Diabetes 1:
- Lack of insulin, impaired release of insulin, insulin is destroyed, cells are
resistant to insulin
- Beta cell dysfunction - increase blood glucose - increase blood glucose in
stomach - decrease glucose uptake - decrease insulin action
Class: Insulin (not the first line)
- Why? Type 1 (not producing insulin) or type 2 (not first line of meds)
- Mech: promotes transport of glucose into the cell
- Ex:
- Long acting- basal (pancreas is stimulated to release insulin) 24 hrs
1 injection, taken at night
- Glargine (lantus)
- Detemir (levemir)
- Rapid action - prandial (min I eat, take this and it lowers the spike)
- Lispro (humalog)
- Insulin aspart (novolog)
- Side effects:
- Primary: hypoglycemia (diaphoresis, headache, blurred vision, drowsy,
tachycardia, nausea)
- Patient:
- Site: abdomen, upper thigh, or arm
- Increase BG monitoring if taking a beta blocker
- Monitor exercise and food intake
- Nursing:
- Do not mix short or long acting insulin
- Observe for specific timing with food (prandial)
- Remember NPO patients
- Rotate injection sites
- Hgb A1C
Sulfonylureas:
- Ind: type 2 diabtes
- Ex: glimeperide (amaryl), glipizide (glucotrol), glyburide
- Mech: stimulated the beta cells to release insulin
- Side effects:
- Hypoglycemic, GI distress
Alpha-glucosidase inhibitor:
- Ind: type 2 diabtes
- Ex: acarbose (precose)
, - Mech: inhibits alpha -glucosidase (an enzyme that breaks down glucose for
absorption) in the SI, delaying the absorption of glucose
- Side effects:
- Primary: hypoglycemia, GI distress
Biguanide: FIRST CHOICE
- Ind: type 2 diabetes - first line treatment, PCOS (polycystic ovary disease)
- Ex: metformin (glucophage)
- Mech: decreases hepatic glucose production, decreases intestinal absorption of
glucose and increases insulin sensitivity
- Side effects:
- Primary: hypoglycemia (min), GI distress, N/V/D right away!!!
- Wild: decreased appetite - weight loss, vit b12 malabsorption
- Life: black box warning: lactic acidosis
- Respiratory hyperventilation, severe abdominal pain
DPP-4 Inhibitors:
- Ind: type 2 DM
- Ex: linagliptin (tradjenta), saxagliptin (onglyza), sitagiptin (januvia)
- Mech: slows the breakdown of GLP1 in the body prolonging the effects of
increased insulin secretion, decreased glucagon secretion and slowing gastric
emptying
- Side effects: minimal hypoglycemia
- Life: acute pancreatitis
Meglitinides: pill form of short acting (3-4 times a day)
- Ind: type 2 diabetes
- Ex: repaglinide (prandin)
- Mech: stimulate the release of insulin from beta cells with food intake
- Side effects: min hypoglycemia
- Wild: upper respiratory tract inflammation
SGLT-2 Inhibitors:
- Ind: type 2 diabetes
- Ex: empagliflozin (jardiance)
- Mech: promotes loss of glucose through the urine
- Side effects:
- Primary: min hypoglycemia
- UTI, Dehydration, Genital fungal infections
- Wild: loss of bone density
Thiazolidinediones: LAST choice
- Ind: type 2 diabtes
- Ex: pioglitazone (actos)
- Mech: decrease insulin resistance by increasing sensitivity to insulin in the cells.
DOES NOT LOWER BG.
- Lack of insulin, impaired release of insulin, insulin is destroyed, cells are
resistant to insulin
- Beta cell dysfunction - increase blood glucose - increase blood glucose in
stomach - decrease glucose uptake - decrease insulin action
Class: Insulin (not the first line)
- Why? Type 1 (not producing insulin) or type 2 (not first line of meds)
- Mech: promotes transport of glucose into the cell
- Ex:
- Long acting- basal (pancreas is stimulated to release insulin) 24 hrs
1 injection, taken at night
- Glargine (lantus)
- Detemir (levemir)
- Rapid action - prandial (min I eat, take this and it lowers the spike)
- Lispro (humalog)
- Insulin aspart (novolog)
- Side effects:
- Primary: hypoglycemia (diaphoresis, headache, blurred vision, drowsy,
tachycardia, nausea)
- Patient:
- Site: abdomen, upper thigh, or arm
- Increase BG monitoring if taking a beta blocker
- Monitor exercise and food intake
- Nursing:
- Do not mix short or long acting insulin
- Observe for specific timing with food (prandial)
- Remember NPO patients
- Rotate injection sites
- Hgb A1C
Sulfonylureas:
- Ind: type 2 diabtes
- Ex: glimeperide (amaryl), glipizide (glucotrol), glyburide
- Mech: stimulated the beta cells to release insulin
- Side effects:
- Hypoglycemic, GI distress
Alpha-glucosidase inhibitor:
- Ind: type 2 diabtes
- Ex: acarbose (precose)
, - Mech: inhibits alpha -glucosidase (an enzyme that breaks down glucose for
absorption) in the SI, delaying the absorption of glucose
- Side effects:
- Primary: hypoglycemia, GI distress
Biguanide: FIRST CHOICE
- Ind: type 2 diabetes - first line treatment, PCOS (polycystic ovary disease)
- Ex: metformin (glucophage)
- Mech: decreases hepatic glucose production, decreases intestinal absorption of
glucose and increases insulin sensitivity
- Side effects:
- Primary: hypoglycemia (min), GI distress, N/V/D right away!!!
- Wild: decreased appetite - weight loss, vit b12 malabsorption
- Life: black box warning: lactic acidosis
- Respiratory hyperventilation, severe abdominal pain
DPP-4 Inhibitors:
- Ind: type 2 DM
- Ex: linagliptin (tradjenta), saxagliptin (onglyza), sitagiptin (januvia)
- Mech: slows the breakdown of GLP1 in the body prolonging the effects of
increased insulin secretion, decreased glucagon secretion and slowing gastric
emptying
- Side effects: minimal hypoglycemia
- Life: acute pancreatitis
Meglitinides: pill form of short acting (3-4 times a day)
- Ind: type 2 diabetes
- Ex: repaglinide (prandin)
- Mech: stimulate the release of insulin from beta cells with food intake
- Side effects: min hypoglycemia
- Wild: upper respiratory tract inflammation
SGLT-2 Inhibitors:
- Ind: type 2 diabetes
- Ex: empagliflozin (jardiance)
- Mech: promotes loss of glucose through the urine
- Side effects:
- Primary: min hypoglycemia
- UTI, Dehydration, Genital fungal infections
- Wild: loss of bone density
Thiazolidinediones: LAST choice
- Ind: type 2 diabtes
- Ex: pioglitazone (actos)
- Mech: decrease insulin resistance by increasing sensitivity to insulin in the cells.
DOES NOT LOWER BG.
