Diabetic Meds

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sjw77
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110333
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Diabetic Meds
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2011-10-19 18:41:54
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diabetic meds
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  1. Diabetes Mellitus
    a metabolic disorder characterized by high blood glucose levels and altered metabolism of proteins and fats; associated with thickening of the basement membrane, leading to numerous complications
  2. Hyperglycemia
    elevated blood glucose levels (>106 mg/dL) leading to multiple signs and symptoms and abnormal metabolic pathways
  3. Hypoglycemia
    lower than normal blood sugar (<40 mg/dL), often results from imbalance between insulin or oral agents and patient's eating, activity and stress
  4. Glycogen
    storage form of glucose, can be broken down for rapid glucose level increases during times of stress
  5. Diabetic medications to control blood glucose
    Prototype: Insulin (hormone)
    • Only one IV form
    • Requires 2 RNs to check IV
    • IV, SubQ (maintenance)**, Implanted pump, Pens
    • 70/30, etc. vary in onset and duration
    • Actions: replacement of endogenous insulin
    • Indications: type 1 (no functioning beta-cells), type 2 (adjunct to diet and oral meds) diabetes
    • Contraindications: none
    • Adverse effects: hypoglycemia, ketoacidosis
    • Drug-drug interactions: MAOIs, beta-blockers (mask symptoms of hypoglycemia), alcohol (mask symptoms of hypoglycemia), Aspirin( mask symptoms of hypoglycemia)
    • Nursing Considerations: allergies, assess body systems for change, assess nutritional and activity level, monitor glucose levels, assess baseline status, follow dietary and exercise regimen, storage and administration teaching, administer drug in relation to meals, monitor during times of stress, monitor response to insulin and any adverse effects, monitor response to drug, monitor for hypoglycemia and GI distress, maintenance by subQ only, caution when mixing types, alternate sites, regular=clear, 70/30=cloudy
  6. Oral Antidiabetic Agents - Sulfonylureas
    • Metabolize in liver.Excrete in urine.
    • Safer for patient with renal dysfunction
    • Longer lasting=less doses
    • Actions: stimulate release of insulin from functioning cells in pancreas; may improve binding of insulin-to-insulin receptor sites or increase number of insulin receptor sites
    • Indications: treatment of Type 2 diabetes (adjunct to diet and exercise)
    • Contraindications: allergy to sulfonylureas, severe infection, pregnancy, lactation, type 1 diabetes
    • Adverse effects: hypoglycemia, ketoacidosis, GI (nausea, vomiting, heartburn)
    • Drug-drug interactions: beta-blockers, any drug that decreases glucose levels, any drug that acidifies urine
    • Nursing Considerations: allergies, assess body systems for change, assess nutritional and activity level, monitor glucose levels, assess baseline status, follow dietary and exercise regimen, storage and administration teaching, administer drug in relation to meals, monitor during times of stress, monitor response to drug, monitor for hypoglycemia and GI distress
  7. Oral Antidiabetic Agents-Sulfonylureas
    Prototype: First Generation - Chlorpropamide (Diabense) - increase cardiovascular deaths
    Second Generation - Glyburide (DiaBeta)
    • Metabolize in liver.Excrete in urine.
    • Safer for patient with renal dysfunction
    • Longer lasting=less doses
    • Actions: stimulate release of insulin from functioning cells in pancreas; may improve binding of insulin-to-insulin receptor sites or increase number of insulin receptor sites
    • Indications: treatment of Type 2 diabetes (adjunct to diet and exercise). Glyburide - with metformin or insulin for stabilization of diabetic patients
    • Contraindications: allergy to sulfonylureas, severe infection, pregnancy, lactation, type 1 diabetes
    • Adverse effects: hypoglycemia, ketoacidosis, GI (nausea, vomiting, heartburn)
    • Drug-drug interactions: beta-blockers, any drug that decreases glucose levels, any drug that acidifies urine
    • Nursing Considerations: allergies, assess body systems for change, assess nutritional and activity level, monitor glucose levels, assess baseline status, follow dietary and exercise regimen, storage and administration teaching, administer drug in relation to meals, monitor during times of stress, monitor response to drug, monitor for hypoglycemia and GI distress
  8. Other Antidiabetic Agent
    Prototype: Metformin (Glucophage)
    • Metabolize in liver.Excrete in urine.
    • Safer for patient with renal dysfunction
    • Longer lasting=less doses
    • Actions: may increase peripheral use of glucose, increase production of insulin, decrease hepatic glucose production, and alter intestinal absorption of glucose
    • Indications: adjunct to diet and exercise for treatment of type 2 diabetics older than 10 yrs; extended release form for patients over 17; adjunct treatment polycystic ovary syndrome
    • Contraindications: allergy to sulfonylureas, severe infection, pregnancy, lactation, type 1 diabetes
    • Adverse effects: hypoglycemia, lactic acidosis, GI upset (nausea, anorexia, diarrhea, heartburn), skin reactions
    • Drug-drug interactions: beta-blockers, any drug that decreases glucose levels, any drug that acidifies urine
    • Nursing Considerations: allergies, assess body systems for change, assess nutritional and activity level, monitor glucose levels, assess baseline status, follow dietary and exercise regimen, storage and administration teaching, administer drug in relation to meals, monitor during times of stress, monitor response to drug, monitor for hypoglycemia and GI distress
  9. Glucose Elevating Agents
    Prototype: Glucagon (GlucaGen)
    • Used in ER
    • IV only
    • Metabolize in liver. Excrete in urine.
    • Actions: Accelerates the breakdown of glycogen to glucose in the liver, causing an increase in blood glucose levels
    • Indications: Counteracts severe hypoglycemia related to insulin or oral agents
    • Contraindications: allergy to sulfonamides or thiazides, pregnancy
    • Adverse effects: GI (nausea, vomiting), CV (hypo/hypertension), hypokalemia, respiratory distress
    • Drug-drug interactions: oral anticoagulants
    • Nursing Considerations: allergy, CNS evaluation, glucose monitoring, have insulin ready, monitor patient response, monitor nutritional status, monitor for hyperglycemia, GI distress

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