Diabetes Meds

Enzymes-lipase, amylase

• B cells- insulin
• Alpha cells- glucagon

• MOA-
• helps to get glucose across the cell
• Facilitate glucose, uptake, storage, metabolism
• increase protein synthesis
• decrease protein breakdown
• increase triglyceride synthesis- increase fat breakdown (without insulin ur body can't breakdown fat)

Glucose is suppose to be in the cell

• Glycogenolysis - glycogen converts glucose (liver)
• gluconeogenesis- Glucose production- from protein/fat breakdown)
• increase liposis- fat break down
• inhibits triglyceride storage

• insulin dependent diabetes metillus 
• - body not making insulin (no or not enough)
• - dx at an early age teens-adult
• - always on insulin- no matter of diet/excerise
• - sooner we dx the better we can treat

• Non insulin dependent diabetes metillus
• - not enough insulin/or not making enough
• - insulin helps to bring glucose across the cell
• - pancreas can get over worked
• - gestational DM- 
• - Juvenille DM- because of obesity
• Body not making enough insulin- insulin resistant

• 100 units
• given Sc, IV

not GI- gi breaks down insulin molecules before it gets to the blood stream

• FBS> 126 a few occasions 
• A1c> 7 (6.5) glycosated Hgb
• Prego> 110

normal bs 70-120

• GTT- glucose tolerance
• GCT glucose challenge

Increase in BS- too much food, not enough insulin, illness or stress

• onset- gradual- dm coma
• BS over 200

• S/s
• Frequent urination
• polydipsia
• polyphagia- cause bs in blood stream
• nausea
• drowiness
• blurred vision
• dry skin
• glucose not in cell but in the bloodstream
• goes to the kidney to get rid of the glucose- hence the going to the batheroom

fast acting

• too little food, too much insulin or dm meds or extra excerise
• onset sudden-insulin shock
• bs> 70

• S/s
• Shaking
• fast hearbeat -tachycardia
• sweating
• anxious
• dizziness
• hunger
• impaired vision
• weakness, fatigue
• headache
• irritable

orange 15 ml proteins/graham

• Diabetes ketoacidosis
• flushed
• hyperglycemia s/s
• losses LOC
• metabolic acidosis because of the increase bs
• breakdown ketones
• Type I

• hyperosmolar non ketadic syndrome
• Type II
• extreme increase of BS
• hyperglycemia s/s
• still have enough of their own insulin to prevent metabolic ketones acidosis

• tissue hypertrophy- using the same site
• lipodystrophy/lipohypertrophy

PVD, CAD, kidney failure, blindness, changes in the cell

• some come pre mixed
• only used if ordered
• for ex: insulin 70/30
• meaning NPH- 70%
• Regular- 30%

MD orders 36

• 36 * .70= 25.2 NPH
• Reg- 10.8

Rapid acting

Onset- 15 mins

Peak- 1 hour (watch for hypoglycemia when it is at its peak- can happen thru out but esp during this time)

duration 6-8

Have food tray before you give this

Rapid acting

onset- 30-60mins

peak- 2-3 hours

duration- 8-12 hours

Intermediate acting

onset- 1-1.5 hours

Peak: 6-8 hours

duration- 24 hours

Long Acting

onset- 1.1 hr

peak: 5 hr

duration- 24 hours

• no highs/low hyperglycemia/hypoglycemia
• can't mixed this with anything

ex- 36u NPH 12u regular

• insert air 36u of air into the NPH
• insert 12u of air into the regular
• draw up 12u of regular
• draw up to 48u from the NPH

depends on ur BS

• this covers their glucose level thru out the day before their meal (morning afternoon evening)
• covers person meal

u will give this along with the standing insulin the pt is suppose to take

humalog, humulin R only

• use 100u syringes with u 100 insulin
• teach s/s hyper/hypoglycemia
• aware of meds that alter BS
• assess s/s for DM and complication
• teach pt how to test bs
• including labs
• change in in activity/diet/stress can change insulin requirement
• assess dexterity and knowledge of insulin management (can they give themselves insulin)
• rotate site
• sliding scales
• give at the same time
• diet
• keep glucose/hard candy for hypo
• keep insulin being used at room temp
• other storage in the refridge
• mixing insulins
• assess sight

glyburide, diabeta, glipizide, micronase

• stimulates the release of b- cells (insulin)
• indirectly enhances the production of insulin
• decrease of hepatic glycogenolysis, gluconeogensis

• onset- 1-2 hr
• peaks 3-4hr
• duration 24hr

SE: GI (nausea, heartburn), hypoglycemia, jaundice (hepatoxicity), metabolic taste

stimulate the pancreas to make more insulin

be careful with allergy to sulfa

• decreases glyconeogenolysis
• increases insulin stimulated glucose transport in adipose and skeletal muscle
• decrease intestinal absorption of glucose
• decrease triglyrides

• gets glucose across the cell
• can be used alone or as a combo
• reduce insulin resistance
• does not promote release of insulin?
• does not cause hypoglycemia?

• teaching- reacts with constrast (MRI)- reacts with kidneys (nephrotoxicity)
• SE: nephro/hepatoxicity
• Synergistic effects- can give with other drugs for greater effect

black box- acidosis

contrain- renal function. HF

Stimulates secretion of insulin from the pancreatic beta cells by binding to beta cell sites

give PO before meals (1/2- 1 hr before meals)

SE- flu like symptoms, respiratory infection, back pain, hypoglycemia, anaphalytic

 

peak 1 hour