Antidiabetics

Antihyperglycemics
Bob is a 25 year old who is 2 DPO
from appendectomy


—Pmhx: Diabetic Type I (IDDM)

—Doctors orders:
• NPO – Ice
chips
• IV D5NS @
100ml/hr
• Morphine
10mg subcu
Q4h
• Gravol 25-
50mg IV q6h
prn
You are his nurse and are
receiving report at 0700 on Bob
—Report reads:

—Bob slept fairly well throughout the night

—Awoke at 0600 with pain to RLQ stating 7/10 with no

nausea

—VS 120/68, 88, 14, 37.2 @ 0600

—Night nurse administered Morphine 10mg subcu at 0615

After report – you go to see Bob
—You find Bob sleeping soundly

—He barely rouses as you talk to him and you notice his
skin is slightly sweaty

—What are your next nursing actions?

Bob’s vital signs
—

—VS 104/58, 90, 12, 37

—BG 3.2 mmol/L

—What Is a normal BG?

Signs and Symptoms of
Hypoglycemia:
—

—Confusion – change in LOC

—Sweating

—Rapid pulse

—Tremors
Type 1 Diabetic - IDDM
—

—Typically diagnosed from ages 11-13

—Genetic, immunological and environmental factors

—Can occur in adulthood

—Autoimmune destruction of pancreatic beta cells –

ABSOLUTE LACK OF INSULIN SECRETION -
HYPERGLYCEMIA



Differentiation – Type 1 and 2
Diabetics
Common Signs & Symptoms of
Hyperglycemia
—Hyperglycemia – BG > 7.0 mmol/L

—Polyuria – excessive urination

—Polyphagia – decreased hunger

—Polydipsia – increased thirst

—Glucosuria – high levels of glucose in the urine

—Weight loss

—Fatigue

Primary goal of Insulin


—To prevent long term complications of diabetes by

keeping BG levels within the target range:
— 4 – 6 mmol/L

—To provide the right amount of insulin so the glucose in

the blood will be available to the cells


—
—
Types of Insulin


—Several types – 1980s - beef/pork pancreas

—Human insulin today is from recombinant (artificial) DNA

technology
— More effective
— Less allergies
— Lower incidence of resistance – beef/pork
— Able to alter its pharmokinetics for:
— Rapid onset of action (10-15 minutes)
— Prolonged duration of action (24 hrs)
•


Common Insulins for IDDM
Onset, Peak, Duration
Peak and Duration
Subcutaneous delivery methods
for Insulin:
—

—Insulin Subcu


—Insulin Pen


—Insulin Pump

Lifespan Considerations:
Gestational Diabetes


—Diagnosed in pregnancy – not present after postpartum

period (6 weeks post birth of child)

—A hormone secreted by the placenta (lactogen)

contribute to destruction of insulin by the placenta
which raise blood sugars

—Oral antihyperglycemic agents are not used due to the

potential effects of the fetus



Nursing Considerations:
—
— Familiar with onset, peak and duration of action
— Monitor pt.’s BG prior to meals and prn
— Determine if pt. able to eat (ie. Nausea)
— Withhold insulin prior to certain tests/procedures
— KNOW THE SIGNS AND SYMPTOMS OF HYPO/HYPERGLYCEMIA
— Pt. teaching
— Drug to drug interactions
Type II Diabetes - NIDDM
—

—The pancreas secrets small amount of insulin

—Insulin receptors in the tissues are resistant/insensitive

to the hormone

—Proper diet/exercise can increase insulin receptors

Oral Hyperglycemics
—

—Common action of lowering BG levels

—Classification based on chemical structure and

mechanism of action

—Single, dual, or triple therapy may be used

—May require Insulin

Classifications
—Sulfonylureas

—Biguanides

—Alpha-glucosidase Inhibitors

—Thiazolidinediones

—Meglitinides

—Incretins (new agents)

Needs to know information on
oral antihyperglycemics:
—Pancreatic Action
— Stimulate pancreatic beta cells to release insulin

—Extrapancreatic Action
— Work in liver to decrease glucose production
— Increase # of insulin receptor cells in peripheral tissues
— Block enzymes in small intestine – delaying the
breakdown of carbohydrate into monosaccharides for
absorption


—
Diagnostics – Blood Glucose