Diabetes Flashcards
(198 cards)
1
Q
What is diabetes?
A
- Abnormal insulin production
- impaired insulin utilization
- or both
2
Q
What cells signal the release insulin?
A
Pancreas
*glucuse breakdown and absorption
3
Q
What does diabetes lead too?
A
High blood sugar levels which can damage organs, b.v, nerves
4
Q
What is type I DM?
A
The pancreas is unable to produce insulin (insulin is absent)
5
Q
What is type II DM?
A
Pancreas does not produce insulin or the body does not effectively use the insulin that is produced.
- insulin insufficient
- insulin poorly utilized
6
Q
Where is the pancreas located?
A
Behind the lower part of stomach
7
Q
What hormones in the Islet of Langerhans?
A
Insulin secreted by beta cells
Glucagon secreted by alpha cells
8
Q
What is fct of pancreas?
A
- Endocrine: manage blood sugar leveles
- Exocrine: enzymes that break down food
9
Q
What effect does insulin have?
A
A hypoglycemic effect
After eat a meal:
1. Blood glucose increase
2. pancreas secrete insulin from beta cells
3. Insulin key: allow glucose to leave blood and enter cells.
10
Q
What stops the pancreas from secreting insulin?
A
When blood glucose stabilizes.
11
Q
What is the effect of glucagon?
A
Hyperglycemic effect
- Antagonist to insulin
- Lvls of glucose low: glucagon secrete from islets of Langerhans
- stimulate LIVER to break down glycogen to be released
12
Q
When would glucose lvls be low?
A
If individual not eaten or overnight
13
Q
What is done with excess glucose?
A
Stored as glycogen in liver (skeletal muscle) => remain until body needs it
14
Q
What is normal condition of glucose?
A
Continuously released into blood stream in small increments (basal rate) => meet need for quick energy.
W/increased bolus when food ingested
15
Q
What is average amount of insulin secreted die?
A
40-50 units
16
Q
What are the ranges for insulin secretion?
A
- 1hr after meal: insulin concentration rises rapidly
- After, insulin decline bc carb absorption from GI tract decline
- After carb absorption and night: [insulin] low and constant
17
Q
What is the normal level of glucose level?
A
Balance b/w insulin and glucagon
4-6 mmol/L
- No caloric intake for at least 8 hours
18
Q
What is HbA1C (glycosylated hemoglobin)?
A
<6.5% in adults
Average of blood glucose in past 2-3 months
Determine glycemic control over
Hgb last 120 days
- What % of Hgb coated in glucose
- Higher A1c = poorer blood sugar control
19
Q
What is fasting plasma glucose lvl (FPG)?
A
4-6 mmol/L (no caloric intake for 8 hrs)
20
Q
What is oral glucose tolerance test (OGTT)?
A
<11.1 mmol/L
- Glucose given orally and test done 1 hr after
21
Q
What is random blood glucose lvl?
A
< or equal to 11.1 mmol/L taken at any time of the day
22
Q
What are urine ketones
A
Poor use of glucose for energy and using fat as source of energy. Not be present within urine
23
Q
Urine glucose?
A
elevated urine levels (glycosuria) is an indicator of diabetes
24
Q
Urine proteins
A
kidney damage
25
Type 1 diabetes
- progressive destruction of beta cells in Islets of Langerhans (months to years before onset)
- immune sys attacks and kills the beta cells of pancreas
- Absence of insulin: insulin deficiency
26
When type 1 DM dev?
- generally before 30 years of age
- not preventable
- approx 10% of ppl have DM I
27
How manage type 1?
Insulin SC (exogenous insulin => outside source)
- Insulin-dependent: need it to survive
28
Clinical manifestation type 1?
Elevate plasma glucose lvls
- Polyuria
- Polydipsia (excessive thirst)
- Polyphagia (excessive hunger)
fatigue, weight loss, lack energy
29
What type 2 DM?
some endogenous => inside body insulin (insufficient), inefficient use of insulin
- Insulin resistance: insulin receptors unresponsive
- in ppl over 35 years old
- 90% of people w/diabetes
30
Clinical manifestation type 2?
Early stages: no symptoms => when have symptoms (gradual or very subtle)
- feeling tired
- frequent infections (bacteria feed off glucose)
- blurred vision
- slow healing of cuts or sores
- tingling or numbness in hands and feet
- Slow dev of 3 polys (unnoticed)
- Dx from MD => elevated fastin plasma glucose lvls
31
What is prediabetes?
high risk for dev DM => prevent diabetes w/appropriate lifestyle changes
32
What are blood values for prediabetes?
HbA1c: 6.0 - 6.4%
Fasting plasma glucose: 6.1-6.9 mmol/L
oral glucose tolerance test: 7.8 to 11.0 mmol/L
33
What are risks for DM II?
Increase risk of heart disease
- prediabetes + HTN +DLP + elevated triglycerides + abd obesity + sedentary lifestly
34
What are goals of diabetes?
- Nutritional therapy
- Exercise
- Self-monitor blood-glucose
- Drug therapy
35
How to do SMBG?
Self-monitor blood glucose
- Allow pt to do so
- Portable blood glucose meters: disposable lancets and glucose test strips
- better control of blood glucose lvls
36
What is other terms for SMBG?
- Acuchaeck
- CBGM: capillary blood glucose monitoring
37
What to teach pt to when monitoring BG?
1. How and when to perform SMBG
2. How to record results
3. Meaning of various BG lvls
4. How behavior and actions affect SMBG results/
38
What is the frequency of SMBG?
depend individually
- avg: 2-4 times a day for pt w/insulin (before meals, 2 hrs after meals and/or at bedtime)
- At least die if not receiving insulin
- When suspect hyper/hypoglycemia
- Any change in med, activity or health.
39
What are possible causes of hypoglycemia?
- not enough food
- excessive exercise
- too much insulin
40
What are S&S of hypoglycemia?
- ANS: Trembling, palpations, sweating, anxiety, hunger, nausea
- CNS: Diffuculty concentrating, confusion, weakness, drowsiness, blurred/doble vision, dizziness, loss of consciousness
41
What is mild hypoglycemia?
ANS present: Trembling, palpations, sweating, anxiety, hunger, nausea
- individual able to self treat
42
What is moderate hypoglycemia?
ANS and CNS symptoms
- able to self treat
43
What is severe hypoglycemia?
- assistance of another prs
- may be unconscious
- plasma glucose <2.8 mmol/L
44
What are steps to address hypoglycemia?
1. Recognize symptoms
2. Conform blood glucose <4 mmol/L
3. Treat with fast sugars (15 g)
4. RETEST in 15 min for BG >4 mmol/:
5. Eat snack or meal
45
What is the 15:15 rule
- Eat 15 g of fast sugar
- Wait 15 min and check again
Do three times in hospital before further intervention required
46
What are examples of 15 g simple carb?
- Glucose tablets
- 3 teaspoons or 3 packets of sugar in water
- 175 mL of juice
- 6 Lifesavers
- 15 mL of honey ( Tbs)
47
What do w/severe hypoglycemia (unconscious)?
- No IV => IM or SC glucagon => tell liver to release glucose into bloodstream
- w/IV: 10-25 g of glucose (220-50 mL of D50W) 1-3 minutes
48
How to prevent hypoglycemia?
Pt education (causes and early signs of hypoglycemia)
- Eat and exercise at reg times
- Always eat smt with alcohol => cause hypoglycemia till up to 24 hrs after + insulin secretion, liver work to remove alcohol from the blood instead of regulating blood sugar
49
What are the possible causes of hyperglycemia?
BG > 7 mmol/L
- Too lil or no diabetes meds
- excessive food intake
- inactivity
- emotional or physical stress
- illness/infection
- some medications (corticosteroids)
50
What are the clinical manifestations of hyperglycemia?
initial: Increased glucose levels > 6 mmol/L
later: classic signs (polyuria, polydipsia, polyphagia) fatigue, drowsiness, weakness
51
What is blood glucose lvls like in the hospital?
Hyperglycemia normal
- 1/3 of pt have hyperglycemia
- pre-existing DM
52
What are adverse effects of hyperglycemia?
- Increased risk of post-op infections
- vaginal yeast infections
- UTIs (glucose in urine)
=> prolong hospital stay => increase resource utilization
53
What are macrovascular DM complications?
- stroke
- heart disease & HTN
- PVD
- ulcers and amputation
54
What are microvascular DM complications?
- Diabetic eye disease: retinopathy
- renal disease (kidney)
- neuropathy
- foot problems
55
How is CV health affected by DM?
- long-term => poor tissue perfusion from b.v. damage
- DM => elevate cholesterol => vessel damage => atherosclerotic plaque => decrease in arterial supply to tissues => tissue damange or death
56
What is the vascular protection checklist?
A: A1C usually ≤7%
B: BP <130/80
C: Cholesterol - LDL ≤2mmol/L
D: Drug protect heart
A - ACEi or ARB, S - Stain, A - ASA
E: Exercise/Eating healthy
S: Smoking cessation
57
How does DM affect peripheral arteries disease/peripheral neuropathy?
Nerve damage + poor blood flow to legs and feet
- Less likely to feel foot injury (blister or cut)
- make harder to heal
- untreated => amputation
58
What are complications of foot and lower extremities?
- Sensroy neuropathy: reduced pt awareness
- PVD: delayed wound helaing
- Poor vision inability see small lesion
59
What could nutrition therapy do?
- Reduce HbA1C by 1% to 2%
- reduce calory intake
- space out carbs intake regularity in meal consumption control BG and wt
60
What is an integral part of DM treatment?
Nutrition therapy and counselling
- Maintain or improve quality of life
- maintain or improve nutritional and physiological health
- prevent and treat acte and long-term complications of DM
61
What BMI # should wt loss be done?
For Patients with BMI ≥25 kg/m2…
- Nutritionally balanced, calorie-reduce diet be followed for lower, healthier body wt
- wt loss 5-10% of initial body wt
- improve insulin sensitivity, glycemic control, BP, lipid lvls
62
What is nutritional therapy for DM 1?
Meal: plan same as pt usual diet and BALANCED with insulin and exercise
- insulin managed day to day
- assess for hypoglycemia
63
What is nutritional therapy DM 2?
Achieving glucose, lipid and BP goals
- calorie reduction
64
Why choose healthy fats?
Good fat: avocado, nuts, olive oil, fish
- Unsaturated liquid at room temp
- Bad saturated fats: solid at room temp
65
What health carbohydrates to choose?
Dietary fibre: 30-50 g a day
- oats, barley, konjac noodles, beans, peas, chickpeas, lentils, vegetables, fruit, broccoli
66
How to read labels for carbs and fibers?
1. Look at serving size and the whole amount of the food
2. Fiber should be substracted from total carbohydrates (not raise BG)
67
Why to consume less Na?
Increase BP bc retains fluid and increases volume
- diuretic to void
68
What is GI?
a ranking of carbs in food and how affect blood glucose lvls.
69
What does it mean carbs low GI value?
- 55 or less
- slower release of glucose in blood: no peak and then drop.
- regulated and gradual BG
70
What does high GI value mean?
- spike in blood glucose lvl: rapidly digested.
- Fluctuations in blood glucose lvls
71
What are examples of low, medium and high GI?
72
What to evaluate effectiveness of diet?
- Blood glucse 2 hrs before and after meal
- HbA1C lvls: under 6%
73
What exercise should pt do?
decrease med need in DM 2 w/diet and exercise
IF not working then oral meds and then insulin
- walking
- in the water: min barriers such as arthritis (walking briskly, swimming)
74
Cautions for diabetes in exercise?
- Risk of hypoglycemia: highest risk at peek time of med action or if food intake insufficient to maintain blood glucose lvls
75
Best time for pt to exercise?
Blood glucose at peak (~1 hr after meal or snack)
- have fast acting glucose available WHEN exercise
76
What recommended exercises and time?
- min of 150 mins moderate aerobic exercise per week
- resistance exercise ≥ 2 times a week
77
Pre-exercise assessment why?
Predisposed to injury before px exercise regimen
78
What to include in pre-exercise assessment?
- neuropathy: have sensation
- retinopathy: can see
- CAD-resting ECG: exercise stress rest
79
How to do resistance exercise?
6-8 exercises for major grp muscles
- 3 sets of 8-12 reps, 1-2 min rest
80
How to perform aerobic exercises?
- walk: 5-15 min
- progress over 12 wks to 50 min per session
- 10 min x3 die
81
What should ppl with diabetes do?
- specific physical activity goals
- anticipate barriers to physical activity (weather) => dev strategies to overcome barriers
- record physical activity
- dev strategies overcome barriers
82
Example of nursing dx?
Unmet for nutrition d/t altered metabolism r/t poorly controlled blood glucose
83
What to assess for when dx w/diabetes?
- Medications
- CV
- family hx
- Recent surgery: infection, wound healing
- symptoms: 3 polys
- malaise
- wt loss
- hunger
- poor healing
- Kussmaul's respirations: ketoacidosis (remove excess CO2), pH lvl, blood lvls acidic
84
What is the nursing dx?
* Ineffective health management
* Risk for injury
* Risk for unstable blood glucose levels
* Risk for peripheral neuro-vascular dysfunction
85
What do you plan for?
- active ct participation
- few to no ep of hype/hyperglycemia
- normal BG lvls
- prevent or delay chronic complications
- lifestlye adjustments with min stress
86
Who is at risk?
- CV problems
- fam hx
- overweight adults at 45 yeards old
- usually dx of DM 2 @ 35
screen w/fasting blood glucose lvls preferred
87
What do you implement?
Health promotion: identify those at risk, routine screening
88
What are cute implementations?
- Hypoglycemia
- Diabetic ketoacidosis
- Hyperosmolar hyperglycemic nonketotic syndrome
89
What are interventions for stress of illness and surgery?
- increases blood glucose level
- continue reg meal plan
- inc. intake of noncaloric fluids
- take oral agents and insulin
- monitor blood glucose: ketone testing if glucose > 14 mmol/L (need MD order)
90
What are ambulatory and home care?
- care for self at home: monitor blood glucose lvls
- personal hygiene
- med identification and travel card
-
91
What to evaluate for?
- Knowledge
- Balance of nutrition
- Immune status
- Health benefits
- No injuries
92
What is diabetic ketoacidosis (DKA)?
Profounds deficiency of insulin
characterized by:
- hyperglycemia
- ketosis
- acidosis
- dehydration
Most likely in type 1
93
What are precipitating factors to DKA?
- lllness
- infection
- inadequate insulin
- poor self-management
94
How is DKA dev?
Insulin supply insufficient => glucose unable to be used for energy
- Break down of fats => ketone => urine
- Blood becomes acidic
Prs doing:
- alter pH balance, metabolic acidosis
- removing as much acid as possible (Kussmaul's breathing and urinating)
95
What is angiopathy?
Disease of b/v
macrovascular
- large and med b.v.
- greater frequency and earlier onset in DM
- altered lipid metabolism common to diabetes
96
What are risk factors to aniopathy?
risk factors:
- smoking
- obesity
- hypertension
- high fat
- sedentary lifestyle
97
What is microvascular angiopathy?
Dislipidemia
- thickening of b.v. membranes and capillaries and arterioles bc of HYPERGLYCIMIA => speciic to DM
98
What is most noticeably affected by microvascular angiopathy
Retinopathy: eyes
Neuropathy: nerves
nephropathy: kidneys
99
When do clinical manifestations appear for microvascular angiopathy?
10-20 years after DM
100
What is diabetic retinopathy?
microvascular damage to retina from hyperglycemia
- Most common cause of new blindneess in ppl of working age
treatment
- laser photocoagulation (prevent further vision loss), vitrectomy (aspirate blood, membrane and fibers inside eye
101
What is nephropathy?
Damage to small b.v. that supply kidney
- LEAD to end-stage renal disease
102
How to prevent nephropathy?
- Tight glucose control
- Blood pressure management
- Angiotensin-converting enzyme (ACE) inhibitors => Used even when not hypertensive
- Angiotensin II receptor antagonists
103
What are interventions for diabetic nephropathy?
yearly screening: microalbumin in urine, serum creatinine
104
What is diabetic neuropahty?
- 40-50% have degree of neuropathy
- due METABOLIC derangements of DM
- distal symmetric => affect bilateral hands and feet
Characteristic: loss of sensation, abn sensation, pain, paresthesias
- foot injury and ulcers without pt having pain
- atrophy of small muscles
105
Treatment of neurpathy drugs?
TIGHT BG control
drug therapy:
- Topical creams
- Tricyclic antidepressants
- Selective serotonin and norepinephrine reuptake inhibitors
- Antiseizure drugs
106
What are autonomic diabetic neuropathy complications?
Affect nearly all body sys
complications: gastroparesis (delayed gastric emptying, CV abnormalities
- Alter sexual fct & neurogenic bladder
- Foot complications: most common cause of hospitalization (micro¯o vascular disease)
107
What do you implement?
Health promotion: identify those at risk, routine screening
108
What values to dx pt in FPG?
Fasting Plasma Glucose: ≥7 mmol/L (no caloric intake for 8hrs)
109
What values to dx in HgA1c?
≥6.5% in adults
110
What values in random blood glucose for dx?
≥ 11.1 mmol/L
111
What is antidiabetic drug for DM I?
Insulin => always required for DM I
- pt endogenous insulin absent
112
What is antidiabetic drug for DM II?
Inadequate insulin for their needs
Antihyperglycemic agents +/- insulin PRN
113
What do the antidiabetic drugs aim to produce?
- normoglycemic state
- euglycemic state
=> NORMAl BG
114
What is the purpose of glucose?
No a cure for DM
- control hyperglycemia
Goal: TIGHT glucose control
- reduce long-term complications
115
Where does originate from?
1. From domesticated animals: pigs (porcine insulin)
116
How is insulin made in lab?
Synthesized using RECOMBINANT DNA tech
- from common bacteria or yeast cells
- human biosynthetic insulin
117
How to alter pharmacokinetic properties of Human Insulin?
Onset, peak, duration
- Adding zinc, acetate buffers and protamine to insulin => diff insulin preparations
118
What are the four major classes of insulin?
1. Rapid Acting
2. Short ACting
3. Intermediate
4. Long acting
119
What are rapid-acting insulin?
lispro (Humalog)
aspart (NovoRapid)
glulisine (Apidra)
appearance: clear, colourless
120
What is onset of rapid acting?
10-15 min
121
What is peak action of rapid acting insulin?
1 to 2 hours
122
What is duration of action?
3 to 5 hours
123
When to admin rapid-acting insulin?
Admin 0-15 ac meals (before)
124
What are short acting insulin?
Reg insulin
(Humulin R, Novolin ge, Toronto)
appearance: clear, colourless
125
What is onset of short acting?
30 min
126
What is peak action?
2 to 3 hours
127
What is duration of action?
6.5 hours
128
When to admin short-acting insulin?
30 mins before a meal
ONLY insulin admin IV route
129
What are characterisitcs of rapid and short acting insulin?
- admin in association w/meals => control BG rise after meals
- Glycemin control b/w meals and at NIGHT, rapid/short acting insulin used w/intermediate OR long-acting insulin => TYPE I
130
What are intermediate-acting insulin?
Isophane insulin suspension (Humulin N, Novolin, NPH)
- cloudy, white
131
What is onset of intermediate acting insulin?
1-3 hours
132
What is peak action of intermediate insulin?
5-8 hours
133
What is duration of intermediate insulin?
up to 18 hours
134
How intermediate insulin combined?
Combined with regular insulin to reduce amount of injection die
135
How is intermediate insulin release longer?
Conjugating regular insulin with protamine (large protein) => delay absorption
- Onset delayed and duration of action extended
136
What are long acting insulin?
glargine (Lantus)
detemir (Levenir)
clear/colorless
137
What is onset of long acting insulin?
90 min
clear/colorless
138
What is peak of long acting insulin?
NO peak (hypoglycemia risk reduced)
- constant lvl of insulin in body
139
When to admin long acting insulin?
glargine admin at bedtime
detemir admin 1-2 x die
140
What to know about detemir?
long-acting insulin
- duration of action: dose dependent
- lower doses => bid
- higher doses => die
141
What more to know about long acting insulin?
Slow onset and prolonged duration => provide BASAL GLYCEMIC CTRL
- NOT meant control hyperglycemia immediately after meal
142
What does an insulin regimen look like?
combo of...
- rapid/short acting insulin => manage surges of BG after meals
- intermediate or long-acting insulin => period b/w meals when blood glucose lvls are lower
require: mixing and admin of diff types of insulin
143
What insulin are you able to mix?
Insulin NPH in longer-acting insulin (intermediate) MIX with rapid or short acting-insulin
144
Can you mix detemir or glargine?
NO bc pH incompatible
145
What are premixed insulins?
Fixed ratio of insulin: % of rapid or short-acting insulin to intermediate-acting insulin
146
What is bolus insulin?
Insulin taken at meal times to keep blood glucose lvls under control following a meal
- Act quickly and short-acting insulin or rapid insulin
147
What is basal insulin?
- keep BG consistent lvls during fasting periods
- act over long period of time: long or intermediate acting insulin
148
What is sliding-scale insulin dosing?
Doses of short-acting (reg) or rapid-acting (lispro or apart) insulins adjusted based off of BG results
149
Where is sliding-scale insulin dosing used?
Hospitalized pt: insulin requirement vary
- stress: infection, surgery, acute illness
- inactivity
150
What is the sliding scale like?
For Humulin R SC
Blood glucose ≤ 10 0 units
Blood glucose 10.1 – 12.0 2 units
Blood glucose 12.1 – 14.0 4 units
Blood glucose 14.1 – 16.0 6 units
Blood glucose 16.1 – 18.0 8 units
Blood glucose ≥ 18.1 10 units and call MD
151
What to do when insulin sliding scale used at bedtime?
Admin HALF of indicated dose => check cap refill glucose after 2hrs of injection
152
What to know abt PO insulin admin?
Insulin inactivated by gastric juices => not taken PO
USUALLY SC (syringe, insulin pen, or continuous SC infusion)
153
What can be given by IV?
Only regular insulin
154
How to admin insulin SC using a syringe?
- only use insulin syringes => calibrated in units + 28-29G and 1/2" length
- Admin at 90 degree angle unless emaciated (abn thin) => 45 degree
155
What is the concentration of insulin?
Number of units per mL of insulin
156
How to admin NPH or pre-mixed insulin?
- Cloud appearance
before prep dose
- NOT shake => roll b/w hands (avoid air trapped in syringe and inaccurate dose admin
157
What are insulin pumps?
- computerized devices
- Insulin doses delivered through catheter => through skin => S/C tissue of abd
- Alternative to multiple insulin injections
158
When to change catheter sie infusion?
Change q3 days around 1" away from old one
159
How to program pumps?
Programmed to release small doses of insulin continuously (basa) and/or a bolus dose close to mealtime
-> closely mimic body's natural release of insulin
160
How to set a basal lvl in insulin pump?
Infuse insulin continuously at a slow but steady rate
161
How does pump provide bolus dose?
Match in size to the carbohydrate content of each meal => could be triggered manually
162
What is used in insulin pumps?
regular, lispro, aspart, glulisine
163
How to store unopened insulin?
Vials and pen catridges => up to three months in the fridge
164
How to store insulin when opened?
Room temperature for up to one month
165
How to never admin insulin?
Cold => trigger tissue atrophy
166
What is lipodystrophy?
Tissue become hardened (lumps) w/orange peel appearance
167
What does lipodystrophy do?
Alter insulin absorption, delay onset
- result if same site injection are used repeatedly
168
How is lipodystrophy resolved?
Area unused for min of 6 months
169
What is current practice for injection sites?
- Rotation to diff anatomical site not recommended => variability in insulin absorption
- enter blood at diff speed in diff site injections
170
What is best practice site for insulin injection?
Abd => insulin work fastest
- insulin arrive a little more slowly from upper arms and more slowly from thighs and buttocks
171
Site rotation
172
What is recommended for each mealtime injection?
Ex:
breakfast insulin injecxtion => abd
supper ac insulin injection => leg die
=> give more BG results
173
What to know about allergies?
Allergies to insulin rare bc of human insulin creation
- Zinc and protein are used as preservatives in insulin and latex rubber stoppers
174
What are insulin adv effects
- hyperglycemia, lipodystrophyl, allergic rxn, insulin insensitivity
175
What are potential drug interactions that anatogonize hypoglycemic effect?
- Antagonize hypoglycemic effects of insulin: cortico steroids, thyroid gland, furosemide => elevated BG lvls
176
What are drug interactions that increase BG lvls?
- Increase hypoglycemic effect => lower blood glucose lvls, alcohol, saulfa antibiotics, salicytes
177
What are families for oral antihyperglycemic agents?
- decrease amount of glucose release by the liver
- increase amount of endogenous insulin produced by the pancreas
- improve way endogenous insulin is used (decrease insulin resistance)
- delay intestinal absorption of glucose
178
Can DM I use oral hyperglycemic agents?
No, pt must have some circulating endogenous insulin
179
What are biguanide?
metformin (Glucophage)
- commonly used for DM II
- first-line drug
180
What is primary action of metformin?
Decreases glucose production by the liver
- Lower amount of glucose released into the blood by the liver
181
What is metformin commonly used w/?
sulfonylurea agents when each drug not results in adequate glycemic control
182
What are adverse effects of metformin?
GI tract
- abd bloating, nausea, cramping, feeling fullness and diarrhea
not cause hypoglycemia => not stimulate pancreas to release insulin
183
Who is well suited for metformin?
Ppl who skip meals: not lower blood glucose any further
184
What is a rare but serious risk in for biguanide?
Lactic acidosis => use consciously w/pt w/renal insufficiency
185
When to withhold metformin?
if pt requires any test that uses contrast medium (increased risk for nephrotoxicity)
- resume when serum creatinine lvls have been assessed.
186
What are sulphonylureas?
glyburide (Diabeta)
gliclazide (Diamicron)
187
What is the prim actino of sulphonylureas?
Stimulate insulin production and secretion by the beta cells of the pancreas
- Helps the pancreas to make more insulin
- Lower BG lvls in pt when diet and lifestyle have failed and A1C lvls remain elevated
188
What is the most frequent adverse effects?
Hypoglycemia
Effect GI sys: N, epigastric fullness, heartburn, increased appetite
189
What are meglitinides?
repaglinide (GlucoNorm)
nateglinide (Starlix)
190
What is the actions of meglitinides?
Structurally diff than sulfonylurea
- increase insulin production and secretion by beta cells of pancreas
191
What to know about duration of action in meglitinides?
Quicker and shorter duration of action: less chance of hypoglycemia bc of BG
192
What are thiazolidinediones (glitazones) ?
rosiglitazone (Avandia)
pioglitazone (Actos)
193
what is the prim action of thiazolidinediones (glitazones)?
Not increase insulin ffrom pancreasa
- enhance sensitivity of insulin receptors
- allows cells to respond to available endogenous insulin more efficiently
- increased glucose uptake by muscle and adipose tissue
194
What are α-Glucosidase Inhibitor examples?
acarbose (Glucobay)
195
What are α-Glucosidase Inhibitor?
- "starch blockers" slows/delays absorption of carbs from small intestine => smaller increase in BG glucose lvls
- glucose absorbed into blood more slowly
- enzymes break down carbs = inhibited
196
When is What are α-Glucosidase Inhibitor admin?
Beginning of each meal (first bite)
- med cannot directly lower fasting blood glucose
197
What are Incretin enhancers examples?
sitagliptin (Januvia)
198
What are Incretin enhancers?
enhacne incretin hormones (endogenous compounds )
1) stimulate release of insulin
2) suppress release of glucagon
