Diabetes Medications: Sulfonylureas

• There are several medications used to treat diabetes. They include Sulfonylureas, Biguanides, Dipeptyl Release Inhibitors and Insulin.

Sulfonylureas

• Indicated only for type 2 diabetes.
• Enable beta pancreas cells to move glucose from the blood to cells for energy.
• Excess glucose entering liver cells is stored as glycogen or fat.
• Low blood glucose triggers glucagon release; glucagon takes glucose from liver cells, releasing it into the blood to raise glucose levels.
• Insulin resistance occurs when receptors on target cells are not as responsive to insulin signaling as they should be.
• Sulfonylureas stimulate beta cells directly to increase insulin release.
• Increased insulin helps with insulin deficiency and overcomes insulin resistance, preventing hyperglycemia.
• Effective at lowering glucose after meals or postprandial glucose levels, but continue increasing insulin regardless of blood glucose level.

Sulfonylureas: Medications

• Glyburide
• Glimepiride
• Glipizide

Sulfonylureas: Adverse Effects

• High risk of hypoglycemia.
• Weight gain can occur because after insulin moves glucose into muscles and liver cells, any remaining glucose is moved into fat cells.
• Allergic reactions are possible if the patient is allergic to sulfa.

Sulfonylureas: Nursing Interventions

• Check for allergies to sulfa, recognizing symptoms of hypoglycemia.
• Take with food to decrease the risk of hypoglycemia.
• Decrease alcohol intake to lower the risk of hypoglycemia.
• Encourage daily exercise and healthy dietary modifications.

Biguanides

• For type 2 diabetes only; Metformin is an insulin sensitizer
• They limit the entry of glucose into bloodstream.
• Decrease glucose production in the liver.
• Reduce glucose absorption in the gut.
• Sensitize insulin receptors in tissues, increasing tissue cell sensitivity and increasing peripheral glucose uptake and utilization.
• Biguanides do not directly stimulate the pancreas to release insulin.

Biguanides: Adverse Effects

• Nausea, vomiting, and transient diarrhea are expected to subside with continuous usage.
• Slow dose titration is recommended to minimize side effects.
• Lactic acidosis can be life-threatening.
• High doses or accumulation may lead to increased lactate production and decreased lactate elimination (lactate buildup can lead to metabolic acidosis).
• Use with caution if the patient has renal insufficiency.
• Alcohol consumption and iodinated contrast can lead to lactic acidosis.
• Chronic use can cause a B12 deficiency due to interference with vitamin B12 absorption.
• Not associated with weight gain due to lack of action for insulin release.
• Low risk of hypoglycemia.

Biguanides: Client Teaching

• Can be taken without food, but taking with food is recommended.
• Decrease/avoid alcohol.
• If the patient is having a CT Scan or iodinated contrast administration, discontinue metformin 24–48 hours prior.
• Monitor for symptoms of lactic acidosis, like malaise, myalgia, and tachypnea.
• Maintain a healthy lifestyle and healthy dietary modifications.

Dipeptyl Release Inhibitors

• Incretin hormones are produced in the small intestine when the patient intakes glucose.
• These medications increase glucose-dependent insulin release and decrease glucagon release to lower blood glucose levels.
• The drugs prevent/stop the DPP4 enzyme from breaking incretin hormones, which enhances glucose-lowering effects.
• The drugs' name typically ends with "-gliptins," such as Alogliptin, Linagliptin, and Saxagliptin.

Dipeptyl Release Inhibitors: Adverse Effects

• Acute or chronic pancreatitis can occur, associated with the stimulation of the pancreas by incretin hormones (use caution with any clients who have risk factors for pancreatitis, like obesity).
• Joint pain can occur from days to years after starting the drug; however, it may be resolved when discontinued.
• Severe allergic reactions, such as angioedema, are possible due to inhibition of the breakdown of proteins that increase vascular permeability.
• Dermatological reactions, such as bullous pemphigoid (an itchy rash with large blisters), can occur.
• Severe cutaneous reactions, such as Steven Johnson's Syndrome (shedding of the top layer of skin), happen.

Dipeptyl Release Inhibitors: Client Teaching

• Report abdominal pain, nausea, and vomiting, and call the healthcare provider immediately.

Insulin

• Insulin replaces or supplements endogenous insulin and facilitates the entry of glucose into cells.
• Exogenous insulin mimics the body's natural insulin production using different insulin types, which are categorized by their onset of action.
• Premeal short-duration insulin is given before a meal: rapid-acting insulin (Lispro, aspart, glulisine - used for postprandial hyperglycemia) and short-acting insulin (regular insulin, given IV for DKA).
• Intermediate-acting insulin is NPH, given twice daily.
• Long-acting insulins include Glargine, detemir, and degludec.
• Premixed insulin contains intermediate-acting insulin and either short- or rapid-acting insulin (the advantage is fewer injections).
• When drawing on the syringe, withdraw the units of insulin first (clear), followed by NPH (cloudy).

This lesson explores Sulfonylureas, a class of medications used to treat type 2 diabetes. It describes how they stimulate beta cells to increase insulin release and lower blood glucose levels. Medications in this class include Glyburide and Glimepiride.