Diabetes Meds

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  1. Pancreas
    Enzymes-lipase, amylase

    • B cells- insulin
    • Alpha cells- glucagon
  2. Insulin (med or ur body)
    decrease blood sugar
    • 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
  3. Glucagon 
    increase blood sugars
    • Glycogenolysis - glycogen converts glucose (liver)
    • gluconeogenesis- Glucose production- from protein/fat breakdown)
    • increase liposis- fat break down
    • inhibits triglyceride storage
  4. Classification:
    Type 1 IDDM
    • 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
  5. Classification:
    Type II NIDDM
    • 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
  6. Concentration Insulins
    • 100 units
    • given Sc, IV

    not GI- gi breaks down insulin molecules before it gets to the blood stream
  7. Dx of DM
    • FBS> 126 a few occasions 
    • A1c> 7 (6.5) glycosated Hgb
    • Prego> 110

    normal bs 70-120
  8. Glucose testing in pregnancy
    • GTT- glucose tolerance
    • GCT glucose challenge
  9. Hyperglycemia
    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
  10. Hypoglycemia low bs
    • 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
  11. DKA
    • Diabetes ketoacidosis
    • flushed
    • hyperglycemia s/s
    • losses LOC
    • metabolic acidosis because of the increase bs
    • breakdown ketones
    • Type I
  12. HNKA
    • 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
  13. Complications-local
    • tissue hypertrophy- using the same site
    • lipodystrophy/lipohypertrophy
  14. Long term effect
    PVD, CAD, kidney failure, blindness, changes in the cell
  15. Mixed insulin
    • 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
  16. Humalog lispro
    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
  17. Humalin R
    Rapid acting

    onset- 30-60mins

    peak- 2-3 hours

    duration- 8-12 hours
  18. NPH
    Humulin N
    Intermediate acting

    onset- 1-1.5 hours

    Peak: 6-8 hours

    duration- 24 hours
  19. Lantus
    Long Acting

    onset- 1.1 hr

    peak: 5 hr

    duration- 24 hours

    • no highs/low hyperglycemia/hypoglycemia
    • can't mixed this with anything
  20. How to mix
    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
  21. Sliding Scale
    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
  22. Nursing intervention Insulin
    • 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
  23. Sulfonyiureas
    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
  24. Glucophage metformin
    • 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
  25. new drug Meglitinides

    Prandin (repaglinide)
    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
Card Set
Diabetes Meds
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