1. Diabetes: Medications Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU) April 10, 2008/sh

2. © 2010 APS Healthcare, Inc. 2 Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

3. © 2010 APS Healthcare, Inc. 3 Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.

4. © 2010 APS Healthcare, Inc. 4 Objectives  Upon completion of the session the participant will: –Identify information a caretaker needs to know when administering medications –Recognize signs and symptoms of low blood sugar (hypoglycemia) –List considerations when planning daily activities for a person taking medication for diabetes

5. © 2010 APS Healthcare, Inc. 5 Diabetes Is…  A disorder of metabolism  A condition where the body has a shortage of insulin or decreased ability to use insulin, resulting in high blood sugar levels  A leading cause of disability  A growing epidemic in the US  A manageable condition

6. © 2010 APS Healthcare, Inc. 6 Types of Diabetes Medications  Insulin  Oral  Other

7. © 2010 APS Healthcare, Inc. 7 Insulin Therapy  Is a protein, and must be injected or inhaled  Insulin- the mainstay of treatment for individuals with Type I diabetes Combinations of Insulin are frequently ordered to allow for better blood glucose control  May be prescribed in some with Type II diabetes

8. © 2010 APS Healthcare, Inc. 8 Characteristics of Insulin  Onset (starts working)  Peak (maximum effect)  Duration (length of time active in blood)

9. © 2010 APS Healthcare, Inc. 9 Types of Insulin  Rapid-acting  Short-acting  Intermediate-acting  Long-acting  Very long acting  Premixed

10. © 2010 APS Healthcare, Inc. 10 Rapid-Acting  Lispro (Humalog) –Onset: 5-15 minutes –Peak: 45-90 minutes –Duration: 3-4 hours  Aspart (Novalog) –Onset: 10-20 minutes –Peak: 1-3 hours –Duration: 3-5 hours

11. © 2010 APS Healthcare, Inc. 11 Short-Acting  Regular (R) Insulin –Onset: 30 minutes –Peak: 2-5 hrs. –Duration: 5-8 hrs

12. © 2010 APS Healthcare, Inc. 12 Intermediate-Acting  NPH (N) or Lente(L) –Onset: 1-3 hrs –Peak: 6-12 hrs –Duration: 16-24 hrs

13. © 2010 APS Healthcare, Inc. 13 Long-Acting  Ultralente (U) insulin –Onset: 4-6 hrs –Peak: 8-20 hrs –Duration: 24-28 hrs

14. © 2010 APS Healthcare, Inc. 14 Very Long-Acting  Insulin Glargine (Lantus) –Onset: 1 hr –Peak: works evenly for 24 hrs –Duration: 24 hrs –Taken once a day at bedtime –Should not be mixed together in a syringe with any other form of insulin before use

15. © 2010 APS Healthcare, Inc. 15 Premixed  NPH and Regular Insulin Mixture- two types of insulin mixed together in 1 bottle –Onset: 30 minutes –Peak: 7-12 hrs –Duration: 16-24 hrs

16. © 2010 APS Healthcare, Inc. 16 Insulin Pump  Controls the exact amount of insulin being delivered  Closest device on the market to an artificial pancreas

17. © 2010 APS Healthcare, Inc. 17 Hypoglycemia  Less than normal amount of glucose in the blood

18. © 2010 APS Healthcare, Inc. 18 Signs of Hypoglycemia  Shakiness  Nervousness  Weakness  Cold, clammy skin  Hunger  Irritability  Headache  Confusion  Rapid heart beat  Fainting  Passing out  Slurred or hard to understand speech

19. © 2010 APS Healthcare, Inc. 19 Hypoglycemia Response  Observe  Plan Ahead  Have a Plan of Action in Place  Document and Report

20. © 2010 APS Healthcare, Inc. 20 Insulin: Review  Know response to Insulin – Onset, peak and duration  Avoid exercise at peak time of insulin  Know the individual’s response to medication and exercise

21. © 2010 APS Healthcare, Inc. 21 Storing Insulin  If using entire bottle within 30 days, store at room temperature. Write date on bottle label when opened.  If you do not plan to use entire bottle within 30 days, store in refrigerator  Do not keep too hot, or too cold  Keep extra bottle on hand. Store in refrigerator.

22. © 2010 APS Healthcare, Inc. 22 Oral Medications (Classifications)  Sulfonylureas  Biquanides  Alpha-Glucosidase Inhibitors  Thiazolidinediones  Meglitinides  D-Phenylanine derivatives (DPP-4)  Combination

23. © 2010 APS Healthcare, Inc. 23 Oral Medications: Need to Know  Potential for low blood sugar reactions  Time of day  With/without meals?  Side effects and special precautions of the medication  Any special instructions

24. © 2010 APS Healthcare, Inc. 24 Considerations: Sulfonylureas  Increases the production of insulin  May cause hypoglycemia  Can cause allergic reactions in individual who has allergies to sulfa medications

25. © 2010 APS Healthcare, Inc. 25 Considerations: Biguanides  Can cause diarrhea, when taken on empty stomach  Not ordered if history of kidney or liver disease  Notify doctor of surgery or medical test using contrast dye  Increases sensitivity to insulin  Decreases production of glucose

26. © 2010 APS Healthcare, Inc. 26 Considerations: Alpha-Glucosidase Inhibitors  Taken 3xday  Each meal, with the first bite of the meal  Should not be taken by people with severe bowel or kidney disease or liver disorders  Decreases the absorption of carbohydrates

27. © 2010 APS Healthcare, Inc. 27 Considerations: Thiazolidinediones  Possible liver problems - liver function needs to be assessed regularly ( Blood Tests)  Report signs of liver problems to doctor that may include: weight gain, swelling. unusual nausea, vomiting, abdominal pain, dark urine  Increases the sensitivity to insulin

28. © 2010 APS Healthcare, Inc. 28 Considerations: Meglitinides  May cause hypoglycemia  Effect is much stronger if taken 3 times a day  Taken before meals  Fast acting, allowing greater flexibility in meal timing

29. © 2010 APS Healthcare, Inc. 29 Combination  May cause hypoglycemia

30. © 2010 APS Healthcare, Inc. 30 Recently Approved Injectable Drugs  Symlin (Brand Name) Pramlintide (Generic)  Byetta (Brand Name) Exenatide (Generic)

31. © 2010 APS Healthcare, Inc. 31 Medication Management Review  More than administration  Involves knowledge  Maximizes benefits  Achieves therapeutic outcomes

32. © 2010 APS Healthcare, Inc. 32 Drug Actions: A Review Absorption Distribution Metabolism Excretion Once administered, all drugs go through these processes:

33. © 2010 APS Healthcare, Inc. 33 Why is Review Important? What we already know: 1.People with Diabetes frequently have many co-existing medical diagnoses 2.Therefore, they are at higher risk of delayed absorption, distribution, metabolism, and excretion 3.Additionally, they are at higher risk for drug to drug interactions due to these delays

34. © 2010 APS Healthcare, Inc. 34 Use Medications Wisely  Be alert for interactions  Check with Doctor  Be informed

35. © 2010 APS Healthcare, Inc. 35 Important Things to Consider  Risk of hypoglycemia  Activities throughout day

36. © 2010 APS Healthcare, Inc. 36 Remember  Medications help lower blood glucose levels to help reduce risk for long term complications  Medications work best when combined with supervision from the doctor and an appropriate meal plan and exercise program

37. © 2010 APS Healthcare, Inc. 37 Reminder!!!!  Hand-washing is the single most effective way to prevent the spread of illness and germs  ALWAYS wash your hands before, and after contact with every person for whom you provide care  Including between medication administration to more than one individual

38. © 2010 APS Healthcare, Inc. 38 References  http://www.diabetes.org/diabetesmedications http://www.diabetes.org/diabetesmedications (retrieved 10/19/2007)  http://diabetes.niddk.nih.gov.dm/medications http://diabetes.niddk.nih.gov.dm/medications (retrieved 9/12/2007)  National Institute of Health; Fact Sheet Diabetes Type 2

39. © 2010 APS Healthcare, Inc. 39 Suggested Supplemental Training  Diabetes Basics - This training should be a pre- requisite to both Diabetes: Complications and Diabetes: Medications trainings  Diabetes Complications

40. © 2010 APS Healthcare, Inc. 40 To register for future trainings, or for more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com www.hcqu.apshealthcare.com

41. © 2010 APS Healthcare, Inc. 41

42. Evaluation Please take a few moments to complete the evaluation form found in the back of your packets. Thank You!

43. Test Review There will be a test review after all tests have been completed and turned in to the Instructor.