Insulin OHA Drugs PDF

ANTIDIABETIC MEDICATIONS 1. 2. 1. 2. 3. 4. 1. 2. Insulin activates the sodium potassium ATPase pumps, which shift potassium into the intracellular space, thereby decreasing potassium levels in the blood. RISK FACTORS FOR DEVELOPING DIABETES 1. 2. 3. Acanthosis nigricans  D...

ANTIDIABETIC MEDICATIONS 1. 2. 1. 2. 3. 4. 1. 2. Insulin activates the sodium potassium ATPase pumps, which shift potassium into the intracellular space, thereby decreasing potassium levels in the blood. RISK FACTORS FOR DEVELOPING DIABETES 1. 2. 3. Acanthosis nigricans  Diabetes labs: 1. 2. - 1. 2. 3. DEADLY EFFECTS OF HYPERGLYCEMIA About 1 to 2% of the mass of the pancreas is made up by the islets of Langerhans, which are endocrine glands made up by five different cell types, and each cell type secretes a specific hormone. The most abundant are: 1. the beta cells, which produce insulin. 2. You can also find alpha cells that secrete glucagon 3. delta cells that secrete somatostatin 4. gamma cells that secrete pancreatic polypeptide 5. and finally epsilon cells that secrete ghrelin. The most important trigger for insulin secretion is glucose Beta cells are sensitive to glucose concentrations in blood, and when blood glucose levels rise, beta cells secrete insulin into the blood to help lower those levels and store glucose. Insulin binds to the insulin receptor located in the membrane of its target cells - mainly in: 1. the liver 2. fat or adipose tissue 3. and skeletal muscles. Insulin is an anabolic hormone, which means that when it binds to the insulin receptor, it promotes the conversion of small energy molecules in the blood - mainly glucose, but also fatty acids and amino acids - into large storage molecules inside insulin’s target cells. Glucose mainly becomes 1. glycogen in the liver 2. fatty acids are stored as fat or adipose tissue 3. and amino acids build up protein in skeletal muscles. INSULIN CATEGORIES - - HYPOGLYCEMIA MANIFESTATIONS AND NURSING MANAGEMENT Next, ensure your client If these occur, stress the understands how to recognize importance of: and manage symptoms of checking their blood glucose level hypoglycemia, such as followed by consuming about half a cup of fruit juice Hunger three glucose tablets Fatigue or approximately 15 grams of sugar Tremors and to check their blood glucose Headache again 15 minutes later. Dizziness and confusion  ❑ ❑ 1. 1. Repeated insulin injection at the same area can lead to lipodystrophy, where there’s an atrophy or hypertrophy of the subcutaneous fat. This presents either as a skin depression or a raised skin lump, respectively.  ❑ ❑ ❑ The abdomen, upper buttocks, back of the upper arms, and the front and outer upper thighs are all recommended sites for insulin injections: Abdomen: The preferred site because insulin is absorbed quickly and consistently. Inject at least 2 inches away from your belly button. Thighs: Insulin is absorbed more slowly from the thighs, but exercise can increase absorption. Inject about 4 inches down from the top of your leg and 4 inches up from your knee.  Ketone bodies acidosis 300-800 mg/dL. Finally, precaution should be they should receive a higher taken in clients with dose of insulin to prevent the a fever, infection, development of or undergoin complications like: g surgery 1. diabetic ketoacidosis 2. or hyperglycemic hyperosmolar nonketotic coma. - - - - - The long-acting insulins, which include insulin glargine and detemir. Once administered, glargine forms a precipitate at the injection site before it’s slowly released into the bloodstream while detemir binds to albumin in the blood for a time before dissociating and becoming active. Long-acting insulins have delayed onset of action - between 1 to 2 hours of administration - as well as their long duration. These medications do not have a peak effect. Detemir typically lasts for around 20 hours whereas glargine can last for up to 24 hours. - - The intermediate-acting insulin, known as neutral protamine hagedorn or NPH insulin. NPH insulin becomes active around 1 to 2 hours after administration with a peak effect after 4 hours and lasts for 16 to 24 hours. - - The short-acting (regular insulin) starts working 30 minutes after administration with a peak effect at 2 to 3 hours and can last between 6 to 8 hours. Rapid acting insulins which include: insulin aspart Lispro and glulisine. These medications: begin working within 5 to 15 minutes of administration with a peak effect at 30 minutes and may last for 3 to 5 hours. Another rapid acting insulin is inhaled insulin, which can only be used as an adjunct to therapy with injected insulins, and never by itself. 5th INSULIN CATEGORY: ULTRA-LONG ACTING Ultra long acting insulin is a relatively new preparation called insulin degludec. Degludec is a depot injection, meaning the medication is deposited beneath the skin and slowly releases insulin into the blood. Its onset of action is between 1 to 2 hours with no peak effect and its duration of action can last up to 48 hours.  INSULIN STORAGE Advise your client to: store unopened vials of insulin in the refrigerator while the insulin vial currently in use can be kept at room temperature away from heat or direct sunlight. (CSII) - - - 1. 2. 3. WARNING! Oral hypoglycemic agents should be avoided by: Patients with liver disease And should not be taken with alcohol Rationale: These products can be hepatotoxic 1. 2. 3. Prolonged use of metformin decreases absorption of: ✓ vitamin B12 ✓ and folic acid which can cause deficiency 1. 2. 3. PATIENT TEACHING ABOUT METFORMIN  SULFA DRUGS 1. 2. MECHANISM OF ACTION Both sulfonylureas and meglitinides are given orally and once administered, they both act on the pancreas by: inhibiting ATP-sensitive potassium channels on the membrane of pancreatic beta cells. As a result, these medications initiate a cascade of events that stimulate the pancreatic beta cells to secrete more insulin ultimately leading to a decrease in blood glucose levels. SIDE EFFECTS:  If your client is prescribed the sulfonylurea CLIENT glipizide, teach them to take their medication once daily, 30 minutes before the first meal of the day. Then, let them know that they should avoid consuming alcohol, since it can increase the risk of TEACHING LACTIC ACIDOSIS. Also, teach them to recognize early symptoms of lactic acidosis, including hyperventilation, muscle pain and changes in their level of consciousness. If these occur stress the importance of CONTACTING DOCTOR RIGHT AWAY. Now, if your client is prescribed a meglitinide, such as repaglinide, instruct them to take their medication within 30 minutes of each meal, and caution them to not take their medication if they’re skipping a meal. 1. 2. 3. - - Thiazolidinediones can increase the risk of: - Fractures - and can also lead to bladder cancer. - Thiazolidinediones also have a boxed warning for heart failure 1. 2. 3.  CLIENT TEACHING  BIGUANIDES AND THIAZOLIDINEDIONES MECHANISM OF ACTION - These enzymes hydrolyze ingested carbohydrates - Alpha-glucosidase enzyme inhibition delays the digestion of carbohydrates - reducing postprandial hyperglycemia These medications should not be given in patients with IBS alpha-glucosidase inhibitors include medications like acarbose and miglitol  MECHANISM OF ACTION  Teach your client to take alpha-glucosidase inhibitors at THE FIRST BITE of their three main meals. CLIENT TEACHING: Let them know that GASTROINTESTINAL SIDE EFFECTS such as abdominal pain, flatulence, and diarrhea are common they usually decrease with time, but encourage your client to notify their doctor if these symptoms persist or worsen. Review with your client the SYMPTOMS OF HYPERGLYCEMIA, such as fatigue, blurred vision, increased thirst, appetite, and urination; if they experience any of these: - advise them to check their blood glucose level - and contact their healthcare provider immediately. Also teach your client to recognize SIGNS OF LIVER DAMAGE, such as fatigue, anorexia, nausea, dark urine, or jaundice. PATIENT EDUCATION FOR DIABETES GENERAL O.H.A. CLIENT TEACHING These medications following a low-carbohydrate and is most high-fiber diet effective when regular physical activity combined with an antidiabetic regimen and frequent blood glucose which includes: monitoring. - - -