Diabetes Pharmacology Lecture Notes PDF

Diabetes Pharmacology By Alia Lagace RN MN CCNE Based on content from Danielle Yaffe  Learning Objectives Build on (review and apply) the objectives from the voiceover prep presentation: Interpret the pharmacokinetics, pharmaco...

Diabetes Pharmacology By Alia Lagace RN MN CCNE Based on content from Danielle Yaffe  Learning Objectives Build on (review and apply) the objectives from the voiceover prep presentation: Interpret the pharmacokinetics, pharmacodynamics, and pharmacotherapeutics of the medications listed Link each of these medication classes to the pathophysiology of diabetes  Agenda 1. Muddiest Point 2. Insulin Review and Active Learning Rapid acting Short acting Intermediate acting Long acting Ultra-long acting Combo 3. Non-insulin DM medications Review and Active Learning Insulin sensitizers Incretin Agents Insulin Secretagogues Miscellaneous Muddiest Point from Prep Let’s Review the Role of Insulin Synthesized by pancreas → beta cells within the Islets of Langerhans Released primarily when blood sugars increase → usually after a carbohydrate rich meal Normally, when we eat a meal, there is increased insulin release Lewis p. 1271  Role of Insulin Which of the following is a consequence of insulin deficiency? Select All That Apply: a. Increased serum blood glucose b. Decreased gluconeogenesis c. Decreased cellular glucose uptake d. Increased glycogen breakdown  Role of Insulin The body needs more insulin in which of the following situations? Select all That Apply: a. Infection b. During an exam period c. When fasting d. Overnight  Short Duration: Rapid Acting Insulin Generic Name Brand Name Onset Peak Duration Nursing Considerations Insulin lispro Humalog 15-30 min ½ to 2.5 hrs 3-6 hrs SC inj: ~15 min before or JUST after meals Subcut pump: provide continuous glucose control Common sliding scale insulin choice Insulin aspart Novolog “ ” “ ” “ ” SC inj: 5-10 mins before meals Subcut pump: provide continuous glucose control Common sliding scale insulin choice  Short Acting Insulin Generic Name Brand Name Onset Peak Duration Nursing Considerations Regular insulin Humulin R, 30-60 min 1-5 hrs 6-10 hrs 30 min pre-meal subcut injection for postprandial control Novolin R, Subcut pump: provides continuous glucose control (not as popular as rapid acting for this) Sometimes used as a sliding scale insulin IV route: in acute care settings  Intermediate Acting Insulin Generic Name Brand Name Onset Peak Duration Nursing Considerations NPH insulin Humulin N, Novolin N 1-2 hrs 6-14hrs 16-24 hrs Subcut inj: twice daily at the same times each day Gently agitate before use “cloudy insulin” Can be mixed with rapid or short acting insulins  Long-Acting Insulin Generic Name Brand Name Onset Peak Duration Nursing Considerations Insulin glargine Lantus ~1hr None 18-24 hrs Subcut inj: typically, ONCE daily at the same times each day Clear insulin Insulin detemir Levemir 1-2hrs None 18-24hrs Subcut inj: typically, ONCE daily at the same times each day Clear insulin  Ultra Long Acting Generic Name Brand Name Onset Peak Duration Nursing Considerations Insulin degludec Tresiba 30-90 min None > 24hrs Once daily at same time  Combination Insulins Generic Name Brand Name Onset Peak Duration Nursing Considerations 70% NPH insulin/30% regular insulin Humulin 70/30 30-60 2-12 hrs 10-16hrs Novolin 70/30 Lehne p. 672  Insulin in Practice Mrs. Johnson is a 58-year-old female, presents to the clinic with a recent diagnosis of diabetes. She reports increased thirst, frequent urination, and fatigue. Mrs. Johnson has a past medical history of hypertension and hyperlipidemia. This Photo by Unknown Author is licensed under CC BY-NC-ND Upon assessment, Mrs. Johnson's blood glucose levels are elevated, the healthcare team decides to initiate insulin therapy and educate Mrs. Johnson about the different types of insulin. What type of insulin do you think would be initially prescribed to Mrs. Johnson for basal insulin therapy? A) Insulin 30/70 B) Insulin lispro C) NPH insulin D) Regular insulin What nursing considerations are important to ensure Mrs. Johnson understands with this medication? 1. ________________ 2. ________________ 3. ________________ To control postprandial glucose spikes, the healthcare team decides to add which type of insulin before meals? A) Insulin aspart B) Insulin glargine C) NPH insulin D) Insulin degludec When should this insulin be administered in relation to mealtimes? __________ Sliding Scale Insulin Break!  False False True False False True  False True False True False True False True Place the Data in the Correct Insulin Jar: Basal Clear Used for sliding scale with meals Insulin Lispro Insulin Aspart Take ~ 30 minutes before meals Provide constant level of Bolus Clear insulin in body, no peak Can be given without food Clear Only type used for IV insulin infusions Insulin Regular Cloudy Basal Take right before meals Take right before meals Used for sliding scale with meals Bolus Insulin NPH Insulin Glargine Only insulin that can be mixed with short acting insulins Most closely mimics endogenous insulin Often given once daily 1) Rapid Acting 2) Short Acting 3) Intermediate Acting 4) Long Acting Jeopardy Time!  Non-Insulin Diabetic Medications Insulin Miscellaneous Insulin Sensitizers Incretin Agents Secretagogues (Glucose wasters) Biguanide GLP 1 receptor Sulfonylureas SGLT 2 (Metformin) agonists (Glyclazide) Inhibitors TZDs (Liraglutide) Meglitinides (Canagliflozin) (Rosiglitazone) DPP 4 Inhibitors (Repaglinide) Alpha- (Sitagliptin) glucosidase Inhibitors (Acarbose)  Insulin Sensitizers Biguanides Thiazolidinediones /TZDs Metformin (Glucophage) Rosiglitazone (Avandia) MOA: 1) Decreases glucose production MOA: 1) Decreasing insulin resistance in in the liver muscle and fat cells 2) Decreasing insulin resistance in muscle and fat cells 2) Decreases glucose production in the liver 3) Slightly reduces glucose absorption in the gut Side Effects: Side Effects: GI upset, lactic - most common URTI, HA, acidosis sinusitis, and myalgia. - greatest risk is heart failure https://www.facebook.com/integrateddiabetesservices/photos/a.460034427389639/3516470258412692/?type=3  Incretin Agents DPP 4 Inhibitors GLP 1 Receptor Agonists Sitagliptin (Januvia) Liraglutide (Victoza) MOA: inhibiting DPP 4 (blocks the breakdown of MOA: Activates GLP 1 incretins) receptors for GLP-1 Side Effects: pancreatitis, allergic Side Effects: GI upset, rxn allergic rxn, pancreatitis, thyroid Ca https://youtu.be/FePjKBoFICA Break!  Insulin Secretagogues Sulfonylureas Meglitinides Gliclazide Repaglinide (Diamicron) (GlucoNorm) MOA: Stimulation of pancreatic insulin release MOA: Stimulation of may also increase target pancreatic insulin release cell sensitivity to insulin Side Effects: hypoglycemia, Side Effects: weight gain hypoglycemia, weight gain https://scribeschool.net/how-insulin-works Miscellaneous: Glucose Wasters SGLT 2 Inhibitors Alpha-Glucosidase Canagliflozin Inhibitors (Invokana) Acarbose (Glucobay) MOA: Inhibits SGLT-2 in the kidney→ reduces MOA: reabsorption of glucose Delays absorption of Increases urinary glucose dietary carbohydrates excretion Side Effects: Side Effects: Yeast infections, UTIs, GI upset, anemia, liver Dehydration, dysfunction Hyponatremia  Beta-Blockers & Blood Glucose What is the connection? https://support.mindwaretech.com/2020/04/measuring-the-autonomic-nervous-system/ Game Time… Let’s Review! Rate how confident you feel on your understanding of DM meds now? Questions?