Diabetes Mellitus Overview Quiz

Drugs for Diabetes Mellitus

• Objectives include reviewing diabetes incidence and causes, insulin types and administration, mechanisms of action, adverse effects and interactions of diabetes medications, and client care issues related to insulins and oral medications.
• 422 million people worldwide have diabetes (WHO).
• In Canada, over 9 million people live with diabetes or prediabetes.
• Indigenous Canadians are 3-5 times more likely than the general population to develop type 2 diabetes.
• Untreated diabetes can lead to heart disease, kidney disease, eye disease, erectile dysfunction, nerve damage, immunosuppression, and poor wound healing.
• Symptoms include unusual thirst, frequent urination, weight change, extreme fatigue, blurred vision, frequent infections, slow-healing cuts/bruises, tingling/numbness in hands/feet, and erectile difficulties. Many people with type 2 diabetes don't experience any symptoms.
• Diabetes Canada provides guidelines for healthcare providers and patients.
• Two main types are type 1 (~10%) and type 2 (~90%), and gestational diabetes. Other forms are also possible like drug-induced.
• Type 1 diabetes involves a lack of insulin production or defective insulin production demanding exogenous insulin. Complications include retinopathy, nephropathy, and neuropathy. Diabetic ketoacidosis (DKA) is also associated. Insulin is the absolute requirement for drug therapy; some oral agents may be used as adjunctive therapy.
• Type 2 diabetes is the most common type (90% of cases), caused by insulin deficiency and/or resistance. Many tissues are resistant to insulin, often due to reduced insulin receptors or lessened receptor responsiveness.
• Gestational diabetes is high blood glucose during pregnancy that resolves after delivery. Insulin is usually the medication of choice, but metformin may also be used.
• Testing for diabetes includes blood glucose measurement, glucose tolerance testing, and measuring HbA1c (glycated hemoglobin). HbA1c measures average blood glucose over 3 months. Non-diabetic levels are typically 4-5.9%, while diabetic levels are >6.5%. Blood glucose treatment targets are usually 5-10 mmol/L.
• Diabetes Canada guidelines suggest an A1C target of ≤7% for most patients with type 1 and type 2 diabetes.
• Treatment of diabetes includes insulins (recombinant human insulins), non-insulin oral and injectable drugs. These drugs target different aspects of glucose control, such as increasing insulin production, improving insulin sensitivity, altering glucose absorption/excretion, etc.
• Insulins come in various types (rapid-acting, short-acting, intermediate-acting, and long-acting). Time frames of action, onset, peak and duration, determine timing of administration. Specific examples are included for different types (e.g., insulin lispro, insulin aspart, insulin glargine, insulin detemir, insulin regular, NPH, etc).
• Medication action sites vary. For example, Biguanides like metformin act on the liver to reduce glucose production.
• Important client care aspects for insulins include correct route, type, timing, and dosage, and double-checking orders with another nurse. Specific oral drugs may have different administration schedules

Medication Sites of Action

• Various medications act on different organs. Biguanides affect the liver, muscle and fat cells involve insulin and thiazolidinediones, pancreas involves DPP-4 inhibitors, glinides, sulfonylureas, and injectable hormones, and intestines involve alpha-glucosidase inhibitors and sometimes injectable hormones. Specific sites of action are mentioned for various drug types.

Insulins

• Function as substitutes for endogenous hormones, mirroring the effects of normal, endogenous insulin.
• Improves the diabetic's ability to absorb glucose into cells, to make proteins and triglycerides, to convert glucose into glycogen in the liver, and to convert glucose to fatty acids in adipose tissue.

Types of Insulins

• Rapid-acting, short-acting, intermediate-acting, and long-acting insulins each have distinct onset, peak, and duration profiles impacting when they are administered. Specific examples, timing details and administration methods are detailed.

Human-Based Insulins

• Characteristics of each type of insulin, like onset, peak, and duration, are crucial.
• Diabetes Canada suggests using basal and rapid-acting insulins to control blood glucose. Specific examples (e.g., insulin lispro, insulin aspart, insulin glargine, insulin detemir, insulin regular, NPH) and their characteristics, plus example dosages and routes are included.

Combination Insulin Products

• Some insulins are premixed (example: 30% regular and 70% NPH) and this simplifies dosing. Specific examples are given like Novolin 30/70 etc. Further information on combined products is available.

Basal Bolus Insulin Therapy (BBIT)

• Involves using basal (long-acting) insulin, bolus (short-acting/mealtime) insulin, and correction insulin.
• The goal is to maintain blood glucose levels in a target range of 5-10 mmol/L. Strategies and steps for implementing this therapy effectively are mentioned.

Too Much Insulin (Hypoglycemia)

• Hypoglycemia warning signs include an alert value of <3.9 mmol/L. Levels 2 and 3 require additional assistance. Issues include CNS effects and SNS activation (giving initial symptoms). Severe cases may result in coma and death.
• Symptoms of hypoglycemia include trembling, palpitations, sweating, anxiety, hunger, nausea and tingling. Specific examples and treatment steps (e.g., glucose tablets or juice) are included.

Adverse Effects of Insulin

• Detailed description of both adrenergic (autonomic) symptoms and neuroglycopenic symptoms. Specific examples of adverse effects for insulin are included.

Interactions with Insulins

• Several medications can either increase or reduce the effect of insulins on blood glucose levels including beta blockers, alcohol, glucocorticoids, and diuretics. Specific examples of interactions and their effects are given (e.g., beta blockers masking hypoglycemia symptoms). Interactions noted include those between insulin and other drugs.

Oral and Other Injectable Drugs for Diabetes

• Oral drugs aim to lower blood glucose levels in type 2 diabetes, used alone or with other agents, in addition to diet and lifestyle changes. Detailed examples of specific drug classes, e.g., Metformin, Sulphonylureas and their roles in managing blood glucose are included.

Diabetes Drugs

• Different classes of diabetes medications have different actions like increasing insulin secretion (Insulin secretagogues - e.g. Sulphonylureas, Meglitinides), improving insulin sensitivity (e.g. Biguanides and Thiazolidinediones, DPP-4 Inhibitors), altering glucose absorption/excretion (e.g., alpha-glucosidase inhibitors), and more. Specific examples are included (e.g., metformin, glyburide). Drug classes are listed for actions and effects.

Incretins

• Incretins, released by intestinal contents (e.g., GLP-1 and GIP), stimulate insulin release—enzymes like DPP-4 can inactivate or break these down.
• Several drugs function by inhibiting the DPP-4 enzyme allowing a rise in plasma incretin levels, thereby potentially reducing glucose levels. Specific types of incretin mimetics and inhibitors are included (e.g., sitagliptin, exenatide, liraglutide, etc.). Further updates on uses for managing appetite and weight may be included.

Incretin Preparations

• Many incretin preparations exist, including daily and weekly injectable options. Specific examples are included (e.g., exenatide, liraglutide, dulaglutide, tirzepatide etc.). Key details and administration instructions are included.

Na-Glucose Transporter Inhibitors

• Newer diabetes medications target sodium-glucose transporter subtype 2 (SGLT2) in the kidneys, leading to glucose excretion in the urine. Specific drug examples are included (e.g., canagliflozin, dapagliflozin, empagliflozin). Effects on urination and risk of UTIs, etc. are mentioned.

SGLT2 Inhibitors Adverse Effects

• Increased urination and potential for hypotension/dizziness. UTIs are possible but usually not a concern. Potential additional adverse effects and related management may be included.

Other Injectable Drugs

• Amylin mimetics (e.g., pramlintide) are generally used in combination with insulin therapies to reduce postprandial glucose levels by delaying gastric emptying and reducing glucagon secretion. Specific examples of use and administration, etc. are detailed

Alpha-glucosidase Inhibitors

• These medications reversibly inhibit the enzyme alpha-glucosidase in the small intestine, thereby hindering digestion of oligosaccharides and disaccharides. This delays glucose absorption. Specific drug examples are included (e.g., acarbose, miglitol.) Detailed effects and administration notes are included. Detailed effects are listed.

Medication Interactions with Oral/Non-Insulin Agents

• Glucocorticoids decrease the effectiveness of blood-glucose lowering drugs, potentially raising blood glucose levels. Important interaction notes are included

Antihyperglycemic Agents Client Care Implications

• Assess for signs of hypoglycemia. If hypoglycemia occurs, treatment includes glucagon (if needed), 120-200 ml of clear juice, glucose tablets/gel, honey, or soft drinks. Follow-up with a meal/snack (carbohydrates plus protein). Monitor blood glucose levels. Specific examples of treatments (e.g., glucose tablets) and instructions for administering the correct therapy are provided. Additional client care implications are also detailed.

Test your knowledge on diabetes mellitus with this comprehensive quiz. Explore key concepts including types, symptoms, management, and complications associated with diabetes. Perfect for students and healthcare professionals alike!