1. Chapter 36 Agents Used to Treat Hyperglycemia and Hypoglycemia

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 2 Diabetes Mellitus Disorder of the pancreas  Results in hyperglycemia Treatment  Insulin  Oral hypoglycemics (continues)

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 3 Pancreatic beta cells  Excrete an insufficient amount of insulin, or no insulin at all  Flawed carbohydrate, fat, and protein metabolism Diabetes Mellitus (continued)

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 4 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

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 5 Symptoms of Diabetes Mellitus Polyuria (increased urine output) Polydipsia (excessive thirst) Polyphagia (excessive hunger)

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 6 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)

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 7 Diabetes Mellitus Type 1 diabetes mellitus  Treated with insulin subcutaneous injections Type 2 diabetes mellitus  Treated with oral hypoglycemic agents (continued)

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 8 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

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 9 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.

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 10 Effects of Insulin Allergic reactions Lipodystrophy Insulin resistance

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 11 Nursing Implications Several drugs antagonize the hypoglycemic effects of insulin. Check your drug manual before administering any drug agent.

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 12 Hypoglycemia Blood glucose is low (< 40 mg/dL)  Produced from  Skipped or irregularly scheduled meals  Excessive exercise  Insulin administration errors

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 13 Signs and Symptoms of Hypoglycemia Sweating Confusion Tachycardia Headache Hunger Weakness Poor muscle control Emotional instability Coma and death

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 14 Hypoglycemia Treatment Glucagon (intramuscular, intravenous, or subcutaneous) IV dextrose 50%, also known as D 50 W

15. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 15 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

16. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 16 Sulfonylureas Action: stimulate the beta cells of the pancreas to secrete more insulin

17. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 17 Biguanides Action: inhibit hepatic glucose production and increase the sensitivity of peripheral tissue to insulin May be given with sulfonylureas

18. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 18 Meglitinide Action  Stimulate the beta cells of the pancreas to secrete insulin  Minimal risk of hypoglycemia

19. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 19 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

20. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 20 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

21. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 21 Side Effects of Sulfa Hematology  Hemolytic anemia, thrombocytopenia, and jaundice Gastrointestinal  Nausea, epigastric fullness, and heartburn

22. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 36 - 22 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