Growth Hormone: Uses and Nursing Considerations

Growth Hormone (Somatropin - Genotropin)

• Secreted by the anterior pituitary gland.
• Regulates an individual's growth.
• Used to stimulate skeletal growth before the closure of a child's bone epiphyses.
• Possible adverse reactions include hypothyroidism, insulin resistance, edema, and joint/muscle pain.
• Use cautiously in patients with thyroid disease, diabetes, and during pregnancy.

Nursing Process: Assessment for Growth Hormone

• Record vital signs, height, and weight before therapy begins, with follow-ups every 3-6 months.
• Administer subcutaneously; swirl, do not shake; discard if cloudy; administer at bedtime if possible.
• Measure and record the child's height and weight to assess response.
• Monitor growth hormone levels, glucose tolerance, and thyroid function periodically during treatment.

Hyperpituitarism

• Suppresses growth hormone release when surgery and radiation are ineffective.
• Used to treat gigantism in children and acromegaly in adults.
• Adverse effects may include nausea, diarrhea, cramps, flatulence, hypo/hyperglycemia, liver injury, and chest pain.
• Cautious use with diabetes mellitus, hypothyroidism, renal/gallbladder disease, and older adults.
• May decrease the effects of antidysrhythmics.
• Administer at room temperature, give slowly, and rotate injection sites.
• Drug options are Sandostatin (octreotide, IM/Subcut/IV), Somatulin (lanreotide, Subcut), and Somavert (pegvisomant, Subcut).

Vasopressin

• Regulates water reabsorption by the kidneys.
• The pituitary gland secretes it when body fluids need to be conserved.
• Used to treat diabetes insipidus, prevent/treat postoperative abdominal distention, and dispel gas for abdominal X-rays.
• Adverse reactions may include tremor, sweating, vertigo, nasal congestion, nausea, abdominal cramping, and water intoxication.

Nursing Process: Assessment for Vasopressin

• Take weight, blood pressure, pulse, and respiratory rate; auscultate the abdomen and measure abdominal girth.
• Signs and symptoms of excessive dosage include skin blanching, abdominal cramps, and nausea.

Medical Management of Vasopressin

• Administration options include PO, IV, IM, Subcut, or via nasal spray for desmopressin.
• Vasopressin can be administered via IM, IV, or Subcut injection.
• Caffeine should be eliminated from the diet.
• IV fluids are given if PO intake is insufficient.
• Drug options include desmopressin acetate (DDAVP), aqueous vasopressin (Pitressin, IM/intranasal), and vasopressin tannate (IM) or lysine vasopressin.
• When administering intra-nasally, the patient should hold the bottle upright with their head vertical.
• Excessive dosage can lead to water intoxication, with signs/symptoms including drowsiness, listlessness, confusion, and headache, progressing to seizures and potentially coma.

Nursing Process: Implementation for Vasopressin

• Educate the patient and family on the importance of measuring fluid intake and output.
• Advise drinking 1-2 glasses of water before taking the drug and maintaining a 24-hour intake/output record.
• Emphasize avoiding alcohol and caffeine while using this drug.
• Educate on injection methods, emphasize rotating injection sites.
• Advise wearing medical identification indicating the condition and drug regimen.

Thyroid Hormones: Uses and Actions

• Used in the treatment or prevention of hypothyroidism, myxedema (severe hypothyroidism in adults), and cretinism (congenital hypothyroidism).
• Also used for euthyroid goiters (enlargement of the normal thyroid gland) and thyroid cancer.
• Thyroid hormones increase the metabolic rate of tissues, heart and respiratory rates, body temperature, cardiac output, and oxygen consumption.
• They also affect the metabolism of fats, proteins, carbohydrates, and overall mental activity.

Thyroid Hormones: Adverse Reactions

• Levothyroxine (Synthroid) is the drug of choice; brands and types should not be changed.
• Common adverse reactions include signs of overdose and hyperthyroidism, with a risk of V/D, diarrhea, weight loss, tachycardia, palpitations, angina, nervousness, tremors, irritability, insomnia, menstrual irregularities, sweating, and heat intolerance.
• Adverse reactions beyond hyperthyroidism symptoms are rare.

Thyroid Hormones: Contraindications and Precautions

• Contraindicated in clients with known hypersensitivity, uncorrected adrenal cortical insufficiency, or thyrotoxicosis (thyroid storm).
• Use cautiously with clients with cardiac disease, renal disease, hypertension, and diabetes.

Thyroid Hormones: Interactions

• Digoxin and beta blockers may exhibit decreased effectiveness when taken with thyroid hormones.
• Oral hypoglycemics and insulin use concurrently may result in an increased risk of hyperglycemia.
• Oral anticoagulants taken with thyroid hormones can cause prolonged bleeding.
• Antidepressants can increase the metabolism of thyroid drugs.

Nursing Process: Assessment for Thyroid Hormones

• Obtain baseline vital signs, weight, and height before starting therapy.
• Perform a physical assessment to note any outward signs of hypothyroidism.
• Monitor vital signs, weight, and height as ordered.
• Watch for signs of hyperthyroidism, which can indicate excessive drug dosage.
• It may take 6-8 weeks to see the full effects of the therapy.
• Monitor T4 and TSH levels.

Nursing Process: Implementation for Thyroid Hormones

• Administer once a day at a low dose initially, increasing over weeks; preferably before breakfast (30-60 min).
• For patients with diabetes, closely monitor for hyperglycemia and notify the provider if it occurs.
• Weigh patients weekly and report any significant weight gain or loss.
• Drug dosage may require periodic adjustments, and regular thyroid function tests, such as T4 and TSH, are needed every 6-8 weeks.
• Replacement therapy is generally lifelong.
• Doses should not be altered or discontinued without provider advice.

Nursing Process: Evaluation for Thyroid Hormones

• Decreased TSH levels and T4 levels within the normal range should be seen.
• Monitor for therapeutic responses, such as weight loss, mild diuresis, increased appetite, increased pulse, and decreased puffiness in the face, hands, and feet.

Thionamides (Antithyroid Drugs): Uses

• Used to manage hyperthyroidism medically.
• Help produce a euthyroid state prior to thyroid surgery and adjunct irradiation therapy of the thyroid gland.
• Utilized in the emergency treatment of thyrotoxicosis.

Antithyroid Drugs: Adverse Reactions

• Hypothyroidism.
• Agranulocytosis (decreased WBC), recognize and report fatigue, fever, sore throat, cough, or any signs of infection.
• Exfoliative dermatitis, report any rashes.
• Thrombocytopenia, recognize and report easy bruising or bleeding.

Antithyroid Drugs: Contraindications, Precautions, and Interactions

• Contraindicated in patients with hypersensitivity to the drug or any of its components.
• Used cautiously during pregnancy due to the risk of hypothyroidism in the fetus.
• The potential for bleeding increases when antithyroid drugs are taken with oral anticoagulants.
• Digoxin levels should be monitored when taken in combination.

Nursing Process: Assessment for Antithyroid Drugs

• Obtain the history of hyperthyroidism symptoms before starting therapy.
• Assess for iodine allergy prior to therapy, especially if the client is prescribed iodine adjunct therapy.
• Monitor thyroid levels.

Nursing Process: Assessment, Continued

• Monitor for adverse drug effects, including symptom worsening or relief, and thyroid storm or hypothyroidism manifestations.
• Watch for indications of adverse reaction relating to decreased blood cells, such as fatigue, fever, sore throat, easy bruising/bleeding, or any other infection signs.
• Cardiac symptoms, like tachycardia or palpitations, are likely; a beta-blocker is may be given.

Nursing Process: Implementation for Antithyroid Drugs

• Keep dosage times consistent each day with meals, to set a reminder.
• If the first or last dose interferes with sleep (drowsiness/insomnia), notify the provider.
• Medication should not be discontinued abruptly.
• Monitor frequently for agranulocytosis, thrombocytopenia, and signs of infection.

Radiopharmaceuticals

• Radioactive isotopes accumulate in the thyroid gland cells causing destruction to the thyroid cells without harming other cells in the body.
• Radioactive iodine (Sodium Iodide 131)'s uses include hyperthyroidism and thyroid cancer.
• It is also used when other antithyroid drugs have not worked.
• Negative effects include radiation sickness, bone marrow depression, and hypothyroidism.

Nursing Process: Implementation (Radiopharmaceuticals)

• Educate the client to maintain a 6-foot distance from others.
• Instruct not to prepare food for others or share utensils.
• Increase fluid intake to 2-3L/day.
• Follow the department of nuclear medicine directions regarding precautions.
• Limit contact with others to 1 minute/day/person.
• Thyroid hormone replacement therapy may be necessary if hypothyroidism develops.
• Schedule necessary follow-up evaluations to review the thyroid gland and effectiveness of treatment.

Iodine Products (Nonradioactive iodine)

• Creates high levels of iodide to reduce iodine uptake by the thyroid gland, which prevents the release of thyroid hormones into the bloodstream.
• Used to reduce gland size before surgery and treat thyrotoxicosis in emergencies.
• Adverse effects include iodism (metallic taste, stomatitis, frontal headache, skin rash).
• Advise clients not to take iodine with food high in iodine.
• Advise mixing the dose with juice for taste.
• Take at the same time each day and do not discontinue abruptly.
• Increase fluid intake

Thyroid and Antithyroid Drugs

• Thyroid Replacements include Levothyroxine sodium e.g. Levothroid and Synthroid
• Antithyroid Medications include:
  • Thionides e.g. Methimazole (Tapazole) and Propylthiouracil (PTU)
  • Radioactive Iodine - Sodium Iodide 131I (Iodotope, oral)
  • Iodine Product - Potassium Iodide (SSKI)

Adrenocortical Hormones: Corticosteroids

• Glucocorticoids and mineralocorticoids are essential for life, influencing many organs and structures.
• Both are anti-inflammatory, regulate blood pressure (increases), aid carbohydrate and protein metabolism, and aid fat metabolism.
• They also act as immunosuppressants that are released during stressful events and CNS (increase mood).
• Collectively these are called corticosteroids.

Uses for Adrenocortical Hormones

• Treats adrenocortical insufficiency (replacement therapy - Florinef) and allergic, collagen and dermatologic reactions/conditions
• Also treats rheumatic disorders and shock (increases BP).
• Acts an anti-inflammatory.

Adverse Reactions of Adrenocortical Hormones

• Can cause increased glucose, buffalo hump, moon face, oily skin and acne.
• Causes excess fat deposits on trunk, wasting of legs and arms, weight gain (increased sodium), or altered skin pigment.
• Also may cause osteoporosis (decreased calcium), and weakness (decreased potassium).

Contraindications/Interactions of Adrenocortical Hormones

• Contraindicated in active infections not controlled by antibiotics.
• Taking diuretics alongside may increase risk of hypokalemia. If hypokalemia occurs, this can increase digoxin toxicity.
• Can decreased the effects of oral antidiabetic drugs, insulin, and vaccines.

Nursing Process: Assessment of Adrenocortical Hormones

• Record vital signs (watch BP closely), weight, and electrolytes, glucose level (DM)
• Perform an assessment of area of disease involvement and record the findings
• Drug can be given IM, Subcut, IV, topically, or as an inhalant, intraarticular, intralesional, soft tissue, or bursa.

Assessment/Implementation of Adrenocortical Hormones

• Watch electrolytes and EKG.
• For long-term diseases, one possible treatment is alternate-day therapy. Take twice the daily dose every other day to decrease adverse reactions.
• Never omit medications. If the patient can't take PO, get an order for parenterally, especially for life-long therapy (e.g Addison's Disease)
• Give dose before 9:00am to minimize adrenal suppression and coincide with normal adrenal function.

Nursing Process: Implementation (Adrenocortical Hormones)

• For diabetic patients, monitor blood glucose levels several times daily or as prescribed. May increase glucose.

• Never discontinue medication suddenly is given for more than 5 days; must be tapered to prevent adrenal insufficiencies.

• Other nursing considerations:

  • Take doses with food or milk in the morning
  • Note that wounds will heal slowly
  • No vaccinations r/t immune decrease
  • Follow a diet that is low in sodium but high in vitamin D, protein and potassium

• Risk for infection: Report any slight rise in temperature or a sore throat and other signs of infection.

• Acute pain: Report any patient complaints of epigastric burning or pain, bloody or coffee-ground emesis, passing of tarry stools

• Excess fluid volume: Check for visible edema. Keep accurate fluid intake and output record, obtain daily weight, monitor breath sounds.

• If topical, don't cover. Avoid sunlight on treated area.

• Many of these drugs end in “one”

Drugs: Examples of Adrenocortical Hormones

• Betamethasone (Celestone)
• Cortisone
• Dexamethasone (Decadron)
• Hydrocortisone (Solu-Cortef)
• Methylprednisolone (Medrol)
• Prednisolone (Prelone)
• Fludrocortisone (Florinef, for Addison's disease adrenal cortical deficiency)

Adrenocorticotropic Hormone (ACTH): Corticotropin

• Stimulates the adrenal cortex to produce and secrete adrenocortical hormones, primarily glucocorticoids.
• Used for managing acute exacerbations of multiple sclerosis, nonsuppurative thyroiditis, hypercalcemia associated with cancer.
• Contraindicated in clients with adrenocortical insufficiency, allergy to pork or pork products, systemic fungal infections, ocular herpes simplex, scleroderma, osteoporosis, and hypertension.

Nursing Process: Assessment

• Obtain client's weight and assess skin integrity, lungs, mental status.
• Monitor client's weight and fluid intake and output daily during therapy.
• Monitor blood glucose levels for a rise in blood glucose concentration.
• Check stools for evidence of bleeding.
• If given IV, Subcut, or IM. Watch for allergic reaction for up to 2 hours post administration.

Nursing Process: Implementation

• Monitoring and managing patient needs is imperative.
• Risk for infection r/t masking infection. Observe skin daily for localized signs of infection, especially at injection sites or IV access sites.
• Be wary of disturbed thought processes. Report evidence of behavior change: mental depression, insomnia, euphoria, mood swings, or nervousness.
• Encourage communication with staff and family members.

Insulin

• Hormone manufactured by beta cells of pancreas in the body
• Promotes protein synthesis.
• Controls the storage and utilization of amino acids and fatty acids.
• Promotes the conversion of glucose to glycogen and in general, helps glucose get into cells.

Insulin: Action and Uses

• Key properties include the time of onset, peak time and the duration.
• Controls type 1 diabetes mellitus, type 2 diabetes, and severe diabetic ketoacidosis.
• Also treats hypokalemia when combined with glucose.

Insulin: Adverse Reactions, Contraindications, and Precautions

• Adverse reaction are hypoglycemia, hyperglycemia, hypokalemia and allergic reaction.
• Contraindicated in patients with hypersensitivity as well as hypoglycemia.
• Use cautiously in patients with renal and hepatic impairment during pregnancy and lactation.
• Hypoglycemia is indicated by TIRED = Tremors, Irritability, Restless, Excessive hunger, + Diaphoresis
• Hyperglycemia shows symptoms of hot, flushed skin, fruity breath, polyuria, loss of appetite, and tiredness.

Nursing Process: Assessment of Insulin

• Pre-administration assessment includes documenting type and dosage of insulin (if used), the type of diabetic diet, and average glucose results from the patient's chart.
• Obtain a h/o diabetic course and evaluate past compliance with the prescribed therapeutic regimen given by the health care provider. HgbA1C of 2.5-6.0 % indicates good compliance whereas HgbA1C > 10% indicates poor compliance.
• Ongoing Assessment includes looking for signs and symptoms of hypoglycemia and hyperglycemia throughout insulin therapy.
• Somogyi effect indicates that there is a rebound hyperglycemia, i.e. high blood sugar levels
• Administer supplemental insulin based on blood glucose readings with amount of insulin prescribed by MD in sliding scale as ordered. Also, alert the health care provider if blood glucose levels are sustained at more than 400 mg/dL.

Nursing Process: Implementation of Insulin

• Promoting an optimal response to therapy involves administering insulin with care (correct syringe).
• Read all drug labels before preparing any insulin preparation
• Read the insulin bottle label carefully to determine the name, source of insulin, number of units per milliliter.

Insulin Interactions

• Hypoglycemia effect increases when drugs ASA, anticoagulants, alcohol, beta blockers, oral hypoglycemics, MAOIs, tricyclic antidepressants, tetracycline are used.
• Hypoglycemia effects decrease with thiazides, glucocorticoids, oral contraceptives, thyroid drugs, and smoking.
• Lipodystrophy can occur, therefore rotation is needed to prevent Atrophy of Subcut tissue (fat).
• Interferes with absorption of insulin; appears as slight dimpling or pitting of Subcut fat

Nursing Process: Implementation/Administration of Insulin

• Insulin should be prepared for administration and can't be given orally.
• The temperature should be room temperature to limit lipodystrophy (loss of local fat deposits) because it looks lumpy and inhibits insulin absorption.
• Check expiration date printed on label of insulin bottle before withdrawing insulin for use in facilities within 28 days of opening.
• Gently rotate the vial between the palms and gently tilt it end-to-end before the withdrawing.
• Check prescribed order for type and dosage of insulin before withdrawing from vial. Availably in U100 and U500.
• Be aware that premixed insulins are available, usually long and intermediate acting as well as short-acting are mostly effective in administration.
• Mixing and dilution should also be performed for any of the previous insulin types.

Nursing Process: Continued Implementation/Administration of Insulin

• Promote an optimal client response by ensuring medication adheres with injection at 45°- for non-obese patients and at 90° with obese patients to facilitate effective delivery upon injection sites.
• A carefully planned injection site rotation pattern must be between 1 -1 1/2 inches apart, writing this plan in both client's chart and/or the area receiving administration,
• Recording usage of inflammation or skin reaction locations must be clearly recorded in after injection. In the event of a allergic reaction to the injects you also must contact health care providers immediately after noticing,
• Furthermore administer via specific sites including 2inches away to the naval, upper arms, or anterior thighs. for maximum absorption rates.

Documentation and Rate of Delivery of Insulin

• Abdomen has the fastest absorption rate.
• It should, therefore, be the one that has recording done on the MAR (Medication Administration Record,
• Various methods are available for administering medications including:
  • Jet injection system
  • Disposable needle and syringes
  • Insulin pump
  • Insulin pen
• To ensure patient safety avoid any oral/fluids terminated through reaction by monitor and management protocols present when swallowing and gag reflexes become present.

Hypoglycemia and Hyperglycemia

• Hypoglycemia can occur when there is a patient's little to not enough food consumption: In these cases, it requires correctly measured insulin levels, and Drastically increased physical activity. These require

  • Careful monitoring/supervision to maintain accurate diet and lifestyle, and
  • Medication administered to inject into other areas away from any previously active areas already experiencing treatment from medication.

• Hyperglycemia will occur with excess administration and food levels but too little too the point of complete absence of administration occurs when someone is:

  • Already emotionally taxed, or suffering the implications and strain brought on by emotional stress, infection, surgery, pregnancy, or other acute illness.

Nursing Process: Instructions

• Patient Education includes a focus on:

  • Diet considerations

  • How Insulin sensitivity effects pregnancy

  • How Exercise effects the body in contrast with insulin resistance

Types of Insulin

• Rapid acting: Clear, and can anticipate hypoglycemia in mid-morning, Peak is at 0.5 to 3 hrs, and with Duration of 3 to 5 hrs, (examples; lispro/aspart for about 15 minutes before and immediately after meals).

• Regular insulin: It is short-acting, clear, the most is commonly administered via SC and IV, given 30 - 60 minutes before meals with anticipated hypoglycemia in the late part of lunch, Peaks are at 1 to 5 hours, and the Duration 6 hours.

• Intermediate insulin: Cloudy, only given via Subcutaneous and Never given in the event you're in crisis, anticipates hypoglycemia around supper hours with a peak around 4 -14 minutes, has the longest Duration at 6 - 10 hrs.

• Mixtures: Have a Both cloudy visual quality and provide two different Onsets, Peaks and Durations, typically one set belonging to the slower peak acting intermediate side, and the rapid of the two will be quick peaking in comparison.)

• Long acting: Clear, given once in 24 hrs, and mixes with nothing at all. In this instance it stays peakless for a long.

• Ultra Long acting: Clear, Peakless, given only once in 24 hrs, snacked, but stays with nothing and has a duration of all hours.

• Rapid: Insulin lispro - Humalog and Insulin aspart - Novolog examples are all examples of rapid Insulin Medication options.

• Short acting insulins include insulin regular – Humulin R or Novolin R

• Intermediate acting includes Isophane insulin suspension (NPH) Humulin N, or Novolin N, and for Lente is Insulin zinc suspension (Lente) – Humulin L, Novolin L

• Mixtures Protamine aspart, or aspard e.g. as with products like Novolog or Protamine lispro, or lispro e.g. with products like Humalog

• Long acting Insulin detemir as found with Levemir and Extended insulin zinc suspension with Ultralente or Humulin U

• Ultra Long acting Insulins include Insulin Degludec using Tresiba or Insulin glargine Lantus options.

Oral Antidiabetic Drugs

• Oral antidiabetic drugs treat patients with type 2 diabetes that is not controlled by diet and exercise alone.
• These drugs are not effective for treating type 1 diabetes.
• Drugs include sulfonylureas, meglitinides, biguanides, and thiazolidinediones.
• Also included are alpha ()-glucosidase inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose co-transporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists.

Sulfonylureas

• Stimulates the release of insulin from the pancreas but only for those who developed disease after age 40 or are on less than 40 units of insulin a day.
• These are intended for cases where the pancreas is functional and able to make some insulin
• Notable Side Effects is Anorexia and abdominal cramps - this will often resolve as treatment continues.
• The most notable side effects are Hypoglycemia and Hepatotoxicity. It may cause Blood dyscrasias - as well
• Dermatologic reactions - these may indicate a need to report for infection.
• This medication is typically accompanied with food - except Glipizide can be taken 30 minutes before meals

Drug and Drug Interactions, Continued

• BUN, Creatinine, Liver Function tests, all blood-based-tests to detect infections, such as those and urine - to detect how effectively the patient has broken all those down.
• Interactions include Alcohol. Cimetidine, as well Propanolol mask symptoms of hypoglycemia, and NSAIDS
  • In short to follow it causes Alcohol with an inability to properly process with Sulfonylureas, also, it will impede when also mixing with Steroids, as well
  • As for drugs, it leads to Chlorpropamide, and Amaryl to which typically only the the elderly would take as an exemption and recommendation.

Meglitinides

• Stimulate release of insulin from the beta cells with a Faster Onset and Shorter Duration than other drugs.
• Can be employed to manage meal-related blood glucose elevations where the target should apply to instances in Type ll Diabetes and 40.
• In conjunction with Metformin its highly beneficial, but this should be avoided being and substitution and rather an alternative treatment.
• These should be taken 30 minutes before meals which may reduce compliance - and if the meal is skipped, the medication will also be skipped.

Meglitinides Adverse Interactions

• Enhances by mixing Sulfonylureas e.g. from that of alcohol, NSAIDS, warfarin, hyperlipidemics and MAOls - or for a reduced effect are often the result of Steroids, phenothiazine, Diuretics as well as lithium Carbonate supplements, these effects should be reported when also experiencing such symptoms.

• Drugs in the Meglinitides medication category often leads to nateglinide, and Repaglinide - with Starlix also as another such Drug Medication option.

Biguanides Action

• Actions revolve around Reducing Hepatic Glucose, this can happen where the levels peripherally are not being maintained effectively. In these circumstances, the patient is often recommended this as a medication as a 1st Choice treatment after others have been ineffective.

• Advantages here are typically no reported weight gain, and cases showing reduced levels of LDL with increased triglycerides.

• This medication is most often taken with other meals which shows benefits when: Taking Iodinated materials being transferred for study/radiological needs - to prevent Renal failure.

• Side effects to Report in addition to Lactic Acidosis can be as follows:

  • Sluggishness

  • Myalgias

  • Respitory Distress

  • Hyperventilation, this effect and all the one's with it, often points to the implication of an onset Lactic Acidosis - though these are all rare and low possibility cases.

BIGUNADIES

• When this type of medical option becomes relevant, the health team must ensure if the patient is Nursing correctly by: With appropriate contrast levels. 48 hours must be provided from contrast to this medication.

Actions of Thiazolidinediones:

• This is in reaction reduction sensitivity to increase insuling responses - This all leads to lower liver rates for those with Type Il diabetes- with a result improved by also including Metformin to promote blood sugar control.

• There are potential adverse reactions with:

  • Lowered liver rates

  • Potential Edima

  • High weight levels - and for some may alter effectiveness when using: oral contraceptives

  • Be Sure to follow through with insulin medication schedules, even though these do include the necessity of an occasional meal. And these meals must happen immediately upon taking the medication.

Actions of Alpha-Glucosidase Inhibitors

• They inhibit absorbtion of Enzyme, as part of a delayed measure meant absorb Enzyme while increasing amounts of glucose.

• They are mostly reserved for Type II related unresponsiveness (meaning when someone has been unable to diet properly or has an excersize disability) It promotes: Reduced hypoglycemia

• Mild-to-mid results of abdominal and other typically unpleasent reactions.

Drug effects of alpha-glucosidase

• They are hypoglycemic and effect for Anemia as some of the main side interactions. With additional increased levels of Hyperglycemia-especially when mixing Steroids, or other medication. Therefore it tends to be with each "First Bites of each 3 meals a day".

• An often issued drug-named Precose - includes Acarbose to improve medication efficacy.

DPP-4 INHIIBITORS

• IN combination with -

  • Januvia
  • Onglyza
  • Tradjenta (and all three of these),

• This should decrease the breakdown when treating type number TWO - as ONE singular Dose

• Have Very Little Side Effects and do cause joint pain + nausea as they have an extremely rare case and effect for causing weight loss if not consumed with food.

• Caution should maintained only those who are:

  • Unable to effectively handle dosage.

Reductions effects on renal failures and bone density with : SLGT2 INHIBITORS

• Increases Bone density
• Fungal infection around a open sore

GLP-1 and NonInsuline Injectable

• It's role is to inject the increase after eating but without any ability too slow the absorption into body unless a secondary injection for these issues becomes readily made.

• This includes - as with "all cases of" that include the medications, Victoza's

  • These serve a critical role for stimulating blood after-meals, therefore there are: Victoza/Trulicity with side effects like Byetta
  • Injection actions have a very low - potential to activate release hormones within the body for specific situations - with short absorption.

INHALED Insulin

• Can serve a meal-time effect
• Use the synthetic route as a source