Diabetes

• drugs for diabetes mellitus

  sulfonylureas - glipizide

  biguanides - metformin

  thiazolidinediones - pioglitazone

  alpha-glucosidase inhibitors - acarbose

  gliptins - sitagliptin

  insulin - lispro, regular, NPH, glargine

  glucagon-like polypeptide receptor agonists - liraglutide

  hyperglycemics - glucagon

  sodium-glucose cotransporter 2 inhibitors - canagliflozin
• adverse effects of metformin

  lactic acidosis, GI upset, diarrhea, vitamin deficiencies
• pharmacologic action of metformin

  decreases liver production of glucose, slightly reduces glucose absorption in gut
• key monitoring parameters of metformin

  renal function, BUN, creatinine, vitamin deficiencies, can give in pregnancy
• patient education for metformin

  avoid alcohol, maintain adequate carb and fluid intake
• pharmacologic action of glipizide

  stimulates pancreas to release more insulin, can increase cellular sensitivity to insulin
• adverse effects of glipizide

  weight gain, hypoglycemia, cardiac toxicity, GI upset
• key monitoring parameters of glipizide

  hypoglycemia (diaphoresis, tachycardia, fatigue, hunger, tremors), CBC
• patient education for glipizide

  take 30 minutes before meals, monitor blood glucose, have high-carb snacks
• pharmacologic action of pioglitazone

  decreases insulin resistance, inhibits gluconeogenesis
• adverse effects of pioglitazone

  upper respiratory tract infection, headache, muscle aches, fluid retention, edema, liver failure, ovulation
• key monitoring parameters of pioglitazone

  liver function, edema, serum lipids, weight gain
• patient education for pioglitazone

  take with or without food, report jaundice, chest pain, shortness of breath
• pharmacologic action of sitagliptin

  increases activity of incretin hormones (stimulate release of insulin in response to glucose)
• adverse effects of sitagliptin

  upper respiratory tract infection, pancreatitis, hypersensitivity, Stevens-Johnson syndrome, angioedema
• key monitoring parameters of sitagliptin

  respiratory, kidney function, may give with metformin
• patient education for sitagliptin

  take with or without food, report respiratory s/s, persistent headaches, or abdominal pain
• insulin lispro onset, peak, & duration

  onset - 15 minutes

  peak - 30 minutes to 3 hours

  duration - 3 to 5 hours
• regular insulin onset, peak, & duration

  onset - 30 to 60 minutes

  peak - 2 to 3 hours

  duration - 3 to 6 hours
• NPH insulin onset, peak, & duration

  onset - 1 to 2 hours

  peak - 4 to 12 hours

  duration - 18 to 24 hours
• insulin glargine onset, peak, & duration

  onset - 1 hour

  peak - none to minimal

  duration - 18 to 24 hours
• types of insulin

  short acting - insulin lispro

  regular acting - regular insulin

  intermediate acting - NPH insulin

  long acting - insulin glargine
• insulin administration

  insulin lispro - SQ or IV

  regular insulin - SQ or IV

  NPH insulin - SQ only

  insulin glargine - SQ only
• short acting insulin is often given when & with what?

  give 15 minutes before or immediately after eating

  often used with intermediate or long acting insulin
• regular insulin can be mixed with what?

  NPH
• how often is NPH insulin given, & what is the opacity?

  BID

  cloudy
• can you give insulin glargine with another insulin?

  no

  give at same time each day
• what type of medication may mask hypoglycemia?

  beta blockers
• when drawing up two insulins to mix, which do you draw first?

  clear -> cloudy