decreases glucose production; increases number of insulin receptors and tissue responsiveness; increases peripheral use of glucose

sulfonylureas adverse effects

weight gain; hypoglycemia; use with caution in older adults, may cause severe renal or hepatic impairment due to inc risk of hypoglycemia

biguanides generic name

metformin (glucophage, glumetza)

biguanides action

decreases glucose production and intestinal absorption of glucose; increases tissue responsiveness and glucose transport into muscle and fat cells; decreases plasma lipids

biguanides adverse effects

weight gain, nausea, diarrhea; potential for lactic acidosis if renal or hepatic impairment; hold before or at time of procedure, and hold for 48 hours after procedure with CT with contrast

biguanides indications

use alone, with sulfonylureas, other oral antihyperglycemics or insulin; first line mrdication for most clients with type 2 DM; use in obese pre-diabetic pts with impaired FBS level

biguanides contraindications

contraindicated in lactic acidosis and risk conditions including: serious hepatic or renal impairment, cardiac or respiratory insufficiency, hypoxia

thiazolidinediones generic name

proglitazone (actos), rosiglitazone (avandia)

thiazolidinediones action

improves insulin sensitivity and transport at use of target tissue; inc gluc uptake in muscle and fat; dec glucose production by liver; improve triglycerides, HDL’s and BP

thiazolidinediones adverse effects

edema, weight gain, CHF, may cause hypoglycemia when used in combination with sulfonylurea or insulin

thiazolidinediones indications

most effectiev for clients with insulin resistance; can use alone, with metformin, a sulfonylurea, or insulin

thiazolidinediones contraindications

contraindicated in active liver disease

GLP-1 receptor agonists generic name

liraglutide (victoza), exenatide (byetta), semaglutide (ozempic, rybelsus)

GLP-1 receptor agonists action

stimulates an endogenous incretin hormone called GLP-1 → stimulates release of insulin and supresses glucagon secretion; reduces glucose output from liver; increases satiety and dec gastric emptying

GLP-1 receptor agonists adverse effects

hypoglycemia-negligible, nausea, vomiting, diarrhea, constipation, headache, worsening retinopathy with rapid HbA1C reduction, pancreatitis reported in individual cases

GLP-1 receptor agonists contraindications

contraindicated in indiviual or familu history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2; avoid using with other incretins

DPP4 inhibitors generic names

sitagliptin (januvia), linagliptin (trajenta)

DPP4 inhibitor action

blocks enzyme DPP4 responsible for break down of incretin hormones, resulting in endogenous incretin enhancement; stimulates glucose dependent insulin secretion; inhibits hepatic glucose production and glucagon release; slows gastric emptying

DPP4 inhibitor adverse effects

upper respiratory tract infections, sore throat, headache, diarrhea, pancreatitis reported in indiviual cases

DPP4 inhibitors contraindications

avoid use with other incretins

SGLT2 inhibitors generic names

dapaglifozin (forxiga), empaglifozin (jardiance)

SGLT2 inhibitors action

blocks resorption of glucose by kidneys; enhances urinary excretion of glucose, and lowers blood glucose levels

SGLT2 inhibitors adverse effects

genital infections, UTIs, hypotension, increased lipids

SGLT2 inhibitors other

reduces risk of CV disease in pts with type 2 DM; reduces risk of CV events in HF pts without DM; reduces risk of disease progression in CKD