1. Introduction to Clinical Pharmacology Chapter 42- Antidiabetic Drugs

2. Diabetes Risk factors for type 2 include: Obesity Older age Family Hx
Hx of gestational diabetes
Impaired glucose tolerance
Minimal or no physical activity
Race/ethnicity

3. Insulin Hormone manufactured by beta cells of pancreas
Controls the storage and utilization of amino acids and fatty acids
Lowers blood glucose levels by inhibiting glucose production by liver

4. Insulin: Action and Uses
*Activates a process that helps glucose molecules enter the cells of striated muscle and adipose tissue
Promotes protein synthesis
Properties of insulin: Onset, Peak, Duration
Controls type 1 diabetes mellitus, type 2 diabetes, Severe diabetic ketoacidosis
Treats hypokalemia in combination with glucose

5. Insulin: Adverse Reactions, Contraindications, and Precautions
Hypoglycemia; Hyperglycemia; Allergic reaction
Contraindicated in patients:
With hypersensitivity, hypoglycemia
Used cautiously in patients:
With renal and hepatic impairment; During pregnancy and lactation

6. Display 42-1 Drugs that alter insulin effectiveness
Estrogens
Methylprednisolone
niacin

7. Oral Antidiabetic Drugs
Used to treat patients with type 2 diabetes that is not controlled by diet and exercise alone
Not effective for treating type 1 diabetes

8. Sulfonylureas
Action
Lower blood glucose by stimulating the B cells of the pancreas to release insulin
Not affective if B cells cannot release a sufficient amount of insulin to meet the individuals needs
*****Examples:
Glucotrol-glipizide
DiaBeta-glyburide
glimpiride/Amaryl

9. Nonsulfonylureas **A-glucosidase inhibitors
Precose (acarbose) and Glyset (miglitol0
Lower blood glucose levels by delaying the digestion of CHO’s and absorption of CHO’s of the intestine
**Thiazolidinediones/glitazones
decrease insulin resistance and increase insulin sensitivity by modifying several processes
Avandia/rosiglitazone and pioglitazone/Actos

10. Adverse Reactions Sulfonylureas
Hypoglycemia, anorexia, nausea, heartburn
Nonsulfonylureas
Lactic acidosis-buildup with metformin use
s/s malaise, abdominal pain, rapid respirations, shortness of breath and muscular pain

11. Contraindications, precautions and interactions
**Sulfonylureas
Oral antidiabetic drugs are contraindicated in patients with known hypersensitivity to the drugs, DKA (tx is insulin), severe infection, or severe endocrine disease
May have an increased hypoglycemic effect when administered with anticoagulants
Nonsulfonylureas
Heart failure, renal disease

12. Hormone Mimetic Agents
Released in response to increases in glucose that occures after eating
Januvia/sitagliptin
Lowers blood glucose level by enhancing the secretion of endogenous incretin hormone

13. Nursing Process: Assessment
Preadministration assessment:
Assess weight, blood pressure, pulse, respiratory rate
Assess skin, mucous membranes, extremities, with special attention given to sores or cuts that appear to be healing poorly and ulcerations or other skin or mucous membrane changes

14. Nursing Process: Assessment
Ongoing assessment:
Monitor vital signs; Observe adverse drug reactions
*monitor q 2-4 hours for s/s of hypoglycemia
Notify primary health care provider if adverse reaction occurs or if there is significant weight gain or loss

15. Nursing Process: Planning
Expected outcomes:
Optimal response to therapy
Support of patient needs related to management of adverse reactions
Reduction in anxiety
Improved ability in coping with diagnosis
Understanding of and compliance with prescribed therapeutic regimen

16. Nursing Process: Implementation
Promoting an optimal response to therapy
Administer insulin, care must be taken to use correct insulin
Carefully read all drug labels before preparing any insulin preparation
Read label of the insulin bottle carefully for name, source of insulin, number of units per milliliter
U100 has 100 units in each milliliter
*Those clients who are resistant to insulin may require larger dose use the U500 concentration

17. Nursing Process: Implementation
Promoting an optimal response to therapy
Mixing Insulins:
Clarify with primary health care provider if patient is to receive regular insulin and NPH insulin, regular and lente insulin
*do not mix or dilute glargine
Ask whether insulins were given separately or together if patient had been using insulin mixtures before admission

18. Nursing Process: Implementation
Insulin administration
Regular insulin is given minutes before a meal to achieve optimal results
Lispro usually lowers the glucose level 1-2 hours after meals
Insulin glargine is given subcutaneously once daily at bedtime

19. Nursing Process: Implementation
Promoting an optimal response to therapy
Sulfonylureas: Give glipizide 30 minutes before meal due to food delays
Nonsulfonylureas: acarbose and miglitol are given three times a day with the first bite of the meal, because food increases absorption

20. Nursing Process: Implementation
Monitoring and managing patient needs
Acute confusion:
Immediately terminate hypoglycemic reaction
Notify primary health care provider if episodes of hypoglycemia occur
Deficient fluid volume:
Notify health care provider if blood glucose levels are elevated or if ketones are present in urine

21. Education
Older adults taking oral antidiabetic drugs are more susceptible to hypoglycemic reactions which may be difficult to detect
Teach to avoid ETOH, dieting, commercial weight loss products and strenuous exercise
Teach to perform finger stick on the side of a finger where there are fewer nerve endings*

22. Nursing Process: Evaluation
Therapeutic drug effect is achieved; Normal or near-normal blood glucose levels are maintained
Hypoglycemic reactions are identified, reported, and managed successfully
Anxiety is reduced
Patient begins to demonstrate ability to cope with disorder and its required treatment