Antidiabetics Overview Unit 9.1

Antidiabetics

• Diabetes Mellitus is a chronic disease of deficient glucose metabolism
• Insufficient insulin secretion from pancreatic beta cells is a cause
• Impaired insulin use is a cause
• Major symptoms include polyuria, polydipsia, and polyphagia
• Type 1 diabetes is insulin-dependent
• Type 2 diabetes is insulin-resistant; body tissues do not respond to insulin
• Insulin receptors may be unresponsive or deficient in number
• Secondary diabetes can be caused by medications (glucocorticoids, thiazides, diuretics, epinephrine)
• Gestational diabetes is caused by hormonal changes during pregnancy
• Hemoglobin A1c (HbA1c) is a derivative of glucose interaction with red blood cells (RBCs)
• RBCs have a lifespan of ~120 days; HbA1c reflects average blood glucose over 3 months
• Treatment goal for diabetes is to keep HbA1c below 7%
• 5% HbA1c = no diabetes
• 5.7% - 6.4% HbA1c = prediabetes
• 6.5% or greater HbA1c = diabetes mellitus
• Insulin action promotes glucose, amino acid, and fatty acid uptake & storage; reduces blood sugar levels
• Hypoglycemia (low blood sugar) symptoms: headache, dizziness, confusion, slurred speech, hunger, weakness, nervousness, anxiety, agitation, tremors, sweating, flushing, lethargy; redness, irritation, or swelling at injection sites, tachycardia, palpitations, and hypoglycemic reaction, shock, anaphylaxis, ketoacidosis
• Interactions: decreased glucose with aspirin, oral anticoagulants, alcohol, other hypoglycemics, beta blockers; increased glucose with thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking
• Contraindications: hypoglycemia and allergy

Insulin Types

• Rapid-acting insulin (e.g., Humalog): onset (15-30 min), peak (30-90 min), duration (3-5 hrs)
• Short-acting insulin (e.g., Regular): onset (30 min), peak (1.5-3.5 hrs), duration (4-12 hrs)
• Intermediate-acting insulin (e.g., NPH): onset (1-2 hrs), peak (4-12 hrs), duration (14-24 hrs)
• Long-acting insulin (e.g., glargine): onset (1-1.5 hrs), duration (24 hrs); administered at bedtime

Insulin Shock vs. Diabetic Ketoacidosis

• Insulin Shock (Hypoglycemic Reaction): headache, lightheadedness, nervousness, apprehension, tremors, excess perspiration (cold, clammy skin), tachycardia, slurred speech, memory lapse, confusion, seizures; blood glucose <60 mg/dL
• Diabetic Ketoacidosis (Hyperglycemic Reaction): extreme thirst, polyuria, fruity breath odor, Kussmaul breathing (deep, rapid, labored, distressed, dyspneic), rapid, thready pulse, dry mucous membranes, poor skin turgor; blood glucose >250 mg/dL

Insulin Types - Combinations

• Composed of short/intermediate acting or rapid/intermediate acting insulins
• Examples include Humulin or Novolin 70/30 (NPH 70%, regular 30%) and NPH 50%/regular 50%
• Can be mixed in other strengths
• Have two onsets, two peaks, and two durations

Knowledge Check

• Client order for NPH and Lispro at 0800 AM, procedure at 1300 PM, NPO at lunch: Hold Lispro and give NPH.
• Metformin ordered daily, CT scan at noon: Hold Metformin 48 hours before and after the procedure

Continuous Glucose Monitor (CGMs)

• Continuously monitor blood glucose (blood sugar)
• Provides real-time updates
• Device attached to the body
• Became popular and more accurate over the years
• Viable treatment option for people with diabetes

Insulin Delivery Devices

• Insulin syringe
• Insulin pen
• Jet injector
• Insulin pump (with wireless pump and infusion set)

Insulin Administration and Storage

• Insulin is given Subcutaneous (SQ), absorbing fastest in the abdomen.
• Use only insulin syringes (U-100)
• Do not shake insulin; roll it gently.
• Do not apply heat or massage injection site.
• Keep unopened insulin refrigerated.
• Remove from refrigerator 30 minutes before use.
• Open insulin can be stored at room temperature for 30 days or in the refrigerator for 3 months
• Avoid direct sunlight and high temperatures

Sliding-Scale Insulin

• Doses adjusted based on individual blood glucose
• Typically administered before meals and at bedtime
• Usually rapid or short-acting insulin
• Example dosage adjustments based on glucose levels provided

Insulin Orders (Morning and Evening Doses)

• Insulin dosages are provided based on blood glucose levels

Nursing Process for Insulin

• Assessment: medication/medical history, insulin type/dosage, vital signs, blood glucose, HbA1c, signs/symptoms of hypo/hyperglycemia
• Nursing interventions/Teaching: Monitor vital signs and glucose, instruct client on hypo/hyperglycemia reporting, teach how to manage hypoglycemic events, encourage compliance with diet, lifestyle, exercise, advise client to wear medical alert tag, teach client on glucose checking, insulin administration and rotation of sites to prevent lipodystrophy

Lipodystrophy

• A condition where there is a loss or abnormal growth of subcutaneous fatty tissue. Can occur where insulin is repeatedly injected.
• Lipoatrophy (loss of subcutaneous fat)
• Lipohypertrophy (overgrowth of subcutaneous fat)

Guidelines for Oral Antidiabetic Therapy for Type 2 Diabetes

• Age of onset of diabetes for oral therapy, diagnosis, weight, fasting blood glucose, units of insulin per day, renal and hepatic function

Oral Antidiabetic Drugs

• Sulfonylureas (Glipizide): used to treat type 2 diabetes, increases insulin production, potential side effects, interactions (alcohol, beta blockers, green tea), contraindications.
• Biguanides (Metformin): used to treat type 2 diabetes, reduces glucose production and improves insulin use effectiveness, side effects, interactions (alcohol, IV contrast dye, green tea).
• SGLT2 Inhibitors (Gliflozins): lowers blood sugar, increases urine output, preventing the kidneys from reabsorbing glucose, potentially reduces cardiovascular risk. Adverse effects, contraindications(pregnancy, renal issues).
• Glucagon-Like Peptide Agonists (GLP-1 Agonists): incretin mimetics; regulate blood sugar in type 2 diabetes, suppress appetite and reduce glucagon effects, slows down gastric emptying; examples of drugs in this category provided. Adverse effects, contraindications, and interactions provided.

Hyperglycemic Agents (Glucagon)

• Secreted by alpha cells in the islets of Langerhans
• Used to treat insulin induced hypoglycemia
• Parenteral route of administration (subQ, IM, IV)
• Acts in ~10 minutes
• Raises blood sugar by triggering glycogenolysis

GLP-1 Agonist Nursing Implications

This quiz provides an overview of antidiabetic agents and their role in managing diabetes mellitus. It covers the causes, symptoms, and treatment goals related to diabetes, including the significance of Hemoglobin A1c in monitoring blood glucose levels. Test your understanding of diabetes management concepts and medication implications.