Chapter 36 Agents Used to Treat Hyperglycemia and Hypoglycemia.

Chapter 36Agents Used to Treat Hyperglycemia and Hypoglycemia

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Diabetes Mellitus

Disorder of the pancreas Results in hyperglycemia

Treatment Insulin Oral hypoglycemics

(continues)


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Pancreatic beta cells Excrete an insufficient amount of insulin, or no

insulin at all Flawed carbohydrate, fat, and protein

metabolism

Diabetes Mellitus(continued)


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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


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Symptoms of Diabetes Mellitus

Polyuria (increased urine output) Polydipsia (excessive thirst) Polyphagia (excessive hunger)


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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)


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Diabetes Mellitus

Type 1 diabetes mellitus Treated with insulin subcutaneous injections

Type 2 diabetes mellitus Treated with oral hypoglycemic agents

(continued)


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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


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Four Preparations of Insulin

Rapid-Acting

Fast-Acting

Intermediate-Acting

Long-Acting

LisproAspart

RegularHumulin-RNovolin-R

NPHLenteHumulin-L

UltralenteHumulin-UGlargine- Lantus

Note the differences in onset, peak, and duration of action.


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Effects of Insulin

Allergic reactions Lipodystrophy Insulin resistance


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Nursing Implications

Several drugs antagonize the hypoglycemic effects of insulin.

Check your drug manual before administering any drug agent.


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Hypoglycemia

Blood glucose is low (< 40 mg/dL) Produced from

Skipped or irregularly scheduled meals Excessive exercise Insulin administration errors


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Signs and Symptoms of Hypoglycemia

Sweating Confusion Tachycardia Headache Hunger

Weakness Poor muscle

control Emotional

instability Coma and death


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Hypoglycemia Treatment

Glucagon (intramuscular, intravenous, or subcutaneous)

IV dextrose 50%, also known as D50W


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Treatment for Type 2 Diabetes

Oral antidiabetic agents Five classes

1. Sulfonylureas (oldest category)• First generation• Second generation

2. Biguanides3. Meglitinides4. Alpha-glucosidases5. Thiazolidinediones


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Sulfonylureas

Action: stimulate the beta cells of the pancreas to secrete more insulin


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Biguanides

Action: inhibit hepatic glucose production and increase the sensitivity of peripheral tissue to insulin

May be given with sulfonylureas


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Meglitinide

Action Stimulate the beta cells of the pancreas to

secrete insulin Minimal risk of hypoglycemia


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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


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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


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Side Effects of Sulfa

Hematology Hemolytic anemia, thrombocytopenia, and

jaundice Gastrointestinal

Nausea, epigastric fullness, and heartburn


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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

Chapter 36 Agents Used to Treat Hyperglycemia and Hypoglycemia.

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Transcript of Chapter 36 Agents Used to Treat Hyperglycemia and Hypoglycemia.