Unit 9.1 Antidiabetics PDF

Antidiabetics NUR 210/BSL 101 Unit 9 DIABETES MELLITUS Chronic disease of deficient glucose metabolism Insufficient insulin secretion from pancreatic beta cells Impaired insulin use Major symptoms: polyuria, polydipsia, polyphagia Types Type 1 - insulin-dependent Typ...

Antidiabetics NUR 210/BSL 101 Unit 9 DIABETES MELLITUS Chronic disease of deficient glucose metabolism Insufficient insulin secretion from pancreatic beta cells Impaired insulin use Major symptoms: polyuria, polydipsia, polyphagia Types Type 1 - insulin-dependent Type 2 - insulin resistant Body tissues do not respond to the action of insulin. Insulin receptors are unresponsive. Insulin receptors are deficient in numbers. Secondary - due to medications (glucocorticoids, thiazide, diuretics, epinephrine) Gestational - due to hormonal changes during pregnancy Hemoglobin A1c - HbA1c Derivative of the interaction of glucose with hemoglobin in red blood cells (RBCs) Used for diagnosis of diabetes as recommended by the ADA RBCs have a lifespan of approximately 120 days - HbA1c level reflects the average glucose level for up to 3 months Treatment goal is to keep the diabetic Hemoglobin client’s HbA1c below 7% HbA1c level of 5% = no diabetes 5.7% to 6.4% indicates prediabetes 6.5% or greater = diabetes mellitus  Action Insulin promotes uptake of glucose, amino acids, and fatty acids Promote use of glucose by body cells, store glucose as glycogen in muscles and liver for future glucose needs Use Reduce blood glucose in diabetes Galen values: 70-110 Hypoglycemia Headache, dizziness, confusion, slurred speech, hunger, weakness Nervousness, anxiety, agitation Tremors, sweating Insulin Flushing, lethargy Redness, irritation or swelling at injection site Adverse Reactions Tachycardia, palpitations, hypoglycemic reaction Shock, anaphylaxis, ketoacidosis Interactions Decreased glucose with aspirin, oral anticoagulants, alcohol, other hypoglycemics, beta blockers Increased glucose with thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking Contraindications Hypoglycemia Allergy Insulin Shock vs. Diabetic Ketoacidosis Insulin Shock - Diabetic Ketoacidosis - Hypoglycemic Reaction Hyperglycemic Reaction Headache, lightheadedness Extreme thirst Nervousness, apprehension, tremor Polyuria Excess perspiration; cold, clammy skin Fruity breath odor Tachycardia Kussmaul breathing (deep, rapid, labored, distressed, dyspneic) Slurred speech Rapid, thready pulse Memory lapse, confusion, seizures Dry mucous membranes, poor skin turgor Blood glucose 250 mg/dL INSULIN TYPES Rapid-acting - Insulin lispro (Humalog) Onset of action (15-30 minutes) Peak (30 minutes to 90 minutes) Duration (3 to 5 hours) Short-acting insulin (clear) - Insulin Regular Onset of action (30 minutes) Peak (1.5 to 3.5 hours) Duration (4 to 12 hours) INSULIN TYPES Intermediate-acting (cloudy) - NPH Insulin Onset of action (1 to 2 hours) Peak (4 to 12 hours) Duration (14 to 24 hours) Long-acting - Insulin glargine Onset of action (1 to 1.5 hours) Duration (24 hours) Administered at bedtime Insulin Types - Combinations Composed of short/intermediate acting or rapid/intermediate acting Humulin or Novolin 70/30 (NPH 70%, insulin regular 30%) NPH 50%, regular 50% Can be mixed in other strengths Have two onsets, two peaks, two durations Knowledge Check You have a client order for NPH and Lispro for 0800 AM and your client is scheduled for a procedure at 1300 PM and will be NPO at lunch. Which of the following is the correct action regarding administration of the 0800 insulin dose? A. Hold both Lispro and NPH B. Hold the Lispro and give NPH C. Hold the NPH and give Lispro D. Give both – monitor glucose, no interaction expected  CGMs continually monitor your blood glucose (blood sugar), giving you real-time updates through a device that is attached to your body. They have become popular and more accurate over CONTINUOUS the years and are now considered a viable treatment option for people with diabetes. GLUCOSE MONITOR American Diabetic Association (2024) Insulin Delivery Devices Methods of insulin administration Insulin pumps Insulin pen injectors Insulin jet injectors Insulin Pump Wireless Pump Insulin Administration and Storage Insulin – given SQ, absorbs faster in abdomen Only use insulin syringe - U-100 Do not shake insulin - roll Do not apply heat or massage injection site Keep unopened inulin in refrigerator Remove from refrigerator 30 minutes before injection to decrease tissue irritation May store open insulin at room temperature for 30 days or in the refrigerator for 3 months Avoid storing insulin in direct sunlight or at high temperatures  Adjusted doses dependent on individual blood glucose Usually done before eating and at bedtime Usually uses rapid or short-acting insulin Example Sliding-Scale Insulin 151-200 2 units insulin lispro 201-250 4 units insulin lispro 251-300 6 units insulin lispro 301-350 8 units insulin lispro Insulin Orders Initial 70/30 Insulin Dosing  Assessment Take a medication/medical history Assess the type of insulin and dosage Vital signs Blood glucose reading, A1C lab Signs and symptoms of hypo/hyperglycemia Nursing interventions/Teaching Nursing process: Monitor vital signs and glucose levels, HgbA1c Instruct client to report hypoglycemia and Insulin hyperglycemia & that hypoglycemia more likely during the peak time of insulin Teach how to stop a hypoglycemic event Encourage compliance with diet, insulin, exercise Advise client to wear medical alert tag Teach client how to check blood glucose Teach client how to administer insulin and rotate sites to prevent lipodystrophy Lipodystrophy  Onset of diabetes mellitus at age 40 years or older Guidelines for Oral Diagnosis of diabetes for less than 5 years Antidiabetic Therapy for Normal weight or overweight Type 2 Diabetes Fasting blood glucose 200 mg/dL or less Less than 40 units of insulin required per day Normal renal and hepatic function  Used to treat type 2 diabetes Action (increases insulin) Stimulates pancreatic beta cells to secrete more insulin Decrease glucose production Makes cells more receptive to insulin Side Effects/Adverse reactions Oral Antidiabetic Drugs Drowsiness, headache, confusion, visual disturbances, GI disturbances, anxiety Sulfonylureas Adverse Reactions Glipizide Hypoglycemia, tachycardia Seizures, coma respiratory depression Contraindications Liver or kidney dysfunction Interactions Alcohol – Antabuse type reaction Beta blockers Green tea – increases hypoglycemia Many other  Uses Control blood sugar in type 2 diabetes Action (decreases sugar) Decrease hepatic production of glucose from stored glycogen Diminishes increase in serum glucose after meals Oral Antidiabetic Drugs Decreases postprandial hyperglycemia Biguanides Decreases glucose absorption from small intestine Increases insulin receptor sensitivity Metformin Increases peripheral glucose uptake at the cellular level Side effects/ Adverse reactions Dizziness, fatigue, headache Agitation Bitter or metallic taste Weight loss GI symptoms – abdominal pain, bloating, discomfort  Adverse Reactions Hypoglycemia (not as common) Lactic acidosis Contraindications Hold medication 48 hours before and after client Oral Antidiabetic Drugs receives contrast dye or client may have lactic Biguanides acidosis or acute renal failure Hepatic/renal dysfunction Metformin Interactions Many IV contrast dye Green tea increases hypoglycemia Can cause liver dysfunction Knowledge Check Metformin is ordered daily for a client. He is scheduled for a CT scan at noon. He had a dose this am. The nursing actions A. proceed as planned B. notify the MD to re-schedule the procedure C. proceed and hold dose tomorrow D. Reschedule for next week SGLT2 Inhibitors - AKA Gliflozins Lowers blood sugar levels by preventing kidneys from reabsorbing sugar - extra sugar is excreted in urine Indications Type II diabetes Reduce risk of CVD with T2D Heart failure Chronic kidney disease (without dialysis) Pharmacokinetics Oral administration - can be taken with food Highly protein bound Long half-life = daily dosing Contraindications Pregnancy Bexagliflozin (Brenzavvy) Chronic renal disease with dialysis Side/Adverse Effects Canagliflozin (Invokana) Volume depletion - frequent urination Dapagliflozin (Farxiga) Genitourinary infections Empagliflozin (Jardiance) Decreased effect with rifampin, phenytoin, phenobarbital, antivirals Ertugliflozin (Steglatro)  Medication review Diuretics Medications that affect renal function Nursing Implications/ Monitor blood glucose Monitor kidney function Client Teaching Administer at same time daily SGLT2 Inhibitors Maintain hydration Empagliflozin Monitor HgA1c for long-term effectiveness (Jardiance) Contact provider if Painful urination Severe pelvic/back pain Genital itching/discharge Flu-like symptoms Swelling, pain in feet lower extremities - exacerbation of peripheral vascular disease associated with diabetes Glucagon-Like Peptide Agonists (GLP-1 Agonists) Agents that act like incretin hormones Dulaglutide (Trulicity) (weekly) Bind to GLP-1 receptors and stimulate Exenatide extended release (Bydureon BCise) (weekly) glucose dependent insulin release acting as Exenatide (Byetta) (twice daily) an antihyperglycemic Semaglutide (Ozempic, Wegovy) (weekly) Suppress appetite and inhibit glucagon Semaglutide (Rybelsus) (taken by mouth once daily) secretion Liraglutide (Victoza, Saxenda) (daily) Slow gastric emptying preventing steep rise Lixisenatide (Adlyxin) (daily) in post-prandial blood glucose levels Tirzepatide (Mounjaro) (weekly) Released after eating and augment the Albiglutide (Tanzeum) (weekly) secretion of insulin released from pancreatic beta cells Stimulates pancreas to secrete insulin when blood sugar levels are high  Action Enhance insulin secretion Increase beta-cell responsiveness Suppress glucagon secretion Slow gastric emptying Reduce food intake GLP-1 Agonist Long half-life Indications Semaglutide Type 2 diabetes (Ozempic/Rybelsus) Obesity Cardiovascular disease Administration Weekly (Sub-Q); daily (oral) Side Effects Nausea, vomiting, diarrhea, constipation, heartburn, belching Injection site itching, redness Early satiety  Adverse Effects Hypoglycemia - low risk Cholecystitis Thyroid tumor Tachycardia Jaundice Pancreatitis GLP-1 Agonist Contraindications Pregnancy Semaglutide History of thyroid cancer - family or client (Ozempic/Rybelsus) History of pancreatitis Severe renal dysfunction Cautions Renal impairment Interactions Metformin/insulin - increased risk of hypoglycemia Delayed gastric emptying may affect absorption of other drugs Antidepressants - hypoglycemia Antibiotics - hypoglycemia  Use contraception in female client of childbearing age Monitor HgA1c for long term effectiveness Continue periodic glucose checks Monitor renal function GLP-1 Agonist Client Teaching Nursing Implications Injection technique Signs/symptoms of hypoglycemia Discontinue prior to elective procedures - decreases risk of aspiration due to delayed gastric emptying Diet/lifestyle modifications Contact provider for severe abdominal pain, signs/symptoms of jaundice  Hyperglycemic hormone secreted by the alpha cells of the islets of Langerhans Increases blood sugar by stimulating glycogenolysis in liver Used to treat insulin-induced hypoglycemia when other methods of providing glucose are not available or client non-responsive Hyperglycemic Agents Route of administration Glucagon Parenteral use (subQ, IM, and IV) Works in about 10 minutes