Type 2 Diabetes medicaations

What class of drug is metformin?

Biguanide

What actions does metformin provide (REI)

• Reduces glucose production by liver 

• Enhances insulin sensitivity 

• Improves glucose transport 

What are side effects of metformin (WGL)

•  may cause weight loss 

• GI disturbances 

• Lactic acidosis (rare) 

When would you HOLD metformin?

if patients is undergoing surgery or radiologic procedure with contrast medium (1-2 days prior to and at least 48 hours after) 

What should you monitor when on metformin?

serum creatinine

What are contraindications for Metformin?

• Renal, liver, cardiac disease 

• Excessive alcohol intake 

What drug class is sitagliptin, saxagliptin, and lingagliptin?

Dipeptidyl Peptidase- 4 (Dpp-4) inhibitor 

What actions do Dipeptidyl Peptidase- 4 (Dpp-4) inhibitor  perform?

• Increases insulin release 

• Decreases glucagon secretion 

• Decreases hepatic glucose production 

What are side effects of Dpp-4 inhibtors?

• Headache 

• Stuffy, runny nose 

• Hypoglycemia 

What should a nurse instruct a patient on Dpp-4 inhibitors?

• Instruct patient about signs and symptoms of hypoglycemia and other adverse effects to report 

• Monitor kidney function 

What drug class is exanatide, liraglutide, dulaglutide, semaglutide?

glucagon-like peptide-1 receptor agonists (GLP-1) 

What do GLP-1s do?

• Increase glucose-dependent insulin secretion 

• Inhibit glucagon secretion 

• Slow gastric emptying 

• Increases satiety 

What are side effects of GLP-1s?

• Weight loss 

• Pancreatitis 

• GI upset: diarrhea, nausea, vomiting 

• Reaction at injection site 

What are some nursing considerations for patients on GLP-1s?

• not recommended in patients with preexisting severe GI disease, including severe gastroparesis 

• Monitor for pancreatitis 

What class is canagliflozin, dapagliflozin, empagliflozin 

sodium-glucose co-transporter 2 (SGLT2 inhibitors) 

What do (SGLT2 inhibitors) do?

• Blocks reabsorption of glucose by kidney 

• Increases glucose excretion 

What are side effects of SGLT2 inhibitors?

• Hypoglycemia 

• UTIs 

What are some nursing considerations for SGLT2 inhibitors?

• Monitor for genital or UTI 

• Take once daily prior to first meal in the morning 

• Monitor Cr levels 

What drug class if glipizde, glyburide, glimperide?

Sulfonylureas

What do sulfonylureas do?

Increased insulin production from pancreas 

What are side effects of sulfonylureas?

• Hypoglycemia 

• Weight gain 

• Drug-drug interactions (NSAIDS, warfarin) 

What are some nursing considerations for sulfonylureas?

• Monitor for hypoglycemia 

• Contraindicated with sulfa allergy 

• Monitor serum creatinine 

• Avoid alcohol use 

• BEERs criteria (avoid with elderly) 

What drug class are pioglitazone, and rosiglitazone?

thiazolidinediones 

What do thiazolidinediones do?

Improve insulin sensitivity, transport, and utilization at target tissues 

What are side effects of thiazolidinediones?

• Hypoglycemia 

• Anemia 

• Weight gain, edema 

• Decrease effectiveness of oral Contraceptives 

• Possible liver dysfunction 

• Impaired platelet function 

What are nursing considerations for thiazolidinediones?

• Monitor liver function tests 

• Instruct patient taking oral contraceptives about increased risk of pregnancy 

what are some ADA healthy food choices?

• Maintain blood glucose levels to as close to normal as safely possible 

• Normal lipid profiles and blood pressure 

• Prevent or slow complications 

• Individual needs; personal, cultural preferences 

• Maintain pleasure of eating 

Emphasis on achieving optimum glucose, lipid, and BP goals

What are nutritional ways to maintain type 2 diabetes?

Weight loss 

Nutritionally adequate meal plan with ↓ fat and CHO 

Spacing meals 

Regular exercise 

How are calorie controlled diets planned?

• by first calculating a person’s energy needs and caloric requirements based on age, gender, height, and weight 

• An activity element is then factored in to provide actual number of calories required for weight maintenance 

• To promote a 1 to 2 lb weight loss per week, 500 to 1000 calories are subtracted from daily total 

• Total calories are distributed into carbs, proteins, fats  

What are the three main forms of carbs?

starch and fiber, including fruits, vegetables and whole, intact grains 

what does fiber do to carbs/glucose?

it slows and moderates blood absorption of the two

what are other positives of fiber and whats the recommended amount daily?

• Fiber acts like your body’s natural scrub brush as cleans digestive tract 

• Helps to feel full (satiety) 

• Lowers cholesterol  

• Recommendations: At least 28 g of fiber should be ingested daily (ADA, 2020). 

What percentage of the diet should carbs and fats and proteins make up?

carbs- 50-60

fats- <30

protein- 10-20

how should diabetes patients approach fats? (what percentages)

• Limit saturated fats to ~10% of total calories* 

• Limit cholesterol to < 300 mg/day 

• Healthy fats come from plants 

• Olives, nuts, avocados 

how much protein should diabetes patients have per kg of body weight?

1-1.5 grams

high protein diets are not recommended

may include some nonanimal sources of protein

why is alcohol a negative for diabets patients?

• Inhibits gluconeogenesis by liver 

• Can cause sever hypoglycemia 

• Blood glucose levels must be monitored 

What can alcohol increase the risk for in diabetes patients?

DKA

What are some plant-based foods?

Whole grains (including corn) 

• Vegetables 

• Legumes (beans, peas, lentils) 

• Fruit 

• Water (not cow’s milk) 

• Small amounts of nuts and seeds 

• Vitamin B12 

What is the minimum amount of exercise recommended a week? what kinds of training should be done 3 times a week?

150 minutes

resistance training

What is the benefit of exercise in diabetes patients?

• Decreased insulin resistance and blood glucose 

• Weight loss 

• Decreased triglycerids and LDL, increased HDL 

• Improve BP, circulation, sleep, mood disorder 

How long does the glucose lowering effect last after exercise?

up to 48 hours

how long should you wait to exercise after a meal?

1 hour

how should individuals with SMBG approach exercise?

Individuals with SMBG > 350 mg/dl (14 mmol/L) and who have ketones in their urine should not begni exercising until the urine test results are negative for ketones and the blood glucose level is closer to normal