Pharm Chapter 44; Drugs For Diabetes

Type 2 diabetes can be managed and controlled through lifestyle changes such as adopting a healthy diet, regular exercise, and maintaining a healthy weight. Additionally, oral hypoglycemic drugs can be prescribed by healthcare professionals to help regulate blood sugar levels. Therefore, the statement that type 2 diabetes is controlled through lifestyle changes and oral hypoglycemic drugs is true.

Clear insulin must be drawn into the syringe first, then cloudy insulin last because clear insulin is a fast-acting insulin that needs to be injected immediately, while cloudy insulin is a long-acting insulin that needs to be mixed before administration. Drawing clear insulin first ensures that it is not contaminated with any residues from the cloudy insulin, and allows for accurate dosing of each type of insulin.

also Polyuria, polydipsia, polyphagia
Glucosuria, weight loss/gain, fatigue

Two new drugs entered market in 2005
Exenatide (Byetta): injectable drug that belongs to class of drugs called incretin mimetics
Mimic effects of incretins—hormones released into blood by intestine in response to food
Pramlintide (Symlin): injectable drug for type 1 and type 2; resembles human amylin
Hormone produced by pancreas after meals; helps body regulate blood glucose

People with type II diabetes mellitus should have a preprandial blood sugar below 110 mg/dl

Prototype drug: glipizide (Glucotrol, Glucotrol XL)
Mechanism of action: to stimulate pancreas to secrete more insulin
Also increases sensitivity of insulin receptors at target tissues
Primary use: for treatment of type 2 diabetes
Adverse effects: hypoglycemia, rashes, photosensitivity possible
Some clients experience nausea, vomiting, loss of appetite

Prototype drug: regular insulin
Mechanism of action: to promote entry of glucose into cells
Primary use: short-acting insulin, with an onset of 30 to 60 minutes, a peak effect at 2 to 3 hours, and a duration of 5 to 7 hours to quickly decrease blood glucose
Also for emergency management of ketoacidosis
Adverse effects: hypoglycemia

human insulin. Made by recombinant DNA technology
More effective, fewer allergies, less resistance
Modified to be more rapid (Humalog) or have prolonged action (Lantus)

Insulin is a hormone released by the pancreas when blood glucose levels increase. It helps to lower blood glucose by promoting the uptake of glucose into cells for energy production or storage. On the other hand, glucagon is also released by the pancreas, but when blood glucose levels decrease. Glucagon acts to increase blood glucose levels by stimulating the breakdown of glycogen in the liver, releasing glucose into the bloodstream. Therefore, both insulin and glucagon play crucial roles in maintaining blood glucose homeostasis, but they have opposite effects on blood glucose levels.

Reduce blood glucose by decreasing insulin resistance and inhibiting hepatic gluconeogenesis
Optimal lowering of blood glucose may take 3 to 4 months of therapy
Most common adverse effects: fluid retention, headache, weight gain
Hypoglycemia does not occur with drugs in this class

Type II diabetes is caused by a combination of factors. One of the main causes is a lack of sensitivity of insulin receptors at target cells, which is known as insulin resistance. This means that the cells in the body do not respond properly to insulin, leading to elevated blood sugar levels. Another cause is a deficiency in insulin secretion, where the pancreas does not produce enough insulin. If left untreated, Type II diabetes can lead to the same chronic conditions as Type 1 diabetes, such as heart disease, kidney problems, and nerve damage.

Hypoglycemia refers to low blood sugar levels, which can lead to various symptoms and complications. Tachycardia, or a rapid heartbeat, can occur as the body tries to compensate for the low blood sugar. Confusion may arise due to the brain not receiving enough glucose for proper functioning. Sweating is a common symptom of hypoglycemia as the body tries to regulate its temperature. Drowsiness can occur as a result of the brain not receiving enough energy. In severe cases, hypoglycemia can lead to coma, convulsions, and even death if left untreated.

Type 1 diabetes is a condition that occurs when there is a complete absence of insulin secretion. This is caused by the autoimmune destruction of the pancreatic islet cells, which are responsible for producing insulin. Without insulin, the body is unable to regulate blood sugar levels, leading to various complications. One of these complications is cardiovascular damage, as high blood sugar levels can damage the blood vessels and increase the risk of heart disease. Additionally, type 1 diabetes can also cause damage to the nervous system, leading to neuropathy and other neurological complications. The main treatment for type 1 diabetes is insulin therapy, where insulin is administered to replace the hormone that the body is unable to produce.

Stimulate release of insulin from pancreatic islet cells
Increase sensitivity of insulin receptors on target cells
Most common adverse effect is hypoglycemia
Usually caused by taking too much medication or not eating enough food

Blood glucose should be monitored daily
Urinary ketones should be monitored if blood glucose is over 300 mg/dl

Feed client simple sugar at first sign of hypoglycemia
Rotate insulin administration sites weekly
Change insulin pump subcutaneous catheters every 2 to 3 days to prevent infections at the site of insertion

Metformin (Glucophage), only drug in this class
Decreases hepatic production of glucose (gluconeogenesis) and reduces insulin resistance
Does not promote insulin release from pancreas

Type 1 diabetes is a chronic condition where the body does not produce enough insulin. Insulin therapy is a crucial treatment for type 1 diabetes, as it involves injecting insulin into the body to regulate blood sugar levels. Additionally, dietary restrictions play a significant role in managing type 1 diabetes. Individuals with this condition need to monitor their carbohydrate intake and follow a balanced diet. Regular exercise is also essential for managing blood sugar levels and maintaining overall health. Amputations are not a treatment for type 1 diabetes and are not relevant to managing the condition.

Newer class of oral hypoglycemics
Act by stimulating release of insulin from pancreatic islet cells
Both agents in this class have short durations of action of 2–4 hours
Efficacy equal to that of sulfonylureas
Well tolerated
Hypoglycemia most common adverse effect

Alpha-glucosidase inhibitors are a type of medication that block the enzymes in the small intestine responsible for breaking down complex carbohydrates into monosaccharides. By inhibiting these enzymes, the digestion of glucose is slowed down, leading to a more gradual release of glucose into the bloodstream. These inhibitors are usually well tolerated and have minimal side effects related to the gastrointestinal system.

Monitor for hypoglycemia up to 48 hours after exercise
If symptoms of hypoglycemia are noted, provide a quick-acting carbohydrate source (e.g., juice or other simple sugar)
Monitor for hypoglycemia more frequently in patients on concurrent beta-blocker therapy

Human regular insulin (Humulin R, Novolin R) promotes cellular uptake of glucose, making it an effective treatment for diabetes. It can be used for emergency treatment of diabetic ketoacidosis (DKA), a life-threatening condition characterized by high blood sugar levels and ketone buildup. It is also safe to use during pregnancy for gestational diabetes. Regular insulin is the only type that can be given intravenously, allowing for rapid action in emergency situations. Weight gain is a possible side effect of insulin therapy. Regular insulin can be used in conjunction with aspirin (ASA), monoamine oxidase inhibitors (MAOIs), alcohol, and anabolic steroids.

Most side effects are minor and GI-related
New extended-release formulation of metformin (Glumetza) allows for once-daily dosing