Diabetes Mellitus Class PDF

Drugs for Diabetes Mellitus Chapter 60 Objectives Review of the incidences and causes of diabetes mellitus Discuss the types and time-lines of administration of insulins used in diabetes treatment Discuss the mechanisms of action, adverse effects and interactions of other diabetes...

Drugs for Diabetes Mellitus Chapter 60 Objectives Review of the incidences and causes of diabetes mellitus Discuss the types and time-lines of administration of insulins used in diabetes treatment Discuss the mechanisms of action, adverse effects and interactions of other diabetes medications Develop understanding of related client care issues with insulins and oral medications How Big is Diabetes Mellitus? 422 million people worldwide have diabetes (WHO) Canada >9 million Canadians live with diabetes or prediabetes Indigenous population 3-5 times more likely than general population to develop type 2 diabetes Diabetes Mellitus Untreated diabetes can lead to: Heart disease Kidney disease Eye disease Erectile dysfunction (impotence) Nerve damage Immunosuppression Poor wound healing Symptoms of Diabetes Mellitus Unusual thirst Frequent urination Weight change (gain or loss) Extreme fatigue or lack of energy Blurred vision Frequent or recurring infections Cuts and bruises that are slow to heal Tingling or numbness in the hands or feet Trouble getting or maintaining an erection It is important to recognize, however, that many people who have type 2 diabetes may display no symptoms  Guidelines healthcare providers patients Diabetes Mellitus Two main types Type 1 (~10%) Type 2 (~90%) Gestational diabetes Others (eg drug-induced) Type 1 Diabetes Mellitus Lack of insulin production need exogenous insulin Production of defective insulin need exogenous insulin Complications Retinopathy, nephropathy, neuropathy Diabetic ketoacidosis (DKA) Type 1 Diabetes Mellitus Drug therapies Insulin – absolute requirement Certain oral antihyperglycemic agents can be used as adjuctive agents Type 2 Diabetes Mellitus Most common type 90% of clients Caused by insulin deficiency and/or insulin resistance Many tissues are resistant to insulin Reduced number insulin receptors Insulin receptors less responsive Gestational Diabetes Hypergylcemia onset during pregnancy, resolves at end of pregnancy Insulin is usually medication of choice Metformin may be used Testing for Diabetes Mellitus Blood glucose measurement Glucose tolerance test % HbA1c (glycated hemoglobin) Testing for Diabetes Mellitus Measure HbA1C Glycated Hb = glucose + Hb Non-diabetic proportion over life-time of RBC 3 months – 4 - 5.9% Diabetic > 6.5% Measure of the average blood glucose over the past 3 months  HbA1c Ave. Blood Glucose (%) (mmol/L) 13 18 mmol/L 12 17 mmol/L 11 15 mmol/L Hyperglycemia past 3 months 10 13 mmol/L 9 12 mmol/L 8 10 mmol/L Treatment Goal 7 8 mmol/L 6 7 mmol/L 5 5 mmol/L Normal Treatment Goals Diabetes Canada Guidelines Treatment of Diabetes Mellitus Insulins Recombinant human insulins Non-insulin drugs oral injectables http://www.youtube.com/watch? v=VVXmFW22nnE&feature=related 7:22 Insulins Medication sites of action Insulins Function as a substitute for endogenous hormone Effects are the same as normal endogenous insulin Improves the diabetic’s ability to Take up glucose into cells Make proteins and triglycerides Make glycogen from glucose in liver Convert glucose to fatty acids in adipose tissue Types of Insulins Rapid-acting Short-acting Intermediate-acting Long-acting  Insulin Type (trade name) Onset Peak Duration Bolus (prandial) Insulins Rapid-acting insulin analogues (clear): Insulin aspart (NovoRapid®) 10 - 15 min 1 - 1.5 h 3-5h Insulin glulisine (Apidra™) 10 - 15 min 1 - 1.5 h 3-5h Insulin lispro (Humalog®) 10 - 15 min 1-2h 3.5 - 4.75 h Insulin lispro U200 (Humalog® 200 units/mL) 10 - 15 min 1-2h 3.5 - 4.75 h Short-acting insulins (clear): Insulin regular (Humulin®-R) 30 min 2-3h 6.5 h Insulin regular (Novolin®geToronto) Basal Insulins Intermediate-acting insulins (cloudy): Insulin NPH (Humulin®-N) 1-3h 5-8h Up to 18 h Insulin NPH (Novolin®ge NPH) Long-acting basal insulin analogues (clear) 90 min Up to 24 h (detemir 16-24 h) Insulin detemir (Levemir®) 90 min Up to 24 h (glargine 24 h) Insulin glargine (Lantus®) Not Up to 6 h applicable Up to 30 h Insulin glargine U300 (Toujeo®) 90 min Up to 24 h (glargine 24 h) Insulin glargine (BasaglarTM) Human-Based Insulins Very Important time frames of insulins are essential to know Human-Based Insulins Rapid acting onset 10-15 minutes peak of action 60-90 minutes duration 3-5 hours Most rapid onset of action, short duration Insulin lispro (Humalog) Insulin aspart (NovoRapid) Taken with each meal Human-Based Insulins Short (fast) acting onset 30-60 minutes peak 2 -3 hours duration 6-7 hours Regular insulin (Humulin R or Novalin R) SC IV infusion pump Can be IM (but rarely) Human-Based Insulins Intermediate acting onset 1-3 hours peak 5-8 hours duration 10-18 hours NPH (neutral protamine Hagedorn) Isophane insulin suspension cloudy appearance Basal therapy Human-Based Insulins Long acting onset 90 minutes NO pronounced PEAK duration 24 hours Insulin glargine (Lantus) Clear, colourless solution Basal therapy Human-Based Insulins Diabetes Canada recommends use basal insulins + rapid acting insulins achieve good glycemic control Human-Based Insulins Combination Insulin products come premixed in one solution Examples: regular insulin 30% and NPH 70% Novolin 30/70 regular insulin 50% and NPH 50% Novolin 50/50 Insulin lispro protamine suspension 75% and insulin lispro 25% Basal Bolus Insulin Therapy Basal Bolus Insulin Therapy (BBIT) in hospital setting 3 components: basal insulin (long acting), bolus (short acting or meal-time) insulin, and correction insulin target range of 5-10 mmol/L prevents blood sugar highs and lows Too Much Insulin? Hypoglycermia warning signs alert value of