Antidiabetic Drugs

Alpha and Beta Cells

Glucagon and insulin secreting cells in the Islets of Langerhans

Alpha cell

Glucagon secreting cell

Beta Cell

Insulin secreting cell

Islet of Langerhans

located in the pancreas

glucagon

raises blood glucose level

insulin

lowers blood glucose level

high blood glucose

pancreas releases insulin, cells take up glucose from blood, liver produces glycogen, blood glucose falls

low blood glucose

pancreas release glucagon, liver breaks down glycogen, blood glucose rises

type 1 DM

insulin dependent diabetes

type 2 DM

non-insulin dependent diabetes

gold standard test to confirm DM

overnight fasting glucose level

normal fasting BG value

4-7mmol/L

A1C (HbA1c) test

test used to assess BG control, measures how much glycosylates hemoglobin is in the blood

HbA1c

formed when blood sugar sticks to hemoglobin of red blood cells (glycosylated)

hypoglycemia

BG

signs and symptoms of hypoglycemia

tachycardia, confusion, sweating, drowsiness, convulsions, coma, death

hyperglycemia

BG> 7.0mmol/L or postprandial (after a meal) BG above 11.1 mmol/L

signs of hyperglycemia

polyuria, polydipsia, polyphagia, glucosuria, weight loss/gain, fatique

polyuria

excessive passage of urine (at least 2.5 L/day)

polydipsia

abnormal thirst

polyphagia

excessive hunger

glucosuria

excess sugar in the urine

Type 1 DM

caused by absolute lack of insulin secretion, due to autoimmune destruction of pancreatic islet cells

Type 1 DM if left untreated

results in serious, chronic conditions: cardiovascular damage, nervous system damage

treatment of type 1 DM

dietary restrictions, exercise, insulin therapy

insulin preparations vary by

onset of action, time to peak effect, duration

rapid-acting insulin

onset of 10-15 min, peak 1-2h, duration 3-5h

short acting insulin

onset of 30 min, peak 2-3h, duration 6.5h

short acting/ regular insulin

can be administered via IV bolus, IV infusion, subcutaneously or IM. Used for emergencies of DKA or coma associated with uncontrolled type 1 Diabetes

Intermediate acting insulins

onset 1-3h, peak 4-10h, duration up to 18h. cloudy; opaque, often mixed with regular insulin

long acting insulins

onset 90 min, peak -NONE, duration up to 24h.

long acting insulins

provides constant level of insulin in body; sometimes called basal insulin

fixed combination Insulins

contain rapid acting insulins, with rapid acting or one type of short acting. Intermediate listed first on label

fixed combination Insulins

allows for twice daily dosing but often isn't as tightly controlled as daily dosing with meals. Alternative for those who cannot afford frequent glucose monitoring or who don't want more than 2 injections per day

Basal- Bolus

preferred method of treatment for hospitalized patients with diabetes; mimics a healthy pancreas by delivering insulin constantly as a basal and then as needed as a bolus

sliding scale insulin dosing

doesn't meet basal insulin requirements and results in large swings in glucose control

Type 2 Diabetes Mellitus

caused by lack of sensitivity of insulin receptors at target cells (insulin resistance) or/and deficiency in insulin secretion

Type 2 DM is controlled through

lifestyle changes and oral hypoglycemic drugs

oral hypoglycemic drugs

lower BGL, have potential to cause hypoglycemia, are not effective for type 1 DM

Classes of oral hypoglycemic drugs

sulfonylureas, biguanides, thiazolidinediones, alpha- glucosidase inhibitors, meglitinides/glinides

Biguanides

metformin is only drug under this classification

biguanides mechanism of action

decrease hepatic glucose production; may also decrease intestinal absorption of glucose and improve insulin receptor sensitivity; improved glucose uptake; decreased liver production of triglycerides and cholesterol; does not stimulate insulin secretion

metformin indications

initial oral antihyperglycemic drug for treatment of newly diagnosed type 2 diabetes if no contraindications

metformin contraindications

not used with children, any kidney disease/ dysfunction because it can increase risk of lactic acidosis associated with kidney disease or diseases that lead to tissue hypoxia

adverse effects of metformin

most common are GI; lessened with low dosages and titrating up slowly, and taking with food

drug interactions with metformin

do not use with iodinated radiologic contrast media as it can cause acute kidney injury and lactic acidosis

sulfonylureas mechanism of action

bind to receptors on B cells to stimulate release of insulin; decrease secretion of glucagon. Therefore, must have working B cells (not used with insulin)

indications of sulfonylureas

second-step drugs for Type 2, can be used in conjuction with metformin

contraindications to sulfonylureas

hypoglycemia, NPO, ethanol use, or advanced age; potential for cross-allergy for those allergic to sulfonamide antibiotics

adverse effects of sulfonylureas

hypoglycemia, presence of liver or kidney disease; weight gain due to stimulation of insulin; epigastric fullness/indigestion, skin rash, nausea

drug interactions with sulfonylureas

other 2nd Gen sulfonylureas and glinides

implementation for antidiabetic drugs

increase frequency of BG monitoring if client is experiencing fever, nausea, vomiting or diarrhea. check urine for ketones if BG is over 14mmol/L