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Drugs Affecting Blood Glucose

Drugs Affecting Blood Glucose. Nur 312 Fall 2004. Statistics. Incidence increasing 1 out of 3 diabetics mellitus (DM) -have not been diagnosed Type 2 – 90-95% Complication from DM – 6 th leading cause of death Leading cause of kidney failure, adult blindness & lower extremity amputation.

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Drugs Affecting Blood Glucose

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  1. Drugs Affecting Blood Glucose Nur 312 Fall 2004

  2. Statistics • Incidence increasing • 1 out of 3 diabetics mellitus (DM) -have not been diagnosed • Type 2 – 90-95% • Complication from DM – 6th leading cause of death • Leading cause of kidney failure, adult blindness & lower extremity amputation

  3. Types • Type 1 – result of lack of sufficient insulin or a total absence of insulin • Type 2 – result of insulin resistance by the tissues & usually a decrease in insulin production

  4. Insulin • Different types • Some may be mixed • Some are premixed • Dosage is in units

  5. Regular Insulin (Humulin R) • Classification – short acting • Give subcut. or IV • Give with intermed. acting insulin • Used with sliding scale (1 unit per 25 mg over 180) & insulin pumps • Onset – 30-60 minutes, peak 2-4 hours & duration 6-8 hours • Stable at room temp for 1 month • AEs – hypoglycemia, lipodystrophy

  6. Teaching & Administration • Teaching points – how to, know signs of hypo & hyper, skin care, etc. • Administer 30-60 minutes before eating – use same anatomic location to promote regular absorption – must eat after insulin • No cold insulin – stable at room temp for 1 month • Double check dosage, roll gently if suspension, clear to cloudy • Monitor blood glucose & A1c

  7. Lispro (Humalog) • Rapid acting • Onset 10-15 minutes, peak 1-2 hours, duration 3.5 hours • Can use with insulin pump • Administer 10-15 minutes before meals

  8. Innovative Insulin Delivery Systems & Monitoring Devices • Insulin pump • Jet injector • Insulin pen • Different modes of delivery – e.g. intranasal • GlucoWatch Biographer

  9. Intermediate Acting Insulins • NPH & Lente • Onset 1-4 hours, peak 6-10 hours, & duration 24 hours • Administer subc. 1-2x/day • When would you look for hypoglycemia if give early morning dose?

  10. Long Acting Insulin • Ultralente • Onset 4-6 hours, peak 18 hours, duration 36 hours

  11. Long Acting Analog • glargine (Lantus) • Peakless • One dose, cannot be mixed, with type 2 start dose at bedtime

  12. Oral Hypoglycemics • Sylfonylureas – glyburide (Diabeta) • Increase prod. of insulin & increase number of insulin receptors • Onset 2 hours, peak 3-4 hours, duration 24 hours • Give 1-2 times daily • AEs – hypoglycemia, nausea, heartburn • Contraindicated if allergic to sulfa

  13. Meglitinides • repaglinide (Prandin) • Increase release of insulin • Take within 15 minutes of meals – do not take if not going to eat • Less risk of hypoglycemia

  14. Biguanides • Decreases hepatic glucose production & enhance insulin stimulated glucose transport • metformin (Glucophage) • AEs – GI - so take drugs with meal • Contraindicated with liver & kidney disease • Available in combination tablets (metformin & glyburide)

  15. Alpha Glucosidase inhibitors • “starch blockers” – delays glucose absorption • acarbose (Precose) • Can be administered alone or in combination with insulin, metformin or sulfonylureas • AEs – primarily GI • If hypoglycemia occurs must use dextrose, oral glucose, absorption of candy/sugar is inhibited thus ineffective

  16. Thiazolidinediones • Fights insulin resistance • rosiglitazone (Avandia) • AEs – edema, weight gain, URI • Contraindicated with liver disease – need to monitor liver enzyemes – can cause liver failure • Expensive • Takes time to work (weeks for some patients)

  17. Glucose Elevating Agents • Glucagon – hyperglycemia hormone – stimulates glyconeogenesis • Usually given to reverse severe hypoglycemia (pt. unconscious) • Given IM, subc., or IV • AE – N&V

  18. Drugs affecting the Reproductive System • Glands and hormones affecting the reproductive system include the pituitary gland: FSH, LH, Prolactin, Oxytocin • Ovaries; estrogen and progesterone • Placenta: Human chorionic gonadotropin and human placental lactogen • Testes: Testosterone

  19. Estrogen • Promoting and maintaining female organs and secondary sexual characteristics • Capillary dilatation and fluid retention, enhances protein anabolism, stimulates epiphyses of long bones. Normal bone density • Inhibits or promotes ovulation, thinning of cervical mucous, growth of pubic hair

  20. Progesterone • Change the endometrial form a proliferative to secretory one • Promotes maturation of the ovarian follicle • Inhibits uterine contractions • Anabolic or androgenic activity

  21. Hormone Replacement Therapy • Hot flashes • Osteoporosis • Cardiovascular disease • Decreased cognitive functions • Conjugated Estrogens “Premarin” • Estrace, patches or pill form

  22. Progestins • Used to treat amenorrhea or stop abnormal bleeding • Used in combination with estrogen as contraceptives (progesterone, provera, depo-provera • Menopausal treatment

  23. Oral Contraceptives • Combination (estrogen and progestin)-inhibit ovulation by suppressing FSH,LH, alter cervical mucous • Monophasic, Biphasic, Triphasic,Progestin Only • AE: dose-related, thromboembolism, stroke, MI, hepatic lesions, gallbladderdisease • Mortality in 35 year olds, smokers

  24. Androgens &Anabolic Steroids • Androgen-male hormone produces masculization and tissue building • Testoterone Produced by the testes in response to LH. • FSH (sperm Cells) • Responsible for normal growth and development of male sex organs • Male secondary sex characteristics

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