Chapter 36 Agents Used to Treat Hyperglycemia and Hypoglycemia.
-
Upload
dortha-matthews -
Category
Documents
-
view
235 -
download
0
Transcript of Chapter 36 Agents Used to Treat Hyperglycemia and Hypoglycemia.
Chapter 36Agents Used to Treat Hyperglycemia and Hypoglycemia
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 2
Diabetes Mellitus
Disorder of the pancreas Results in hyperglycemia
Treatment Insulin Oral hypoglycemics
(continues)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 3
Pancreatic beta cells Excrete an insufficient amount of insulin, or no
insulin at all Flawed carbohydrate, fat, and protein
metabolism
Diabetes Mellitus(continued)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 4
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
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 5
Symptoms of Diabetes Mellitus
Polyuria (increased urine output) Polydipsia (excessive thirst) Polyphagia (excessive hunger)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 6
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)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 7
Diabetes Mellitus
Type 1 diabetes mellitus Treated with insulin subcutaneous injections
Type 2 diabetes mellitus Treated with oral hypoglycemic agents
(continued)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 8
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
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 9
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.
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 10
Effects of Insulin
Allergic reactions Lipodystrophy Insulin resistance
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 11
Nursing Implications
Several drugs antagonize the hypoglycemic effects of insulin.
Check your drug manual before administering any drug agent.
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 12
Hypoglycemia
Blood glucose is low (< 40 mg/dL) Produced from
Skipped or irregularly scheduled meals Excessive exercise Insulin administration errors
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 13
Signs and Symptoms of Hypoglycemia
Sweating Confusion Tachycardia Headache Hunger
Weakness Poor muscle
control Emotional
instability Coma and death
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 14
Hypoglycemia Treatment
Glucagon (intramuscular, intravenous, or subcutaneous)
IV dextrose 50%, also known as D50W
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 15
Treatment for Type 2 Diabetes
Oral antidiabetic agents Five classes
1. Sulfonylureas (oldest category)• First generation• Second generation
2. Biguanides3. Meglitinides4. Alpha-glucosidases5. Thiazolidinediones
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 16
Sulfonylureas
Action: stimulate the beta cells of the pancreas to secrete more insulin
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 17
Biguanides
Action: inhibit hepatic glucose production and increase the sensitivity of peripheral tissue to insulin
May be given with sulfonylureas
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 18
Meglitinide
Action Stimulate the beta cells of the pancreas to
secrete insulin Minimal risk of hypoglycemia
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 19
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
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 20
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
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 21
Side Effects of Sulfa
Hematology Hemolytic anemia, thrombocytopenia, and
jaundice Gastrointestinal
Nausea, epigastric fullness, and heartburn
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
36 - 22
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