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- Fasting Blood glucose test
- A1C >_ 6.5%
- FBS > 126 mg/do
- NPO for 8 hours before
- Generally reflects glucose from hepatic production
Casual blood glucose
- BG > 200 mg/do
- Non fasting
Postprandial blood glucose
- After meals
- Blood is drawn 2 hours after standard meal and reflect the efficiency of insulin-mediated glucose uptake by peripheral tissues
- The glucose normally attaches to hemoglobin molecule on rbc
- The higher the blood glucose levels, the higher the levels of glycosylated hemoglobin (HBA1C)
- A1C is an average blood glucose level measured over the previous months
- Urine levels of ketones can be tested by clients by use of a dipstick or tablets
- The presence of ketones (ketonuria) indicates body is using fat for energy which may result in ketoacidosis
Primarly used for?
- In type2 DM
- increased insulin production from the panceas
- Increase insulin production for the pancreas
- Rapidly absorbed and eliminated
- When taken just before meal (30min), there is a mimicking the normal blood glucose response to eating
What does it do?
- Primary action- reduce glucose production by the liver
- Enhances insulin sensitivity, improves glucose transport, does not promote weight gain
- Side effects- needs to be held 48 hours before and after administration of IV contrast
- Precose (acarbose)
- Glyset (miglitol)
- "Starch blockers"
- Works by slowing down the absorption of carbohydrates in the small intestine
- Taken with the first bite of each main meal
- They are most effective in lowering post prandial blood glucose.
- Effectiveness of these medications is measured by checking 2 hour postprandial glucose levels
OA- Thiazolidinedioes (TZD)
- Avandia (rosiglitazone)
- Actos (pioglitazone)
Most effective for who?
They don't do what?
Not recommended for who?
- "Insulin sensitizers"
- Most effective for people who have insulin resistance
- They improve sensitivity, transport, and utilization at target tissues
- They don't increase insulin production, will not cause hypoglycemia when used alone
- NOT RECOMMENDED FOR HF patients (can increase/cause fluid retention)
OA- DDP-4 inhibitors
- Sitagliptin (januvia)
- Vildagliptin (galvus)
- Saxagliptin (onglyza)
How do they work?
Work by preventing the break down of a naturally occurring compound in the body which will inhibit insulin secretion. This compound reduces blood glucose levels
Metformin / rosiglitazone
Stimulates incretin hormone
Reduces glucose release by liver
Increase satiety -weight loss
Slows gastric emptying
Not given with insulin
For type 2 that have not achieved control with oral agents
Incretin mimetic (byetta)
SubQ -thigh of abdomen only
Decreases gastric emptying and glucose output from liver
Increase satiety - weight loss
Rapid acting insulin
- Humalog (lispro) & Novolog (aspart)
- Onset : 15 min
- peak: 60-90 min
- Humulin R, NovolinR, Relion R
- Onset: 30-1 hour
- Peak: 2-3 hours
Intermediate acting insulin
- Humulin N, Novolin N, Relion N
- Onset: 2-4 hours
- Peak: 4-10 hours
Long lasting insulin
- Glargine (lantus) & Detemir (Levemir)
- No peak action
- Used once daily
- SubQ. Either am or pm for patient who requires basal insulin for the control of hyperglycemia
Side affects for sulfonylureas
Side effects for meglitinides
- Weight gain
- Hypoglycemia (less likely than sulfonylureas)
Side affects for avandamet
Rosiglitazone and metaformin
- Mi or stroke
- 48 hours before and after IV conntrast
Drugs that lower glucose
- Tricyclic antidepressants
Drugs the raise glucose
- Furosemide (lasix)
Alcohol inhibits what?
- Gluconeogenesis (breakdown of glycogen to glucose) by the liver
- Can cause severe hypoglycemia
Patients who use what drugs are at increased risk of hypoglycemia
Damage to blood vessels
Autonomic neuropathy can cause
- Hypoglycemic unawareness
- Bowel incontinence
- Urinary retention