diabetes

Therapeutic Use: Primarily used to treat hypoglycemia resulting from insulin overdose. Glucagon elevates blood sugar levels by stimulating glycogenolysis in the liver, which releases glucose into the bloodstream.
Adverse Reactions: Common side effects include gastrointestinal symptoms such as nausea and vomiting. Other concerns may involve hypotension and a rare risk of anaphylaxis, which is an acute allergic reaction potentially resulting in shock.
Client Instructions: Clients and their families should be informed that vomiting can occur following glucagon administration. It is crucial to keep the client in a lateral position until consciousness is regained to prevent aspiration. Clients must also be educated on the signs and symptoms of hypoglycemia (e.g., confusion, sweating, tremors) to facilitate early detection and treatment.

Examples: Glipizide, Glucotrol, Glyburide, Glimepiride.
Therapeutic Use: Designed to stimulate the pancreas to release insulin, thereby effectively lowering blood sugar levels.
Adverse Drug Reactions: The primary side effect is hypoglycemia. Others include gastrointestinal disturbances like nausea and diarrhea.
Client Instructions: Patients should wear a medical alert bracelet to identify their condition. They must monitor for and report any signs of hypoglycemia and should regularly test blood glucose levels. It's advisable to consume a carbohydrate snack immediately if hypoglycemia occurs and to retest blood glucose levels in 15-20 minutes.

Examples: Repaglinide (Prandin).
Therapeutic Use: These medications work to stimulate insulin release from the pancreas in response to food intake.
Adverse Drug Reactions: Side effects may include hypoglycemia, nausea, and vomiting.
Client Instructions: Patients are encouraged to wear a medical alert bracelet and to report any signs of hypoglycemia. Carrying carbohydrate snacks to treat symptoms is also recommended, along with lying down if feeling nauseated.

Example: Metformin.
Therapeutic Use: Primarily reduces hepatic glucose production and increases insulin sensitivity in peripheral tissues.
Adverse Drug Reactions: Rare but serious risk of lactic acidosis; common side effects include nausea, diarrhea, vomiting, a metallic taste, and vitamin deficiencies (B12, folic acid).
Client Instructions: Patients should avoid alcohol to reduce the risk of lactic acidosis. They must report any signs of weakness, fatigue, lethargy, or hyperventilation. Notably, side effects may lessen over time, and there is caution when using metformin with contrast dye due to potential kidney failure risk.

Example: Pioglitazone.
Therapeutic Use: These drugs enhance the sensitivity of insulin receptors, promoting better glucose uptake.
Adverse Drug Reactions: Common side effects include fluid retention and potential hepatotoxicity, as well as increased serum lipid levels, upper respiratory infections, and myalgia.
Client Instructions: Patients should report any symptoms of swelling, rapid weight gain, or shortness of breath, indicating possible heart failure.

Example: Acarbose.
Therapeutic Use: These medications slow carbohydrate digestion, thereby preventing post-meal blood sugar spikes.
Adverse Drug Reactions: Potential gastrointestinal effects such as distention, flatus, and diarrhea. Risk of hypoglycemia can increase when combined with insulin or sulfonylureas. There is also a risk of liver dysfunction.
Administration: To be taken with the first bite of food, ideally three times daily.
Client Instructions: Patients should be alerted to possible gastric side effects and are advised to adhere to dietary recommendations. It is critical to report any symptoms of hypoglycemia.

Examples: Exenatide (Trulicity, Byetta, Victoza, Mounjaro).
Therapeutic Use: This class of drugs increases insulin secretion in response to high blood sugar levels, slows gastric emptying, and decreases liver sugar production.
Adverse Drug Reactions: Hypoglycemia, gastrointestinal issues (nausea, vomiting, diarrhea), and rare occurrences of pancreatitis.
Client Instructions: Patients should always carry carbohydrate snacks and recognize signs of hypoglycemia. Any severe abdominal pain should be reported immediately to allow for appropriate medical intervention.

Example: Pramlintide (Symlin).
Therapeutic Use: Mimics amylin, a hormone that slows gastric emptying, reduces liver sugar production, and promotes feelings of fullness.
Adverse Drug Reactions: Risks include hypoglycemia, nausea, and reactions at the injection site.
Client Instructions: Emphasize wearing a medical alert bracelet and always carrying carbohydrate snacks for potential hypoglycemic events.

Examples: Sitagliptin (Januvia).
Therapeutic Use: These drugs reduce DPP-4 enzyme action, resulting in increased activity of gut hormones, thus improving glucose levels after meals.
Adverse Drug Reactions: Potential severe side effects include upper respiratory infections, headaches, pancreatitis, Stevens-Johnson syndrome, and anaphylaxis.
Client Instructions: Patients must report any persistent respiratory problems or fever immediately and regularly monitor their blood glucose levels.

Examples: Empagliflozin (Farxiga, Jardiance).
Therapeutic Use: They lower blood sugar by preventing kidneys from reabsorbing glucose, thus promoting its excretion in the urine.
Adverse Drug Reactions: Risks include diabetic ketoacidosis, hypoglycemia, hypokalemia, dehydration, and acute kidney injury.
Client Instructions: Patients should regularly monitor their blood pressure and blood glucose levels, stay hydrated, and be aware of risks for yeast infections and urinary tract infections (UTIs).

Types:
- Rapid: e.g., Lispro; onset in 15 minutes.
- Short: e.g., Regular; onset in 30 minutes.
- Intermediate: e.g., NPH; onset in 1-2 hours.
- Long-acting: e.g., Glargine; effective throughout the day.
Therapeutic Use: Utilized for the control of blood sugar levels in patients with diabetes.
Adverse Drug Reactions: Common issues include hypoglycemia and injection site reactions, which can manifest as lipodystrophy and lipohypertrophy.
Client Instructions: Patients should wear a medical alert bracelet, monitor for symptoms of hypoglycemia regularly, and always carry carbohydrate snacks. It's critical to rotate injection sites and avoid injecting cold insulin to ensure effective absorption. Patients must report any concerning signs such as weakness, nausea, palpitations, or paresthesia.