Chapter 36 Agents Used to Treat Hyperglycemia and Hypoglycemia

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Diabetes Mellitus Disorder of the pancreas  Results in hyperglycemia Treatment  Insulin  Oral hypoglycemics (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Pancreatic beta cells  Excrete an insufficient amount of insulin, or no insulin at all  Flawed carbohydrate, fat, and protein metabolism Diabetes Mellitus (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Insulin Promotes:  Glucose transport across cell membranes  Conversion of glycogen into glucose Utilizes fatty acids and inhibits lipolysis Enhances protein synthesis and inhibits protein breakdown

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Symptoms of Diabetes Mellitus Polyuria (increased urine output) Polydipsia (excessive thirst) Polyphagia (excessive hunger)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Diabetes Mellitus Two types: 1. Type 1 (formerly known as insulin- dependent diabetes mellitus, IDDM) 2. Type 2 (formerly known as noninsulin- dependent diabetes mellitus, NIDDM) (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Diabetes Mellitus Type 1 diabetes mellitus  Treated with insulin subcutaneous injections Type 2 diabetes mellitus  Treated with oral hypoglycemic agents (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Insulin Synthetic human insulin  Produced either by:  Recombinant DNA synthesis of human insulin  Conversion of pig to human insulin Human in origin  Humulin, Novolin, and Lispro Older versions  Pig or cow in origin

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Four Preparations of Insulin Rapid- Acting Fast- Acting Intermediate- Acting Long- Acting Lispro Aspart Regular Humulin-R Novolin-R NPH Lente Humulin-L Ultralente Humulin-U Glargine- Lantus Note the differences in onset, peak, and duration of action.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Effects of Insulin Allergic reactions Lipodystrophy Insulin resistance

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nursing Implications Several drugs antagonize the hypoglycemic effects of insulin. Check your drug manual before administering any drug agent.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Hypoglycemia Blood glucose is low (< 40 mg/dL)  Produced from  Skipped or irregularly scheduled meals  Excessive exercise  Insulin administration errors

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Signs and Symptoms of Hypoglycemia Sweating Confusion Tachycardia Headache Hunger Weakness Poor muscle control Emotional instability Coma and death

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Hypoglycemia Treatment Glucagon (intramuscular, intravenous, or subcutaneous) IV dextrose 50%, also known as D 50 W

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Treatment for Type 2 Diabetes Oral antidiabetic agents  Five classes 1. Sulfonylureas (oldest category) First generation Second generation 2. Biguanides 3. Meglitinides 4. Alpha-glucosidases 5. Thiazolidinediones

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Sulfonylureas Action: stimulate the beta cells of the pancreas to secrete more insulin

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Biguanides Action: inhibit hepatic glucose production and increase the sensitivity of peripheral tissue to insulin May be given with sulfonylureas

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Meglitinide Action  Stimulate the beta cells of the pancreas to secrete insulin  Minimal risk of hypoglycemia

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Alpha-glucosidase Inhibitors Action: inhibit an enzyme called alpha- glucosidase (enzyme responsible for the hydrolysis of saccharides to be converted to glucose) Must be taken with meals May be given with sulfonylureas

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Thiazolidinediones (Glitazones) Action  Decrease insulin resistance by decreasing gluconeogenesis, glucose output, and triglyceride synthesis in the liver Monitor for hepatic toxicity. May be given with sulfonylureas

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Side Effects of Sulfa Hematology  Hemolytic anemia, thrombocytopenia, and jaundice Gastrointestinal  Nausea, epigastric fullness, and heartburn

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Side Effects Biguanides  Abdomen bloating, nausea, cramping, and diarrhea Alpha-glucosidase inhibitors  Flatulence, diarrhea, and abdominal pain Thiazolidinediones  Hepatic toxicity, weight gain, edema, and mild anemia