chapter 36 agents used to treat hyperglycemia and hypoglycemia
TRANSCRIPT
Chapter 36Agents Used to Treat Hyperglycemia and Hypoglycemia
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Diabetes Mellitus
Disorder of the pancreas Results in hyperglycemia
Treatment Insulin Oral hypoglycemics
(continues)
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Pancreatic beta cells Excrete an insufficient amount of insulin, or no
insulin at all Flawed carbohydrate, fat, and protein
metabolism
Diabetes Mellitus(continued)
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Insulin
Promotes: Glucose transport across cell membranes Conversion of glycogen into glucose
Utilizes fatty acids and inhibits lipolysis Enhances protein synthesis and
inhibits protein breakdown
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Symptoms of Diabetes Mellitus
Polyuria (increased urine output) Polydipsia (excessive thirst) Polyphagia (excessive hunger)
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Diabetes Mellitus
Two types:1. Type 1 (formerly known as insulin-
dependent diabetes mellitus, IDDM)2. Type 2 (formerly known as noninsulin-
dependent diabetes mellitus, NIDDM)
(continues)
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Diabetes Mellitus
Type 1 diabetes mellitus Treated with insulin subcutaneous injections
Type 2 diabetes mellitus Treated with oral hypoglycemic agents
(continued)
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Insulin
Synthetic human insulin Produced either by:
Recombinant DNA synthesis of human insulin Conversion of pig to human insulin
Human in origin Humulin, Novolin, and Lispro
Older versions Pig or cow in origin
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Four Preparations of Insulin
Rapid-Acting
Fast-Acting
Intermediate-Acting
Long-Acting
LisproAspart
RegularHumulin-RNovolin-R
NPHLenteHumulin-L
UltralenteHumulin-UGlargine- Lantus
Note the differences in onset, peak, and duration of action.
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Effects of Insulin
Allergic reactions Lipodystrophy Insulin resistance
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Nursing Implications
Several drugs antagonize the hypoglycemic effects of insulin.
Check your drug manual before administering any drug agent.
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Hypoglycemia
Blood glucose is low (< 40 mg/dL) Produced from
Skipped or irregularly scheduled meals Excessive exercise Insulin administration errors
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Signs and Symptoms of Hypoglycemia
Sweating Confusion Tachycardia Headache Hunger
Weakness Poor muscle
control Emotional
instability Coma and death
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Hypoglycemia Treatment
Glucagon (intramuscular, intravenous, or subcutaneous)
IV dextrose 50%, also known as D50W
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Treatment for Type 2 Diabetes
Oral antidiabetic agents Five classes
1. Sulfonylureas (oldest category)• First generation• Second generation
2. Biguanides3. Meglitinides4. Alpha-glucosidases5. Thiazolidinediones
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Sulfonylureas
Action: stimulate the beta cells of the pancreas to secrete more insulin
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Biguanides
Action: inhibit hepatic glucose production and increase the sensitivity of peripheral tissue to insulin
May be given with sulfonylureas
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Meglitinide
Action Stimulate the beta cells of the pancreas to
secrete insulin Minimal risk of hypoglycemia
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Alpha-glucosidase Inhibitors
Action: inhibit an enzyme called alpha-glucosidase (enzyme responsible for the hydrolysis of saccharides to be converted to glucose)
Must be taken with meals May be given with sulfonylureas
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Thiazolidinediones (Glitazones)
Action Decrease insulin resistance by decreasing
gluconeogenesis, glucose output, and triglyceride synthesis in the liver
Monitor for hepatic toxicity. May be given with sulfonylureas
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Side Effects of Sulfa
Hematology Hemolytic anemia, thrombocytopenia, and
jaundice Gastrointestinal
Nausea, epigastric fullness, and heartburn
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Side Effects
Biguanides Abdomen bloating, nausea, cramping, and
diarrhea Alpha-glucosidase inhibitors
Flatulence, diarrhea, and abdominal pain Thiazolidinediones
Hepatic toxicity, weight gain, edema, and mild anemia