- A metabolic disorder characterized by hyperglycemia (high blood glucose) because: - Pancreas does not produce any insulin - Pancreas produces not enough insulin - Cells of the body do not respond appropriately to insulin

- Is the only drug administered for type 1 diabetes - Administered subcutaneously, only regular insulin can be administered intravenously - Measure in 100 units/mL - Schedule II

- Regular insulin may be administered IV - when mixing insulin in a single syringe, if one is cloudy, it gets drawn up second - Rapid acting insulins cannot be mixed with other insulins

- insulin aspart - insulin aspart/insulin aspart protamine crystals - insulin detemir - insulin glargine - insulin glulisine - insulin lispro - insulin lispro/insulin lispro protamine - insulin NPH - insulin NPH/insulin regular - insulin regular - porcine insulin isophane

Diabetes - Chapter 26 Flashcards by Tayler Trainer

Diabetes Mellitus

A metabolic disorder characterized by hyperglycemia (high blood glucose) because:
Pancreas does not produce any insulin
Pancreas produces not enough insulin
Cells of the body do not respond appropriately to insulin

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Hormone Regulation of Blood Glucose Levels

Glucose is obtained from digestion and absorption of ingested food and is also made in the liver and muscles
Absorbed glucose is carried by the blood to all cells of the body
B cells in the pancreas release insulin in response to rising blood sugar

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Diabetes Complications

Retinopathy
Blindness
Blurred vision
Nephropathy
Stroke
Heart attack
Hypertension
Angina
Hyperlipidemia
Infections
Amputations
etc.

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Types of Diabetes Mellitus

Prediabetes
Type 1 diabetes
Type 2 diabetes
Gestational diabetes

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Prediabetes

-BG level higher than normal; 50% progress to diabetes

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Type 1 Diabetes

Autoimmune disease

- Immune system attacks and destroys B-cells resulting in a total lack of insulin production

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Type 2 Diabetes

Most common

- Pancreas does not produce enough insulin and/or cells become resistant to insulin

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Gestational Diabetes

-Occurs in about 3-20% of all pregnant women

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Risk Factors for Type 2 Diabetes

Age
Family history
Genetics
Having gestational diabetes
Diagnosis of prediabetes
High blood pressure
High cholesterol
Overweight
Sleep apnea

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Symptoms of Type 1 and 2 Diabetes Mellitus

Hyperglycemia
Extreme fatigue
Increased thirst
Frequent urination
Constant hunger
Weight loss
Blurred vision
Diabetic ketoacidosis

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Diagnostic Tests for Diabetes

Fasting blood glucose test
Oral glucose tolerance test
Random blood glucose
Hemoglobin A1c

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Lifestyle Modifications for Diabetes Mellitus

Weight loss
Physical activity
Stop smoking
Eat low glycemic index foods

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Pharmacy Supplied Diabetic/Insulin Supplies

Syringes
Pen needles
Blood glucose testing strips
Lancets
Alcohol swabs
Sharps disposal
Infusion sets for pumps
Insulin pens
Blood glucose meters
Urine strips for ketones and/or glucose

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Pharmacological Management of Diabetes Mellitus

Insulin
Sulfonylureas
Biguanides
a-Glucose inhibitors
Meglitinides
Thiazolidinediones
Dipeptidyl peptidase-4 inhibitors
Incretin mimetics
SGLT2 inhibitors

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Insulin

Is the only drug administered for type 1 diabetes
Administered subcutaneously, only regular insulin can be administered intravenously
Measure in 100 units/mL
Schedule II

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Insulin Dosage Delivery Systems

Vial
Cartridge pen
Prefilled disposable pan
Pump

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Insulin Storage Conditions

Protect from extremes in heat and cold
Refrigerate unopened vials
Vial or pen in use may be stored at room temp for 28 days

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Insulin Tech Note

Regular insulin may be administered IV
when mixing insulin in a single syringe, if one is cloudy, it gets drawn up second
Rapid acting insulins cannot be mixed with other insulins

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Insulin Examples

insulin aspart
insulin aspart/insulin aspart protamine crystals
insulin detemir
insulin glargine
insulin glulisine
insulin lispro
insulin lispro/insulin lispro protamine
insulin NPH
insulin NPH/insulin regular
insulin regular
porcine insulin isophane

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Generic: insulin aspart

NovoRapid

-Rapid acting

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Generic: insulin aspart/ insulin aspart protamine crystals

NovoMix 30

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Generic: insulin detemir

Levemir

-Long acting

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Generic: insulin glargine

Lantus

-Long acting

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Generic: insulin glulisine

Apidra

-Rapid acting

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Generic: insulin lispro

Humalog -Rapid acting

Generic: insulin lispro/ insulin lispro protamine

Humalog Mix 25 | Humalog Mix 50

Generic: insulin NPH

Humulin-N Novolin ge NPG -Intermediate acting

Generic: insulin NPG/ insulin regular

Humulin 30/70 Novolin ge 30/70 novolin ge 40/60 Novolin ge 50/50

Generic: insulin regular

Humulin-R Novolin ge Toronto -Short acting

Generic: porcine insulin isophane

Hypurin NPH Hypurin Regular -intermediate short

Insulin ADR's

- Hypoglycemia - Weight gain - Pain or irritation at injection site - Fat accumulation or loss at injection site - Hypokalemia

Symptoms of Hypoglycemia

- Shakiness - Dizziness - Nervousness - Sweating a lot - hunger - Headache - Pale face - Passing out

Treatment Options for Mild to Moderate Hypoglycemia

- 15g glucose tables - 15 mL table sugar dissolved in water - 175 mL juice or regular soft drink - 6 lifesavers - 15 mL honey

Hypoglycemia Treatment if Patient is Unconscious

- Glucagon kit | - IV glucose

Diabetic Ketoacidosis (DKA)

- Is a life threatening condition; Cells cannot get the glucose needed for energy due to a lack of insulin - High levels of glucose remain in the blood but cannot be transported into cells - Ketone bodies enter the bloodstream, causing a chemical imbalance

Causes of DKA

- too low insulin - Having a severe infection or other illness - Severe dehydration - Combination of these things -Most common in type 1 but can occur in type 2

Symptoms of DKA

- Flushed, hot, dry skin - Blurred vision - Feeling thirsty and urinating a lot - Drowsiness - Rapid, deep breathing - Strong fruity breath odour - Loss of appetite, vomiting, etc. - confusion

Sulfonylureas

-AKA oral hypoglycemic agents

Sulfonylureas MOA

- Stimulate insulin release from pancreatic B-cells - Decrease glycogenolysis - Increase insulin binding - Increase insulin receptor sensitivity

First Generation Sulfonylureas examples

- tolbutamide | - chlorpropamide

Generic: tolbutamide

tolbutamide | Orinase

Generic: chlorpropamide

chlorpropamide | Diabinese

Second Generation Sulfonylureas Examples

- glyburide - glicazide - glimepiride

Generic: glyburide

Diabeta

Generic: gliclazide

Diamicron | Diamicron MR

Generic: glimepiride

Amaryl

Sulfonylureas ADR's

- Hypoglycemia - Weight gain - Nausea/vomiting - Abdominal pain - Diarrhea - Headache - Dizziness

Sulfonylureas Warning Labels

- TAKE WITH BREAKFAST OR FIRST MEAL OF THE DAY - AVOID PROLONGUED EXPOSURE TO SUNGLIGHT - AVOID ALCOHOL - SWALLOW WHOLE; DONT CRUSH OR CHEW

Biguanides

Classified as antidiabetic agents

Biguanides MOA

- Increases peripheral glucose uptake and utilization in skeletal muscles and adipose tissue - Lowers postprandial plasma glucose

Biguanides Examples

-metformin

Generic: metformin

Glucophage Glumetza - Bid ot tid, Glumetza is ER so once daily - Always with meals

Metformin ADR's

- Gas - Heartburn - Metallic taste in mouth - Mild stomachache - Nausea - Weight loss -Lactic acidosis

Biguanides Warning Labels

- TAKE WITH FOOD - SWALLOW WHOLE; DONT CRUSH OR CHEW - AVOID ALCOHOL

Alpha-Glucosidase Inhibitors

- Reduce peak plasma glucose levels | - Not used as monotherapy, adjunct only

Alpha-Glucosidase Inhibitors MOA

-Inhibit the action of a-glocosidases therefore prolong the digestion of carbohydrates and delay their absorption in the small intestine

Alpha-Glucosidase Inhibitors Examples

-acarbose

Generic: acarbose

Glucobay

Alpha-Glucosidase Inhibitors ADR's

- GI gas - Bloating - Abdominal pain - Diarrhea

Alpha-Glucosidase Inhibitors Warning Labels

-MUST BE TAKEN WITH THE FIRST BITE OF EACH MEAL

Meglitinides

- Common ending: "glinide" | - Stimulate insulin secretion from pancreatic beta cells

Meglitinides Examples

- nateglinide | - replaglinide

Generic: nateglinide

Starlix

Generic: replaglinide

GlucoNorm

Meglitinides ADR's

- Hypoglycemia - Nausea/vomiting - Headache

Meglitinides Warning Labels

- MUST ONLY BE TAKEN IMMEDIATELY PRIOR TO MEALS TO AVOID SERIOUS HYPOGLYCEMIA - SKIP A MEAL, SKIP A DOSE

Thiazolidinediones

- Common ending: "glitazone" - Called "insulin sensitizers" - use limited to patients that do not respond to other agents

Thiazolidinediones MOA

- Increase tissue sensitivity - Increase uptake of glucose in the liver and muscles - Reduce plasma fasting glucose concentrations, insulin resistance, and A1c

Thiazolidinediones Examples

- pioglitazone - rosiglitazone - rosiglitazone/metformin

Generic: pioglitazone

Actos

Generic: rosiglitazone

Avandia

Generic: rosiglitazone/metformin

Avandamet

Thiazolidinediones ADR's

- Headache - Weight gain - Diarrhea - Nausea/vomiting - Muscle pain - Blurred vision - Hypoglycemia

Dipeptidyl Peptidase-4 Inhibitors

- Common ending: "gliptin" | - Potentiate the action of GLP-1 and GIP leading to an increase in release of insulin and a decrease in glucagon

Dipeptidyl Peptidase-4 Inhibitors Examples

- linagliptin - saxagliptin - sitagliptin - alogliptin

Generic: linagliptin

Trajenta

Generic: saxagliptin

Onglyza

Generic: sitagliptin

Januvia

Generic: alogliptin

Nesina

Dipeptidyl Peptidase-4 Inhibitors Combinations Examples

- saxagliptin/metformin - sitagliptin/metformin - linaglipton/metformin - alogliptin/metformin

Generic: saxagliptin/metformin

Komboglyze

Generic: sitagliptin/metformin

Janumet

Generic: linagliptin/metformin

Jentadueto

Generic: alogliptin/metformin

Kazano

Dipeptidyl Peptidase-4 Inhibitors ADR's

- Hypoglycemia - Gas - Heartburn - Nausea - Metallic taste - Stuffy, runny nose

Incretin Mimetics (Glucagon-like Peptide {GLP-1} receptor agonist)

- GLP-1 is an incretin - Stimulate GLP-1 receptors in the a and B-cells in the pancreas - Delay gastric emptying - Decrease appetite

Incretin Mimetics Examples

- exenatide | - liraglutide

Generic: exenatide

Byetta -Bid before am and pm meals

Generic: liraglutide

Victoza -once daily

Incretin Mimetics ADR's

- Nausea | - Pancreatitis with liralgutide (rare)

SGLT2 Inhibitor

- Adjunct, oral agent for type 2 only - Inhibits sodium-glucose cotransporter 2 in the kidneys - allows more glucose to go into urine instead of being reabsorbed

SGLT2 Inhibitors Examples

- cangliflozin | - dapagliflozin

Generic: cangliflozin

Invokana

Generic: dapagliflozin

Forxiga

SGLT2 Inhibitors ADR's

- Increased risk of yeast infections and UTI's | - Hyperkalemia

Diabetes - Chapter 26 Flashcards

(95 cards)