Drugs for Diabetes

• What are the drugs used to treat Diabetes?

  - Insulin

  - Oral Hypoglycemics
• What are the prototype drugs for Insulin?

  - Rapid-acting: Insulin lispro, Insulin aspart, Insulin glulisine

  - Long-acting: Insulin Glargine, Insulin Detemir, Insulin Degudec

  - Short-acting: Humulin R, Novolin R

  - Intermittent-acting: Humulin N, Novolin N (NPH) insulin, Humilin RL, Novolin R L (Lente)
• What is the mechanism of action of Rapid Acting Insulin?

  - Used as bolus (similar to the action of the pancreas when the glucose starts to climb)

  - Used in insulin pumps!
• Describe a Bolus dose?

  Higher amount after meals
• What is the onset of Rapid Acting Insulin?

  Rapid onset

  - Starts in 15 minutes
• What is the duration of Rapid Acting Insulin?

  Short duration

  - Lasts 5 hours, peaks in 2.5 hours
• What is the mechanism of action of Long-Acting Insulin?

  Acts like basal (similar to the basal secretion of the pancreas)
• Describe Basal dose?


  Low dose of insulin, background insulin
• What is the onset of Long-Acting Insulin?

  Slower absorption

  - Onset for 1 hour
• What is the duration of Long-Acting Insulin?

  Prolonged action

  - Lasts 24 hours, NO peak
• What is the mechanism of action of Short-Acting Insulin?

  Regular insulin

  - IV only
• What is the onset of Short-Acting Insulin?

  Onset is 30 minutes
• What is the duration of Short-Acting Insulin?

  Prolonged action

  - Lasts 8 hours
• Is Intermittent-acting Insulin common or uncommon?

  Uncommon
• What is the duration of Intermittent-acting Insulin?

  Lasts 16 - 24 hours
• What are the prototype drugs of Oral Hypoglycemics?

  Biguanide- Prototype: MetforminSulfonylureas- Prototype: “gly” - glyburide/glipizide/glimepirideSGLTs inhibitors (Sodium Glucose Contransport 2 Inhibitors)- Prototype: Canagliflozin
• What is the mechanism of action of Metformin?

  1. Increases the use of glucose by muscle and fat cells

  2. Decreases hepatic glucose production and

  3. Decreases intestinal absorption of glucose
• What is the side and adverse effect of Metformin?

  - Lactic acidosis

  - Abdominal bloating

  - Nausea
• What is the Nursing Implication of Metformin?

  - No hypoglycemia- Monitor for fatal lactic acidosis
• What type of diabetes is Metformin used for?

  Type 2 DM
• How long should the patient be on Metformin?

  Must stay on the medication for 12 days (2 weeks)
• What should patients NOT receive while taking Metformin?

  Contrast dye

  - Messes with the kidneys
• What is the mechanism of action of glyburide/glipizide/glimepiride?

  Increases secretion of insulin
• What is the side and adverse effect of glyburide/glipizide/glimepiride?

  Hypoglycemia

  - Shaky, Sweating, Tachycardia
• What is the nursing implication of glyburide/glipizide/glimepiride?

  - Contraindicated during pregnancy

  - Renal/Hepatic impairment

  - Critical illness
• What is the mechanism of action of Canagliflozin?

  1. Blocks reabsorption of glucose in the kidney;

  2. Promotes excretion of excess glucose in the urine

  3. Renal protection decreasing protein loss
• What is the side and adverse effects of Canagliflozin?

  UTIs
• What is the nursing implication of Canagliflozin?

  Monitor for:

  - dehydration

  - hypotension

  - UTIs

  - vulvovaginal candidiasis
• What part of the body does Canagliflozin target?

  The kidneys (renal)
• Identify factors that may affect the adjustment of insulin dosage?

  Varies every day

  - Patients don't eat the same food every day

  - Different calories in food
• What are the complications of Insulin treatment?

  - Hypoglycemia

  - Hyperglycemia
• Describe Hypoglycemia regarding insulin treatment

  Hypoglycemia: Too much insulin taken or given
• What are the Symptoms of Hypoglycemia?

  Cold sweating, Increased pulse, shakiness
• What is the 15,15,50 rule of Hypogylcemia?

  15 grams of simple sugar (apple juice), wait 15 minutes, sugar should increase blood sugar level by 50 points
• What is the treatment of Hypoglycemia?

  IV glucose, Baqsimi (glucagon dry nasal powder for 4 years and older)

  - Glucagon IM can be used if IV glucose is not available
• Describe the symptoms of Hyperglycemia regarding insulin treatment

  Vomiting, Nausea, Rapid/Deep breathing, Unusual thirst
• What is the treatment for Hyperglycemia?

  Water, Insulin. Blood ketones, Check urine ketones, Check pump site if on a pump
• Describe and discuss the patient teaching guidelines of insulin and oral hypoglycemics

  Focus on Medications/Exercise/Diet- MyPlate: More vegetables, a Quarter of protein, and carbs- 30 minutes of exercisingBlood glucose at normal or near-normal levelsPromote normal metabolism of- Carbohydrates, fat, proteinPrevent acute and long-term complicationsPrevent hypoglycemic episodesHypoglycemic seizures must be avoided!!!