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1
PRESENTATION ON AAN3: DIABETES NURSING
St. Paul University Philippines
Tuguegarao City, Cagayan 3500
GRADUATE SCHOOL PROGRAM
Mater o! S"ien"e in Nuring
DIABETES URSIG
!"ST CETUR# ATI$ DIABETEC DRUGS AD ALTERATI%E DRUGS USED TO
MAAGE DIABETES MELLITUS
DOAH &AI MADRIAGA AGUSTI' R
MSN STUDENT
ELI(ABETH C. BAUA' DS
PRO#ESSOR
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1
PRESENTATION ON AAN3: DIABETES NURSING
21st Century Anti-Diabetic Drugs
Diferent kinds o diabetes pills work in diferent ways to control
your blood sugar (blood glucose).
Combining two diferent kinds o diabetes pills can work better tolower your blood sugar than a single medicine.
But combining two kinds o diabetes pills can make it more likely
that your blood sugar will drop too low (hypoglycemia).
Agents used in diabetic therapy include the following:
1 Sulfonylureas
• Stimulate your pancreas to make more insulin which helps
lower your blood glucose.
Available sulfonylureas include:
• !maryl (glimepiride)
• DiaBeta (glyburide)
• Diabinese (chlorpropamide)
• "lucotrol (glipi#ide)
• "lucotrol $% (glipi#ide long&acting)
• "lynase (glyburide)
• 'icronase (glyburide)• tola#amide
• tolbutamide
o Possible side eects of the sulfonylureas are:
o %ow blood
glucose
o pset stomach
o Skin rash
o eight gain
•
2 Biguanides
• *hese agents are considered the +rst choice or oral type ,
diabetes treatment. *hey reduce hyperglycemia by
decreasing hepatic gluconeogenesis (primary efect) and
increasing peripheral insulin sensiti-ity (secondary efect).
•
• Biguanides are absorbed rom the intestines and are not
bound to plasma proteins. *hey are not metaboli#ed and arerapidly eliminated by the kidneys.
•
•
•
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1
PRESENTATION ON AAN3: DIABETES NURSING
• Available Biguanides include:
• "lucophage
(metormin)
• "lucophage $
(metormin long&acting)
• iomet (metormin
li/uid)
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•
o 0ossible side efects o the biguanides are nausea and Diarrhea
when you are +rst start taking this type o 'edicine.
•
3 Alpha-glucosidase inhibitors
• & !lpha&glucosidase inhibitors work by slowing down the
digestion o oods high in carbohydrate such as
rice potatoes bread milk and ruit.
• !-ailable alpha&glucosidase inhibitors include
• "lyset (miglitol)
• 0recose (acarbose)
•
o Possible side eects of the alpha-glucosidase inhibitors are:
stomach pain, gas, bloating, or diarrhea – these symptoms
usually go away gradually
•
4 Thiazolidinediones (TZs!
• 'ake you more sensiti-e to insulin.
•
• !-ailable thia#olidinediones include
• !ctos (pioglita#one)
• !-andia (rosiglita#one)
•
NOTE:
f you ha!e heart failure" you should not ta#e this type of pill$
This type of pill can cause congesti!e heart failure$ %tudies ha!e shown that A!andia is associated with an
increased ris# for heart attac#s and chest pain or disco&fort
fro& bloc#ed blood !essels$
o Possible side eects of include:
o congestive heart failure is the most serious side eect,
o Anemia,
o an increased risk of getting pregnant even if youre taking birth
control pillso increased risk of bone fracture in women
•
•
•
•
' (eglitinide deri!ati!es
& 'eglitinides stimulate your pancreas to make more
insulin.
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•
• *he only a-ailable meglitinide is
• 0randin (repaglinide)
•
o Possible side eects of Prandin are:
o low blood glucoseo weight gain
o upset stomach
o back pain or a headache
•
) D-*henylalanine Deri!ati!es
& 2elp your pancreas make more insulin /uickly or a short
period o time right ater meals. *he only a-ailable D&
phenylalanine deri-ati-e is Starli3 (nateglinide)•
o Possible side eects of !tarli" are:
o low blood glucose
o weight gain
o di##iness
+ D**-, nhibitors
& %ower your blood glucose by helping your body make
more insulin when it4 s needed especially right ater meals.
5t also helps keep your li-er rom putting stored glucose
into your blood.& Dipeptidyl 0eptidase&6 (D00&6) 5nhibitors are usually
prescribed or people with type , diabetes who ha-e not
responded well to drugs such as metormin and
sulonylureas.
• *he only a-ailable D00&57 5nhibitor is 8anu-ia (sitagliptin)
o *ossible side eects of .anu!ia are:
o runny nose
o sore throat
o 2eadache
•
•
•
•
•
• 2ow do they work9
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• *hey work by blocking the action o D00&6 an en#yme
which destroys a group o gastrointestinal hormones called #ncretins$
*his incretins help stimulate the production o insulin when it is needed
(e.g. ater eating) and reduce the production o gucagon by the li-er
when it is not needed (e.g. during digestion). *hey also slow down
digestion and increase appetite. So by protecting incretins rom
damage D00&6 inhibitors help regulate blood glucose le-els.
/ Co&bination Diabetes *ills
• %$ Actoplus "et is a combination o !ctos (pioglita#one)
and "lucophage (metormin)
• &$ A#anda$et is a combination o !-andia (rosiglita#one)
and "lucophage (metormin)
• '$ A#andaryl is a combination o !-andia (rosiglita#one)
and !maryl (glimepiride)
• ($ uetact is a combination o !ctos (pioglita#one) and
!maryl (glimepiride)
• )$ %luco#ance is a combination o "lucophage
(metormin) and 'icronase (glyburide)
• *$ &anu$et is a combination o 8anu-ia (sitagliptin) and
"lucophage (metormin)
• +$ "etaglip is a combination o "lucotrol (glipi#ide) and
"lucophage (metormin)
ote: one pill helps your body make more insulin$ he other pill
lowers the amount of glucose made by your liver and helps your
insulin work the way it should$
0 ile acid seuestrants
• & Colese-elam is :D! appro-ed as an ad;uncti-e therapy to
impro-e glycemic control in adults with type , diabetes mellitus.
• & Colese-elam is a high&capacity bile acid se/uestrant. 5t is
indicated as an ad;unct to diet and e3ercise to impro-e
glycemic control in adults with type , diabetes mellitus. *he
precise mechanism by which colese-elam impro-es glycemic
control is largely unknown.
13 nsulins
Antidiabetics" 4apid-Acting nsulins
•
4apid-acting insulins ha!e a short duration of action
and are appropriate for use before &eals or when
blood glucose le!els e5ceed target le!els and
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correction doses are needed$ These agents are
associated with less hypoglyce&ia than regular insulin$
•
#nsulin aspart . ovo/og 0• & 5nsulin aspart has a short onset o action o &?> minutes. 5nsulin aspart
is :D! appro-ed or use in insulin pumps.
•
#nsulin glulisine . Apidra 0
• & 5nsulin glulisine has a rapid onset o action o &?> minutes. 5nsulin glulisine is
:D! appro-ed or use in insulin pumps.•
5nsulin inhaled ( !re##a )
• & @rally inhaled rapid&acting insulin in powder
orm.
•
5nsulin lispro (2umalog)
• & 5nsulin lispro has a rapid onset o action o
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• & 5nsulin detemir is indicated or once&
or twice&daily dosing in patients with type 1 or , diabetes
mellitus. *he duration o action is up to ,6 hours.
•
5nsulin "largine (%antus)
• & 5nsulin glargine has an onset o action
o 6&F hours and duration o action o ,6 hours. 0eak
efects occur within 1&1F hours.
Alternati!e (edicines
• So ar scienti+c support or the claim that any
remedy can treat diabetes is lacking. 5tGs important to note
that sel&treating with alternati-e medicine and a-oiding or
delaying standard care may be harmul or your
health. 2ere are some natural treatments that are being
e3plored.
1. "inseng
,. Cinnamon
=. !loe 7era
6. Bitter 'elon
>> study published in Archives of #nternal
2edicine. 5n a small e3periment in-ol-ing nine diabetes
patients and 1> people without diabetes researchers ound
http://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://altmedicine.about.com/od/ginseng/a/american_ginseng.htmhttp://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://reference.medscape.com/drug/lantus-toujeo-insulin-glargine-999003http://altmedicine.about.com/od/ginseng/a/american_ginseng.htm
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that taking !merican ginseng supplements prior to eating
helped keep post&meal blood sugar le-els in check.I
•
2$ Cinna&on& H! couple o studies ha-e ound that
cinnamon impro-es blood glucose
control in people with type ,
diabetes. 5n the +rst study > people
with type , diabetes were di-ided
into si3 groups. *hree groups took
1 = or g o cinnamon a day and
the remaining three groups
consumed 1 = or g o placebo capsules. !ter 6> days all
three doses o cinnamon signi+cantly reduced astingblood glucose triglycerides %D% cholesterol and total
cholesterol.I& H5n another study ? people with type , diabetes (not on
insulin therapy but treated with other diabetes
medication or diet) took either a cinnamon e3tract
(e/ui-alent to = g o cinnamon powder) or a placebo
capsule three times a day. !ter our months there was a
slight but statistically signi+cant reduction in asting blood
glucose le-els in people who took the cinnamon (1>.=)
compared with the placebo group (=.6) howe-er there
was no signi+cant diference in glycosylated hemoglobin
or lipid pro+les.I
•
$ Aloe ,era& !lthough aloe 7era gel is better
known as a home remedy or
minor burns and other skin
conditions recent animal studies
suggest that aloe 7era gel mayhelp people with diabetes.
•
& ! 8apanese study e-aluated the
efect o aloe 7era gel on blood
sugar. esearchers isolated a
number o acti-e phytosterol
compounds rom the gel that were ound to reduce blood
glucose and glycosylated hemoglobin le-els.
•
• Aloe has also been lin#ed with:• J Decreased blood lipids (ats) in patients with
abnormally high le-els o these molecules in the blood (e.
g. some people with type , diabetes) andEor acute
hepatitis (li-er disease)
•
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• J Decreased swelling and aster healing o
wound in;uries.
• . /eg wounds and ulcers are common
complications of diabetes, and they typically take longer
time to heal than in healthy non-diabetic individuals$0
•
• *hese positi-e efects are thought to be due to the
presence o compounds such as lectins mannans and
anthra/uinones.
•
;$ itter (elon$ Bitter melon also known as bitter gourd
or karela (in 5ndia) is a uni/ue
-egetable&ruit that can be used as ood
or medicine.$ 5t is the edible part o the plant
'omordica Charantiawhich is
considered the most bitter among
all ruits and -egetables.
•
• & *he plant thri-es in tropical and subtropical regions
including
• South !merica !sia parts o !rica and the
Caribbean
•
• & *he bitter melon itsel grows of the -ine as a green
oblong&shaped ruit with a distinct warty e3terior & though
its si#e te3ture and bitterness -ary between the
diferent regions in which it grows & and is rich in
-ital -itamins and minerals.
•
8ow does it aect diabetes<
• & 5n addition to being a ood ingredient bitter melon
has also long been used as a herbal remedy or a
range o ailments including type , diabetes.
• & *he ruit contains at least three acti-e substances
with anti&diabetic properties including charantin which
has been con+rmed to ha-e blood glucose&
lowering efect vicine and an insulin&like compound
known as polypeptide-p.
$ *hese substances either work indi-idually or together to
help reduce blood sugar le-els.
• & 5t is also known that bitter melon contains
a lectin that reduces blood glucose concentrations by
http://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.html
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acting on peripheral tissues and suppressing appetite &
si&ilar to the eects of insulin in the brain.
• & *his lectin is thought to be a ma;or actor behind
the hypoglycemic efect that de-elops ater eating bitter
melon.
%cienti9c e!idence
• & 5n 8anuary ,>11 the results o a our&week clinical trial were
published in the 8ournal o Kthno pharmacology which showed
that a ,>>> mg daily dose o bitter melon signi+cantly reduced
blood glucose le-els among patients with type , diabetes
although the hypoglycemic efect was less than a 1>>> mgEday
dose o metormin. LFM
• & @ther older studies ha-e also suggested an association
between bitter melon intake and impro-ed glycemic control while
a report published in the 'arch ,>>F issue o Chemistry and
Biology ound that bitter melon increased cellular uptake o
glucose and impro-ed glucose tolerance. L?M
•
http://www.diabetes.co.uk/body/brain.htmlhttp://www.diabetes.co.uk/body/brain.html
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'$ =enugree#
• & :enugreek is an aromatic plant that has
many uses both culinary N (enugreek is a
key ingredient o curries and other
5ndian recipes) & and medicinal.
• &*he plant which is widely grown in South
!sia Aorth !rica and parts o the
'editerranean has small round lea-es and
also produces long pods that contain
distincti-e bitter&tasting seeds.
• &*he lea-es are either sold as a -egetable (resh lea-es sprouts
and microgreens) commonly known as methi or as an herb
(dried lea-es) while the seeds are used both whole and in
powdered orm as a spice.
• &!s well as being a popular cooking ingredient enugreek has a
number o health bene+ts and is used in both !yur-edic and
traditional Chinese medicine.
•
8ow does it aect diabetes<
•
& :enugreek seeds (trigonella oenum graecum) are high insoluble +bre which helps lower blood sugar by slowing down
digestion and absorption o carbohydrates. *his suggests they
may be efecti-e in treating people with diabetes.
• & 'ultiple studies ha-e been carried out to in-estigate
the potential anti&diabetic bene+ts o enugreek.
• & @ these se-eral clinical trials showed that enugreek
seeds can impro-e most metabolic symptoms associated with
both type % and type & diabetes in humans by lowering bloodglucose le-els and impro-ing glucose tolerance.
•
%cienti9c e!idence
• 5n one study researchers in 5ndia ound that adding 1>> grams o
deatted enugreek seed powder to the daily diet o patients with
insulin&dependent (type 1) diabetes signi+cantly reduced
their asting blood glucose le-els impro-ed glucose tolerance and
also lowered total cholesterol %D% or Obad4 cholesterol and
triglycerides.
• 5n another controlled trial incorporating 1< grams o powdered
enugreek seed into a meal eaten by people with type , diabetes
reduced the rise in post&meal blood glucose while a separate
http://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/Diabetes-and-Carbohydrate-diets.htmlhttp://www.diabetes.co.uk/diabetes-and-metabolic-syndrome.htmlhttp://www.diabetes.co.uk/how-to/bring-down-high-blood-sugar-levels.htmlhttp://www.diabetes.co.uk/Diabetes-and-Carbohydrate-diets.htmlhttp://www.diabetes.co.uk/diabetes-and-metabolic-syndrome.htmlhttp://www.diabetes.co.uk/diabetes-and-metabolic-syndrome.html
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study ound that taking ,.< grams o enugreek twice a day or
three months lowered blood sugar le-els in people with mild
but not se-ere type , diabetes.
•
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)$ 7inger
•
$ "inger is the thick knotted underground stem (rhi#ome) o the
plant HPingiber oQcinaleI that has been used or
centuries in !sian cuisine and medicine.
•
$ Aati-e to !rica 5ndia China !ustralia and
8amaica it is commonly used as a spice or
Ra-ouring agent in cooking as an alternati-e
Oherbal4 treatment or -arious ailments such as
nausea and indigestion and or ragrance in soaps and
cosmetics.
•
$ "inger rhi#ome can be used resh dried and powdered or as a
;uice or oil. 5t has a pungent and sharp aroma and adds a strong
spicy Ra-or to ood and drink.
•
•
8ow does it aect diabetes<
• 7lyce&ic control
• ! study published in the !ugust ,>1, edition o the natural
product ;ournal 0lanta 'edica suggested that ginger may impro-e
long&term blood sugar control or people with type , diabetes.
• esearchers rom the ni-ersity o Sydney !ustralia ound that
e3tracts rom Buderim "inger (!ustralian grown ginger) rich in
gingerols & the ma;or acti-e component o ginger rhi#ome & can
increase uptake o glucose into muscle cells without using insulin
and may thereore assist in the management o high blood sugar
le-els.
• nsulin secretion
• 5n the December ,>>? issue o the Kuropean 8ournal o 0harmacology researchers reported that two diferent
ginger e3tracts spissum and an oily e3tract interact with
serotonin receptors to re-eres their efect on insulin secretion.
*reatment with the e3tracts led to a =< per cent drop in blood
glucose le-els and a 1> per cent increase in plasma insulin
le-els.
•
+$ O#ra•
$ @kra is ast gaining a reputation as a so&called GsuperoodG or
people with or at risk o diabetes or cancer.
http://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.htmlhttp://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/food-and-recipes.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.htmlhttp://www.diabetes.co.uk/high-low-blood-sugar-symptoms.html
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•
$ @kra is a tall&growing -egetable that traces its
origin rom ancient Kthiopia (!byssinia) through
to Kastern 'editerranean 5ndia the !mericas
and the Caribbean.
•
$ Commonly reerred to as lady+ngers or by its
biological names !belmoschus esculentus and 2ibiscus
esculentus okra is known to ha-e a positi-e efect on blood sugar
control among many other health bene+ts.
•
$ *hese tender pods are -ery low in calories pro-iding ;ust =>
calories per 1>> g and contain no saturated ats or cholesterol.
*hey are also rich in nutrients completely non&to3ic and ha-e no
ad-erse side efects.•
8ow does it aect diabetes<
• K-idence o okra ha-ing anti&diabetic properties has increased in
recent years with multiple 7itro (laboratory) and 7i-o (animal)
studies con+rming okra as a potent blood glucose&lowering (or
anti&diabetic) ood.
• 5n one study published ,>11 in the 8ournal o 0harmacy
Bio!llied Sciences researchers in 5ndia ound that diabetic mice
ed dried and ground okra peels and seeds e3perienced a
reduction in their blood glucose le-els while others showed a
gradual decrease in blood glucose ollowing regular eeding o
okra e3tract or about ten days.
• @utside o scienti+c research many people with diabetes ha-e
reported decreasing blood sugar le-els ater soaking cut&up okra
pieces in water o-ernight and then drinking the ;uice in the
morning while in *urkey roasted okra seeds ha-e been used as a
traditional diabetes medicine or generations.
•
/$ O#ra
•
http://www.diabetes.co.uk/diabetes_care/Diabetes_and_blood_glucose.htmlhttp://www.diabetes.co.uk/diabetes-medication/index.htmlhttp://www.diabetes.co.uk/diabetes_care/Diabetes_and_blood_glucose.htmlhttp://www.diabetes.co.uk/diabetes_care/Diabetes_and_blood_glucose.htmlhttp://www.diabetes.co.uk/diabetes-medication/index.html
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$ Banaba is a Rowering plant that grows
in warm climate like the 0hilippines
5ndia and others. Banaba is widely used
in the 0hilippines and as herbal
medicine or diabetes. hile in 5ndia
Banaba is also used as !yur-edic
medicine or the treatment o diabetes.
*he Banaba lea-es and Rowers contain
3orrosolic Acid, a substance being studied or its insulin like efect
o lowering the glucose in the body. Banaba is also being studied
as a weight&loss supplement or its ability to delay or reduce the
absorption o carbohydrates. Banaba is also rich in -itamins and
minerals including #inc and magnesium. Banaba is also rich in
dietary +bers.
•
•
•
•
2ow to use Banaba 2erb or Diabetes
•
*he ollowing details the preparation and application o Banabaherbal medicine or diabetes.
1. Dry Banaba lea-es and ruits or about two weeks.,. Cut Banaba lea-es into pieces=. Boil the dried Banaba lea-es and ruits in water.6. @ne cup o dried banaba lea-es and ruits to one cup water. minutes. Strain the lea-es and ruits.. *ake the Banaba herbal tea or 6 to times daily.
•
E!idence ased-*ractice
'annabis co$pound legally sold in pill for$ for rst ti$e
could pro#ide health benets for people )ith diabetes*
.!eptember &4%)0
• TCannabis pillsT ha-e been legally sold in Kurope or the
+rst time. *he capsules which are a-ailable to buy online
could ofer health bene+ts to people with diabetes.
http://www.diabetes.co.uk/recreational-drugs/cannabis.htmlhttp://www.diabetes.co.uk/blog/2015/07/diabetes-pa-and-the-ten-best-diabetes-apps-available/http://www.diabetes.co.uk/recreational-drugs/cannabis.htmlhttp://www.diabetes.co.uk/blog/2015/07/diabetes-pa-and-the-ten-best-diabetes-apps-available/
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• *here is substantial e-idence to suggest that 3annabidiol
.3B50, a compound ound in cannabis has bene+cial
efects on a number o health conditions including chronic
pain cancer an3iety diabetes epilepsy rheumatoid arthritis
0*SD sleep disorders and heart disease.
• :or people with diabetes research suggests
that CBD reduces the pain o neuropathy and lowers blood
glucose le-els. 5t can also bene+t some diabetic
complications including glaucoma.
• *he pills which are sold by ''8 0hyo*ech o !ustralia do
not pro-ide the ThighT o smoking cannabis which is caused
by tetrahydrocannabinol (*2C). *hey contain only CBD which
is the speci+c compound linked to health bene+ts.
• *he capsules are manuactured in Swit#erland and
registered in "ermany. *hey can be purchased in Kurope on
the companyGs website. ! 1>mg bo3 can be purchased or
UF?.>> (or V>mg bo3 costs U> (or V6,.,,).
%ources:
• httpEEwww.diabetes.co.uk
• httpEEaltmedicine.about.com
• 'edscape.com
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