Diabetes Meds

• Exemplars - Treatment


  • Type 1 Diabetes
  • Type 2 Diabetes
• Insulin


  Exogenous insulin - Insulin from an outside source, required for type 1 diabetes, prescribed for patients with type 2 diabetes who cannot manage blood glucose levels by other means

  
• Commercially Available Insulin Preparations

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• Insulin Regimens


  Basal-bolus regimen - Most closely mimics endogenous insulin production, Rapid- or short-acting (bolus) insulin before meals, Intermediate- or long-acting (basal) background insulin once or twice a day, Less intense regimens can also be used
• Mealtime Insulin (Bolus)


  Rapid-acting (bolus) insulin preparations like Lispro and aspart, Short-acting (bolus) insulin like Regular with onset of action 30 to 60 minutes, Injected 30 to 45 minutes before meal
• (Basal) Background Insulin


  Used to manage glucose levels in between meals and overnight, Long-acting (basal) insulin like Insulin glargine (Lantus) and detemir (Levemir), Intermediate-acting insulin like NPH with duration 12 to 18 hours

  
• Combination Insulin Therapy


  Can mix short- or rapid-acting insulin with intermediate-acting insulin in same syringe, Provides mealtime and basal coverage in one injection, Commercially premixed or self-mix
• Insulin Storage


  Do not heat/freeze, Extra insulin should be refrigerated
• Insulin Administration


  Given by subcutaneous injection, Cannot be taken orally, Absorption is fastest from abdomen, followed by arm, thigh, and buttock

  
• Subcutaneous Injection Sites


  • Abdomen, Arm, Thigh, Buttock
• Insulin Pen


  Keep on hand, Click for sight issues

  
• Insulin Pump


  Continuous subcutaneous infusion, Battery-operated device, Connected to a catheter inserted into subcutaneous tissue in abdominal wall, Program basal and bolus doses that can vary throughout the day, Potential for keeping blood glucose levels in a tighter range

  
• Inhaled Insulin


  Afrezza - Rapid-acting inhaled insulin, Administered at beginning of each meal or within 20 minutes after starting a meal, Not a substitute for long-acting insulin
• Oral Agents


  • Metformin (Glucophage)
  • Sulfonylureas (glipizide, glyburide, glimepiride)
  • Glinides (repaglinide, nateglinide)
  • Thiazolidinediones (pioglitazone, rosiglitazone)
  • Alpha-Glucosidase Inhibitors (acarbose, miglitol)
  • Dipeptidyl Peptidase-IV (DPP-IV) Inhibitors (sitagliptin, saxagliptin, linagliptin)
  • Sodium Glucose Co-transporter Inhibitors (SGLT2 inhibitors - canagliflozin, dapagliflozin, empagliflozin)
  • Incretin Mimetics (exenatide, dulaglutide, liraglutide, semaglutide)
• Metformin


  Side effects: GI - bloating, nausea, cramping, diarrhea, Lactic acidosis - rare but can be fatal, Nursing considerations: Contrast media, Contraindicated in later stages of kidney failure, Take with meals
• Sulfonylureas


  Examples: glipizide, glyburide, glimepiride, Side effects: Hypoglycemia, Nausea, heartburn, Weight gain, Nursing implications: Potential cross allergy with sulfa drugs, Hypoglycemia
• Glinides


  Examples: repaglinide, nateglinide, Side effects: Hypoglycemia, Weight gain, Take with food
• Thiazolidinediones (Glitazones)


  Examples: pioglitazone, rosiglitazone, Side effects: NOT recommended in heart failure, Edema and weight gain, Rhabdomyolysis, Nursing Implications: Daily weights, Careful cardiac assessment, Urine color & lower extremity assessment, Slow onset of action
• Alpha-Glucosidase Inhibitors


  Examples: acarbose, miglitol, Side effects: GI - flatulence, diarrhea, abdominal pain, MUST be taken with food
• Dipeptidyl Peptidase-IV (DPP-IV) Inhibitors

  Examples: sitagliptin, saxagliptin, linagliptin, Side effects: Upper respiratory infection, Headache, diarrhea, Acute renal failure, Pancreatitis, Rhabdomyolysis, Nursing Considerations: BUN/Creatinine, amylase & lipase, urine color and lower extremity assessment
• Sodium Glucose Co-transporter Inhibitors (SGLT2 inhibitors)


  Examples: canagliflozin, dapagliflozin, empagliflozin, Side effects: Yeast infections and UTIs, Hypotension, hypovolemia, hyperkalemia, increased LDLs, Nursing Considerations: Rifampin can decrease effects, Hypoglycemia with other diabetes drugs, Kidneys must be functioning
• Incretin Mimetics


  Examples: exenatide, dulaglutide, liraglutide, semaglutide, Side effects: N & V, diarrhea, Weight loss, Nursing considerations: ONLY in Type 2 diabetes, Best to give 60 minutes before a meal
• Nursing Implementation - Acute Illness and Surgery

  Frequent monitoring of blood glucose, Increase insulin for type 1 diabetes, Type 2 diabetes may necessitate insulin therapy, Maintain normal diet if able, Increase noncaloric fluids, Continue taking antidiabetic medications, IV fluids and insulin, Frequent monitoring of blood glucose
• Acute illness and surgery can lead to increased blood glucose level secondary to counterregulatory hormones
• If normal diet not possible during acute illness, supplement with CHO-containing fluids while continuing medications