1. Drugs for Diabetes Mellitus
N364 –Pharmacology

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

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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. Insulin Preparations Vary

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

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

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

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