DRUGS FOR chapter 41 diabetes mellitus pharmacology

what is the treatment for type 1 diabetes

insulin ONLY

WHAT is insulin

- human insulins only in the US

- synthetic product is identical to endogenous insulin

how is insulin administered

1. cannot be given orally

2. most given sub-q

3. regular insulin can also be administered IV

4. measured with orange-tipped syringe or pen

which insulin is rapid acting

-lispro

-aspart

what is the onset of rapid acting insulin

15-30 minutes

what is the peak of rapid acting insulin

30 minutes to 2.5 hours

what is the duration of rapid acting insulin

3-6 hours

which insulin is short acting

regular

what is the onset of short acting insulin

30-60 minutes

what is the peak short acting insulin

1-5 hours

what is the duration of short acting insulin

6-10 hours

which insulin is intermediate acting

NPH

What is the onset of intermediate acting insulin?

1-2 hours

what is the peak of intermediate acting insulin

4-12 hours

what is the duration of intermediate acting insulin

16 hours

which insulin Is Long acting

glargine, detemir

what Is the onset of long acting insulin

3-4 hours

what is the peak of long acting insulin

continous, no peak

what is the duration of long acting insulin

24 hours

what is ULTRA long acting insulin

- provides basal insulin over 42 hour period

what is the action of insulin

- increases glucose uptake by cells

- decreases glucose production by liver

use of insulin

-lower blood glucose

- regular may be given IM or IV in an emergency

- can be used in children and older adults

contraindication of insulin

hypoglycemia

how do you time insulin with meals

-plan for onset of insulin to start with meal

- Lispro (rapid acting): 15-3o mins before meal

- regular (short acting): 30-60 mins before meal

adverse effects of insulin

-hypoglycemia

- local reactions; pain + redness at injection site

- make sure to rotate site

what are the drug interactions of insulin

-any drug that affects glucose levels

-beta blockers, MAOIs, herebals

nursing implications of insulin

•Be aware of mealtimes

•Rotate injection site (abdomen best)

•Monitor for hypoglycemia during sleep

•Insulin pumps (provides basal dose, usually rapid or short)

•High risk medication

what is programmed insulin

- given to regulate levels between meals

- set amount ordered

- watch nutrition status

- usually with meals

- given regardless of what your blood sugar is

what is a sliding scale insulin

- dosing based on blood sugar level

-notify doctor is pt is NPO

- not a set amount

- given in combo with programmed insulin

What is glyburide used for? (sulfonylureas)

- stimulate pancreas to release insulin

- increase the number of insulin receptors

what is the indicated use for glyburide (sulfonylureas)

-elevated serum glucose

- must have some functioning pancreatic beta cells (type 2)

what are the adverse effects of glybruide (sulfonylureas)

hypoglycemia

what are the contraindications of glyburide (sulfonylureas)

- sulfa allergy

- renal failure

- liver failure

what are the drug to drug interactions of glyburide (sulfonylureas)

- beta blockers

- alcohol

what does an alpha-glucosidase inhibitor (acarbose) do

- delays digestion of carbohydrates

- creases the increase in blood sugar after meals

- given in combo with a sulfonyurea

indication for use of alpha-glucosidase inhibitor (acarbose)

- decrease glucose after a meal

adverse effects of alpha-glucosidase inhibitor (acarbose)

-hypoglycemia

-GI upset

contraindications of alpha-glucosidase inhibitor (acarbose)

-hepatic disease

-bowel conditions (IBS)

what are the drug to drug interactions of acarbose

can decrease digoxin levels

nursing implications of acarbose

take at beginning of meal

what does biguanides (metformin) d0

-it decreases liver glucose production

- increases the use of glucose by muscle and fat cells

- decreases intestinal absorption of glucose

what is the indication for use of biguanides (metformin)

-insulin resistance

- commonly first choice for type 2 diabetes

- used to treat PCOS

what are the adverse effects of biguanides (metformin)

- lactic acidosis

- GI upset

what are the contraindications biguanides (metformin)

-renal failure

-HOLD METFORMIN for 48 hours before AND after contrast media (CT dye, heart cath) testing ti avoid renal failure

what is the black box warning for biguanides (metformin)

patients over 80 years old, higher risk of lactic acidosis

what are the nursing implications of biguanides (metformin)

- take with meals

- increased effects if taken with furosemide, digoxin and vancomycin

- monitor renal function

- monitor for lactic acidosis

what does TZD's (Rosiglitaxone) do

-stimulate insulin receptors on muscle, fat, and liver cells

- used in combo with insulin, sulfonylureas, or Biguanides

what is the indications of use with TZD's (Rosiglitaxone)

-insulin resistance

- doesn't do anything with blood sugar

what are the adverse effects of TZD's (Rosiglitaxone)

-liver toxicity

- CHF

- weight gain

what are the contraindications of TZD's (Rosiglitaxone)

- liver disease

- cardiovascular disease

what is the black box warning of TZD's (Rosiglitaxone)

RISK OF CHF AND MYOCARDINAL INFARACTION with use if pt has CV disease

nursing implications of TZD's (Rosiglitaxone)

- take with meals

-monitor liver function studies

- monitor pts for signs of heart failure

-Gemfibrozil may increase effects

- may take 12 WEEKS to reach PEAK effects

what does Repaglinide do?

- stimulates pancreas to release insulin

- needs working beta cells

- used in combo with TZD's and Biguanide

indication for use for Repaglinide

elevated serum glucose

what are the adverse effects of Repaglinide

-hypoglycemia less so than sulfonylureas

- GI upset

what are the contraindications of Repaglinide

- renal disease

- liver disease

-type 1 diabetes

what are the nursing implications of Repaglinide

-take just before meals

-if meal skipped, skip dose

-if meal added, add dose

- Gemfibrozil and Itraconazole increase effects

What does sitagliptin do?

- balance the release of insulin and limit the release of additional glucose from the liver

-inhibition of glucagon secretion

-delayed gastric emptying

-makes you feel full

- may take in combo with TZD's or Biguanide

what is the indication for use with Sitagliptin

elevated serum glucose

what are the adverse side effects of Sitagliptin

-upper respiratory tract infections

- heart failure

what are the contraindications of Sitagliptin

- type 1 diabetes

- insulin use

-renal failure

nursing implications of Sitagliptin

ONLY ONE DAILY- with or without meal

what does Amylin Analogs (Pramlintide) injections do

- suppresses glucagon secretions after meals

-increases the sense of fullness

-used in addition to insulin, sulfonylureas, or biguanides

what are the indications of use for Pramlintide injections

regulate the rise in blood glucose after meals

what are the adverse effects of Pramlintide injections

hypoglycemia

what is the black box warning of Pramlintide injections

SEVERE HYPOGLYCEMIA if mixed with INSULINS

what are the nursing implications of Pramlintide injections

-monitor blood sugars closely

- avoid giving with anticholinergics (slows down GI tract)

- may promote weight loss

- SUB Q injection before meals

what does Incretin Mimetics (Exenatide) injections do

- stimulates the pancreas to secrete the right amount of insulin based on the food that was just eaten

- can be used in combo with oral meds

what is the indication of use Exenatide injections

glucose elevations after meals

what are the adverse effects of Exenatide injections

- hypoglycemia

- GI distress and nausea

- pancreatitis

what are the contraindications of Exenatide injections

-liver disease

what is the black box warning of Exenatide injections

RISK FOR THYROID CANCER

what are the nursing implications of Exenatide

-Sub Q injection within 1 hour of breakfast and dinner

- must be refrigerated

-some extended release versions available, only need 1 weekly injection

- may promote weight loss

what does (canaglifozin) injections do?

-blocks reabsorption of glucose in the kidney, promotes excretion of glucose in urine

- used In combo with other anti-diabetics

what is the indication of use of (canaglifozin) injections

improved glucose control

what are the adverse effects of (canaglifozin) injections

- dehydration

-hypotension

-electrolyte imbalance

increased risk of leg/foot amputations

what are the contraindications of (canaglifozin) injections

renal failure

what are the nursing implications of (canaglifozin) injections

- take with the first meal of day

- use caution in combo with meds that DECREASE BP

- risk for dehydration or syncope

hyperglycemia management (when to seek DOCTOR)

-blood sugar more than 250

- ketones in urine

-fever above 101

- vomiting/diarrhea

-if you miss multiple doses of a med

hypoglycemia management if alert

•NEED Rapidly absorbed sugar (10-20 mins to start working)

•Alert:

•4oz juice or soda

•1 tube glucose gel

•2-3 glucose tabs

hypoglycemia management if unable to swallow

•Dextrose 50% half ampule

•Glucagon IM/SQ

•Avoid taking so much sugar that you cause Hyperglycemia!

managing sick days with diabetes

-illness can cause stress and increase blood sugar

- continue to take anti-diabetic meds

-check glucose at least 4x daily

- test for ketones in urine

- if unable to eat, continue liquids; 15 g carbs Q1-2hours, drink 2-3 quarts of fluids