Drugs for Diabetes Mellitus N364 –Pharmacology

Pancreas Endocrine –secretion of glucagon & insulin Insulin released when blood glucose increases Glucagon released when blood glucose decreases

Type I Diabetes Mellitus Absolute lack of insulin secretion Autoimmune destruction of pancreatic islet cells Treatment Dietary restrictions Exercise Insulin therapy

Type II Diabetes Mellitus Causes Lack of sensitivity of insulin receptors at target cells (insulin resistance) Deficiency in insulin secretion Treatment Controlled through lifestyle changes Treated with oral hypoglycemic drugs All oral hypoglycemics lower blood-glucose levels

Hypoglycemia (Blood Glucose < 70) Can result from Insulin overdose Improper timing of insulin dose Skipping a meal Signs and symptoms: Confusion Pale, cool, moist skin

Hyperglycemia (Blood Glucose > 300) Signs and symptoms: Fasting blood glucose greater than 126 mg/dl Polyuria, polydipsia, polyphagia, glucosuria Can result from under dose of insulin or oral hypoglycemic

Insulin High Alert Medication “The right amount of insulin must be available to cells when glucose is available in the blood” Rapid, short, intermediate, long acting Routes of administration Subcutaneous (SQ) Intravenous Only regular insulin can be given intravenously

Oral Hypoglycemics For Type 2 Diabetes Mellitus Action: lowering blood glucose levels when taken on regular basis Initiate with single drug, if glycemic control not achieved, second drug added Failure to achieve with two oral hypoglycemics, indicate need for insulin Insulin may become necessary, or required temporarily Prototype Drug: Metforfim (Glucophage)

Insulin Preparations Vary

Nurse’s Role Obtain medical, surgical, drug history Assess lifestyle and dietary habits Know signs and symptoms of hypoglycemia and hyperglycemia

Nurse’s Role –Insulin Therapy Be familiar with onset, peak, and duration of action of prescribed insulin Insulin Compatibility Education Monitor FSBS Diet

Classes of Oral Hypoglycemic Drugs Sulfonylureas Biguanides Thiazolidinediones Alpha-glucosidase inhibitors Meglitinides

Prototype Drugs Human Regular Insulin (Humulin R, Novolin R) Metformin (Fortamet, Glucophage, Glumetza)