Ant|d|abet|c agents

O Clucose 8egulaLlon
O Clucose ls Lhe leadlng source of energy
O Clucose ls sLored ln Lhe body for rapld release ln Llmes of sLress
O @o provlde consLanL supply Lo Lhe neurons
O @he mlnuLe Lo mlnuLe conLrol ls Lhe funcLlon of Lhe endocrlne pancreaLlc gland

1he pancreas
O ndocrlne produces hormones
O ocrlne release sodlum blcarbonaLe and pancreaLlc enzymes dlrecLly Lo Lhe blle ducL Lhen
released Lo Lhe small lnLesLlne
-D-
O Pormone produced by Lhe beLa cells of Lhe lsleLs of langerhans when Lhe glucose level rlse
O clrculaLes Lhrough ouL Lhe body and reacLs wlLh speclflc lnsulln recepLor slLes Lo sLlmulaLe
LransporL of glucose Lo cells for energy
O sLlmulaLes Lhe release of glycogen ( glucose sLorage for release ln Llmes of sLress or low glucose
O Converslon of llplds lnLo faL sLored ln Lhe adlpose Llssue
O SynLhesls of proLelns from amlno aclds
O 8elease afLer a meal
O lL clrculaLes and affecL meLabollsm Lhe body elLher sLore or use Lhe nuLrlenLs from Lhe meal
O 8lood glucose levels fall lnsulln level drops off
O lnsufflclenL lnsulln due Lo
pancreas
lnsulln recepLor slLes lose Lhelr senslLlvlLy
noL enough recepLor slLes (obeslLy)
nsuff|c|ent nsu||n Metabo||c Changes
O Pyperglycemla Clycosurla
O CysLlLls Sugar rlch urlne ldeal for bacLerla
O laLlgue glucose canL be used
O olyphagla hypoLhalamlc cenLers canL Lake ln glucose and sense sLarvaLlon
O olydlpsla lncreased LonlclLy of Lhe blood lncrease glucose and wasLe producLs ln Lhe blood
and loss of fluld wlLh glucose ln Lhe urlne hypoLhalamlc sense a need Lo lncrease fluld ln Lhe
sysLem LhlrsLy
nsuff|c|ent nsu||n Metabo||c Changes
O Llpolysls ( faL breakdown) for energy because glucose ls noL usable
O keLosls use of faL keLones wasLe canL be removed effecLlvely
O Acldosls llver can'L remove all Lhe wasLe producLs from Lhe breakdown of glucose faLs and
proLeln
O Muscles break down for Lhe essenLlal amlno aclds because proLelns are noL belng bullL
elevaLed 8un ( wasLe producLs) and poor heallng
|abetes Me|||tus ("honey ur|ne")
@wo Lypes
O @ype 1
O @ype 2
Cllnlcal slgns
1 Pyperglycemla
lasLlng plasma glucose 7 mmol/L 126mg/dl
2 Clucosorla
Slgns SympLoms of uM
O olydlpsla
O olyurla
O olyphagla
O JL loss
O laLlgue
O 8lurred vlslon
A8L1 ML1D
O AffecLs carbohydraLe proLeln and faL meLabollsm
O Lhlckenlng of Lhe basemenL membrane ln large and small blood vessels
O damage Lo Lhe vessel llnlng narrowlng and decreased blood flow Lhrough Lhe vessel
O lnablllLy of oygen Lo rapldly dlffuse across Lhe membrane
O resulLlng Lo a number of dlsorders
O ALherosclerosls hearL aLLacks and sLroke plaques
O 8eLlnopaLhy loss of vlslon as Llny vessels around Lhe eyes are narrowed and closed
O neuropaLhles moLor and sensory changes ln Lhe feeL and legs wlLh progresslve changes ln
oLher nerves as oygen supply ls cuL off
O nephropaLhy renal dysfuncLlon due Lo changes ln Lhe basemenL membrane of Lhe glomerulus
O verall ls due Lo Lhe lack of Lhe hormone lnSuLln
1ype 1 |abetes Me|||tus
M
O characLerlzed by loss of Lhe lnsullnproduclng beLa cells of Lhe lsleLs of Langerhans of Lhe
pancreas leadlng Lo a deflclency of lnsulln
O AffecLed cllenLs need eogenous lnsulln
O ulabeLlc keLoacldosls (ukA)
O ral anLlhyperglycemlc agenLs noL effecLlve
1ype 2 |abetes Me|||tus
O MosL common Lype
O Caused by lnsulln deflclency and lnsulln reslsLance buL Lhere ls noL an absoluLe of lnsulln
producLlon
O Many Llssues are reslsLanL Lo lnsulln
O 8educed number lnsulln recepLors
O lnsulln recepLors less responslve
O Obeslty omooq cbllJteo ooJ oJolesceot ls locteosloq tbe loclJeoce
1ype 2 d|abetes
Metabo||c syndrome
@he clusLer of cooccurrlng condlLlons of
Abdomlnal obeslLy Lrlglycerldes 8
Are sLrongly assoclaLed wlLh Lhe developmenL of Lype 2 dlabeLes
beslLy worsens lnsulln reslsLence because adlpose Llssue ls Lhe slLe of large porporLlons of Lhe body's
defecLlve lnsulln recepLors
1ype 2 |abetes Me|||tus (cont'd)
4 Several comorbld condlLlons
O Clucose lnLolerance
O beslLy
O uysllpldemla
O PyperLenslon
O lnsulln reslsLance
O Pyperlnsullnemla
O Mlcroalbumlnemla (proLeln ln Lhe urlne)
O nhanced condlLlons for embollc evenLs (blood cloLs)
O PearL dlsease
@ypes of AnLldlabeLlc AgenLs
lnsullns
ral anLlhyperglycemlc agenLs
8oLh alm Lo produce normal blood glucose sLaLes
lnsulln
Are processed wlLhln Lhe body llke endogenous lnsulln
urug of cholce ln pregnancy( does noL cross Lhe placenLa) and lacLaLlon ( desLroyed ln Lhe Cl LracL)
no conLralndlcaLlons
Pypoglycemla and keLoacldosls
uo noL comblne wlLh beLa blocker or herbal Lheraples
SubcuLaneous lnsulln ln[ecLlon prlmary dellvery sysLem
Puman8ased lnsullns
8apld acLlng(ospott llspto)
ShorL acLlng (teqolot bomollok 1otooto)
lnLermedlaLe acLlng (nomollo N Nln)
Long acLlng (qlotqloe Jetemlt)
ComblnaLlon lnsulln producLs (bomoloq bomollo J0/70 20/80)
keqolot losollo
1be ooly losollo ptoJoct tbot coo be qlveo by lv bolos lv lofosloo ot eveo lM

roper Lechnlque of lnSuLln AuMlnlS@8A@ln
subcuLaneous rouLe ( malnLenance doses)
lnsulln syrlnge wlLh a 23 gauge Z lnch needle
CenLly roLaLe vlal and avold vlgorous shaklng Lo ensure unlform suspenslon of lnsulln
ln[ecL Lhe lnsulln lnLo Lhe loss connecLlve Llssue underneaLh Lhe skln
Abdomen upper Lhlgh upper arm
lnserL Lhe needle aL a 43 degree angle
ull Lhe plunger back Lo make sure LhaL Lhere ls no blood
ln[ecL Lhe lnsulln
8oLaLe slLes regularly Lo prevenL Llssue damage
lnSuLln AuMlnlS@8A@ln
8egular lnsulln lM or lv ln emergency slLuaLlons
use cauLlon when mllng Lypes of lnsulln
admlnlsLer mlLures of regular and nP or
regular and lenLe wlLhln 13 mlnuLes afLer comblnlng Lhem
do noL ml lanLus or levemlr wlLh any oLher lnsulln Lo avold preclplLaLlon and lneffecLlve doslng
lnSuLln AuMlnlS@8A@ln
SLore ln a cool place away from dlrecL sunllghL
redrawn syrlnges are sLable for 1 week lf refrlgeraLed
MonlLor durlng Llmes of Lrauma or sLress poLenLlal dosage ad[usLmenLs

ral AnLlhyperglycemlc AgenLs
lndlcaLlons
used alone or ln comblnaLlon wlLh oLher agenLs and/or dleL and llfesLyle changes Lo lower Lhe
blood glucose levels ln cllenLs wlLh Lype 2 dlabeLes
ral AnLldlabeLlc AgenLs
@reaLmenL for Lype 2 dlabeLes lncludes llfesLyle modlflcaLlons
uleL eerclse smoklng cessaLlon welghL loss
ral anLlhyperglcemlc agenLs may noL be effecLlve unless Lhe cllenL also makes behavloural or llfesLyle
changes
ral AnLldlabeLlc AgenLs (conL'd)
1 Sulfonylureas lnsulln secreLagogues sLlmulaLe lnsulln secreLlon
1
sL
generaLlon chlorpropamlde LolbuLamlde Lolazamlde
2
nd
gen gllmeplrlde glplzlde g|ybur|de
ral AnLldlabeLlc AgenLs (conL'd)
2 -onsulfonylureas effecLlve ln comblnaLlon wlLh sulfonylureas and lnsulln
Alpha glucosldase lnhlblLors acrabose and mlgllLol
8lguanlde meLformln(glucophage)
MegllLlnldes replagllnlde neLegllnlde
Lhlazollnedlones plogllLazone and roslgllLazone

ral AnLlhyperglycemlc AgenLs
Sulfonylureas (Clyburlde)
8lnd Lo poLasslum channels on pancreaLlc beLa cells Lo lncrease lnsulln secreLlon
lorces Lhe eLra glucose ouL of Lhe blood lnLo Lhe cells where lL can be sLored and used for energy
8eLa cell funcLlon musL be presenL
lmprove senslLlvlLy Lo lnsulln ln Llssues and lncrease Lhe number of recepLors
All can cause hypoglycemla
noL effecLlve for all dlabeLes and may lose Lhelr effecLlveness over Llme wlLh oLhers
Sulfonylureas
1
sL
generaLlon
lncreased rlsk of cardlovascular dlsease and deaLh
Sulfonylureas
2
nd
generaLlon advanLages
1 safer wlLh renal dysfuncLlon ecreLed ln urlne and blle
2 do noL lnLeracL wlLh many proLeln bound drugs
3 longer duraLlon of acLlon once or Lwlce a day lncreaslng compllance
Sulfonylureas
ConLralndlcaLed wlLh known allergy compllcaLed by fever severe lnfecLlon severe Lrauma
ma[or surgery keLoacldosls severe renal and hepaLlc dlsease Lype 1 dlabeLes pregnancy and
lacLaLlon
Pypoglycemla Cl effecLs allergy cardlovascular morLallLy
CauLlon wlLh use of beLa blocker and alcohol
ral AnLlhyperglycemlc AgenLs
Alpha Clucosldase lnhlblLors
Acarbose and MlgllLol
8everslbly lnhlblL Lhe enzyme alphaglucosldase ln Lhe small lnLesLlne
8esulL delayed absorpLlon of glucose
MusL be Laken wlLh meals Lo prevenL ecesslve posLprandlal blood glucose elevaLlons
Mlld effecL on glucose levels
PepaLlc LolclLy
uo noL enhance lnsulln secreLlon
AddlLlve effecLs wlLh sulfonylureas
Acarbose Cl upseL
ral AnLlhyperglycemlc AgenLs
8lCuAnlu
M@l8Mln
uecrease producLlon of glucose by Lhe llver
lncrease upLake of glucose by Llssues
uo noL lncrease lnsulln secreLlon from Lhe pancreas Lherefore does noL cause hypoglycemla
lacLlc acldosls
Cl upseL
ral AnLlhyperglycemlc AgenLs
MCLl@lnluS
8ALClnlu Anu nA@LlCLlnlu
lnsulln secreLagogues sLlmulaLe lnsulln secreLlon
8apld acLlng wlLh shorL half llfe
@aken [usL before meals Lo lower posLprandlal levels
Long Lerm effecL are noL known
@aken wlLh meLformln
ral AnLlhyperglycemlc AgenLs
@PlAZLlulnulnS
lCLl@AZn 8 8SlCLl@AZn
uecrease lnsulln reslsLance
lnsulln senslLlzlng agenLs"
lncrease glucose upLake and use ln skeleLal muscle
lnhlblL glucose and Lrlglycerlde producLlon ln Lhe llver
MonlLor for llver funcLlon
ral AnLlhyperglycemlc AgenLs
8AMLln@lu
lCLl@AZn 8 8SlCLl@AZn
uecrease lnsulln reslsLance
lnsulln senslLlzlng agenLs"
lncrease glucose upLake and use ln skeleLal muscle
lnhlblL glucose and Lrlglycerlde producLlon ln Lhe llver
MonlLor for llver funcLlon
newesL ral AnLlhyperglycemlc AgenLs
ramllnLlde
ModulaLe gasLrlc empLylng afLer a meal a feellng of fullness
revenLs posLmeal rlse ln glucagon LhaL usually elevaLes Lhe glucose level
SynLheLlc form of human amylln a hormone produced by pancreaLlc beLa cells ln
regulaLlng posLmeal levels
newesL ral AnLlhyperglycemlc AgenLs
ramllnLlde
ln[ecLed subcuLaneously lmmedlaLely before each ma[or meal of Lhe day 2 lnches away
from lnsulln ln[ecLlon slLe
8apld onseL of acLlon and peaks ln 21 mlnuLes
newesL ral AnLlhyperglycemlc AgenLs
8A8ACLuu
uepress elevaLed glucagon secreLlon
Clven Su8C 2 a day wlLhln 60 mlnuLes before Lhe mornlng and evenlng meals
eaks wlLh ln 2 hours
ffecLs lasL 8 Lo 10 hours
ral AnLlhypoglcemlc AgenLs
Slde ffecLs
Sulfonylureas (Clyburlde)
Pypoglycemla hemaLologlcal effecLs nausea eplgasLrlc fullness hearLburn many oLhers
8lguanldes (MeLformln)
Abdomlnal bloaLlng nausea cramplng dlarrhea meLalllc LasLe reduced vlLamln 812 levels
ral AnLlhyperglycemlc AgenLs
Slde ffecLs (conL'd)
Alphaglucosldase lnhlblLors (arcabose)
llaLulence dlarrhea abdomlnal paln
@hlazolldlnedlones (AcLos)
ModeraLe welghL galn edema mlld anemla hepaLlc LolclLy
AnLlhyperglycemlc AgenLs
nurslng lmpllcaLlons
8efore glvlng any drugs LhaL alLer glucose levels obLaln and documenL
A Lhorough hlsLory
vlLal slgns
8lood glucose level
oLenLlal compllcaLlons and drug lnLeracLlons
nurslng lmpllcaLlons
8efore glvlng any drugs LhaL alLer glucose levels
1 Assess Lhe cllenL's ablllLy Lo consume food
2 Assess for nausea or vomlLlng
3 Pypoglycemla may be a problem lf anLlhyperglycemlc agenLs are glven and Lhe cllenL
does noL eaL
4 lf a cllenL ls n for a LesL or procedure consulL physlclan Lo clarlfy orders for
anLlhyperglycemlc drug Lherapy
nurslng lmpllcaLlons (conL'd)
keep ln mlnd LhaL overall concerns for any dlabeLlc cllenL lncrease when Lhe cllenL
ls under sLress
Pas an lnfecLlon
Pas an lllness or Lrauma
ls pregnanL
nurslng lmpllcaLlons (conL'd)
@horough cllenL educaLlon ls essenLlal regardlng
ulsease process
uleL and eerclse recommendaLlons
SelfadmlnlsLraLlon of lnsulln or oral agenLs
oLenLlal compllcaLlons
nurslng lmpllcaLlons (conL'd)
Jhen lnsulln ls ordered ensure
1 CorrecL rouLe
2 CorrecL Lype of lnsulln
3 @lmlng of Lhe dose
4 CorrecL dosage
lnsulln order should be prepared dosages are secondchecked wlLh anoLher nurse
nurslng lmpllcaLlons (conL'd)
lnsulln
Check blood glucose level before glvlng lnsulln
8oll vlals beLween hands lnsLead of shaklng Lhem Lo ml suspenslons
nsure correcL sLorage of lnsulln vlals
nL? lnsulln syrlnges callbraLed ln unlLs are Lo be used Lo measure and glve lnsulln
nsure correcL Llmlng of lnsulln dose wlLh meals
nurslng lmpllcaLlons (conL'd)
lnsulln (conL'd)
Jhen drawlng up Lwo Lypes of lnsulln ln one syrlnge always wlLhdraw Lhe regular lnsulln flrsL
rovlde Lhorough cllenL educaLlon regardlng selfadmlnlsLraLlon of lnsulln ln[ecLlons lncludlng Llmlng of
doses monlLorlng blood glucoses and ln[ecLlon slLe roLaLlons
nurslng lmpllcaLlons (conL'd)
ral anLlhyperglycemlc agenLs
Always check blood glucose levels before glvlng
usually glven 30 mlnuLes before meals
Alphaglucosldase lnhlblLors are glven wlLh Lhe flrsL blLe of each maln meal
meLformln ls Laken wlLh meals Lo reduce Cl effecLs
nurslng lmpllcaLlons (conL'd)
Assess for slgns of hypoglycemla
lf hypoglycemla occurs
Clve glucagon
Pave Lhe cllenL eaL glucose LableLs or gel corn syrup honey frulL [ulce or nondleL sofL drlnk
r have Lhe cllenL eaL a small snack such as crackers or half a sandwlch
MonlLor blood glucose levels
nurslng lmpllcaLlons (conL'd)
MonlLor for LherapeuLlc response
uecrease ln blood glucose levels Lo Lhe level prescrlbed by physlclan
Measure hemoglobln A
1c
Lo monlLor longLerm compllance Lo dleL and drug Lherapy
JaLch for hypoglycemla and hyperglycemla
essen|ng I|ngert|p a|n Irom 1est|ng
ont use rubb|ng a|coho|
kepeaLed use wlll Lhlcken Lhe skln lnsLead wash your hands ln warm soapy waLer prlor Lo your
flngersLlck
Jarm waLer wlll help you produce a beLLer drop of blood
nce your flnger ls prlcked do noL squeeze lmmedlaLely lnsLead hang your hand down and leL gravlLy
do Lhe work for you
@ry mllklng your flnger prlor Lo lanclng
cesslve squeezlng Lo geL Lhe blood Lo flow could cause brulslng
1ry a sha||ower puncture
@he deeper you lance Lhe more Llssue you damage
essen|ng I|ngert|p a|n Irom 1est|ng
1ry d|fferent |ancets
Look for shorLer and flner producLs
lLs beLLer Lo spread Lhe damage over as many slLes as posslble lnsLead of abuslng LhaL favourlLe spoL
@argeL Lhe sldes of your flngers lnsLead of Lhe sofL cenLre area where Lhere are more nerve endlngs
suggesL cllenLs go ln a horseshoe paLLern around Lhelr flngerLlps
App|y f|rm pressure at the s|te of the f|nger pr|ck
uslng a Llssue for several seconds or unLll you have no more leakage
?ou wanL Lo make sure LhaL Lhe bleedlng has compleLely sLopped aL Lhe slLe Lo prevenL brulslng and
furLher paln
Clucose LvA@lnC ACn@S
ulazolde oral
Clucagon parenLeral emergency cases
ure glucose
ral glucose LableLs ( CluLose or lnsLa Clucose)
CLuCS LvA@lnC ACn@S
8y decreaslng lnsulln release and
AcceleraLlng Lhe breakdown of glycogen ln Lhe llver Lo release glucose
no adequaLe sLudles wlLh glucagon use ln pregnancy
Clucagon Cl upseL
ulazolde headache cerebral lschemla CPl
Clucagon + anLlcoagulanL lnc rlsk of bleedlng