CHAPTER 32 Pharm - Diabetes

Diabetes Overview

• Type 1 diabetes is genetic and characterized by a complete lack of insulin production.
• Type 2 diabetes is marked by insufficient insulin production and can be controlled through lifestyle changes.

Complications of Diabetes

• Retinopathy is a complication of diabetes that causes eye pain.
• Neuropathy is a complication of diabetes that causes nerve pain.
• Nephropathy is a complication of diabetes that affects the kidneys.
• Long-term diabetes can lead to edema, numbness, tingling in the extremities, and decreased circulation, indicating plaque buildup in arteries and vessels.

Treatment of Diabetes

• Type 1 diabetics always require insulin therapy.
• Type 2 diabetics may require lifestyle changes, including weight loss, dieting, exercise, and quitting smoking and drinking.
• The goal for HbA1C levels is less than 7%.
• The goal for fasting blood glucose levels is 80-130 mg/dL.

Medications for Diabetes

• Metformin is the first-line drug for type 2 diabetes and should be taken with a meal.
• The mechanism of action (MOA) for Metformin is to decrease glucose production and intestinal absorption.
• Adverse effects of Metformin include bloating, cramping, and feeling full.
• Lactic acidosis is a rare but lethal side effect of Metformin.
• Metformin is contraindicated in patients with renal or hepatic disease.

Other Medications for Diabetes

• Pioglitazone and Rosiglitazone have adverse effects, including edema, weight gain, and potential heart failure exacerbation.
• Patients taking Pioglitazone and Rosiglitazone are at risk for fractures due to decreased bone marrow.
• Pioglitazone and Rosiglitazone are contraindicated in patients with heart failure.
• DPP-IV inhibitors (gliptin medications) may cause upper respiratory infections and pancreatitis.
• The MOA for GLP-1 (tide medications) is to slow gastric emptying.
• Adverse effects of GLP-1 (tide medications) include hemorrhagic or necrotizing pancreatitis (rare).
• GLP-1 (tide medications) have a Black Box warning for thyroid cancer risk.

SGLT2 Inhibitors (Flozin Medications)

• Contraindications for SGLT2 inhibitors include DKA and moderate to severe kidney impairment.
• Adverse effects of SGLT2 inhibitors include yeast infections, UTIs, acute kidney injury, hypotension, and hypovolemia.
• The FDA warns of the possible adverse effect of Fournier's gangrene (necrotizing fasciitis of the perineum) with SGLT2 inhibitors.

Hypoglycemia

• Hypoglycemia is defined as a blood glucose level of less than 70 mg/dL.
• Early signs of hypoglycemia include confusion, irritability, tremors, and sweating.
• Late signs of hypoglycemia include hypothermia, seizures, and possible coma or death.
• Glucose-elevating drugs are used in acute hypoglycemic situations to raise blood sugar.
• Glucose-elevating drugs should only be used in conscious patients who have had a thorough assessment, including vital signs and blood sugar levels.
• Educate patients taking SUBQ insulin to rotate their injection site, administer at least 2 inches from the belly button, and have clean and dry skin.
• Foods that can help with hypoglycemia include corn syrup, honey, fruit juice, non-diet soft drinks, crackers, or half a sandwich.