Antidiabetic and Hypoglycemic Agents
Lilley Pharmacology Text: Chapter 30

Syllabus Assistive Guides:

Prototype Drugs: Antidiabetic: pg. 33

Learning Questions: pg. 34

Treat Diabetes

Lower Blood Sugar

Insulin

Oral Agents

Protein Hormone

Secreted Beta Cells-Pancreas

1-2 Units per hour

4-6 Units per meal

1 units x 24hrs +

4 units x 3 meals

Total 36 Units per day

 

Metabolism of Carbohydrates, Fats, Protein

Endocrine

Exocrine

Islands of Langerhans secretes 3 hormones:

Glucagon (alpha cells)

Insulin (beta cells)

Delta cells - somatostatin

 

 

Pancreas releases insulin into the bloodstream

Blood carries it to all cells in the body

Lowers Blood Sugar

Decreases breakdown of glycogen in the liver

Decreases the breakdown of fat to fatty acids in adipose tissue

Decreases protein breakdown in muscle

 

Commercial Insulin

Has the same effect as endogenous insulin

We are trying to mimic action of pancreas by giving Commercial Insulin (Exogenous Insulin) in clients who cannot produce their own insulin!!!!!

Patients who’s Beta Cells become

Overwhelmed: Disease

Exhausted: Stress or Drugs

Destroyed: Virus, Cancer

 

Results from an autoimmune disorder that destroys pancreatic beta cells

Also called Insulin Dependent Diabetes Mellitus IDDM

Disorder of Carbohydrate Metabolism

Glucosuria

Polydipsia

Polyuria

Polyphagia

Insulin preparations

Onset of action

Duration of action

Degree of purity

Source

 

 

 

 

 

Insulin Preparations
All insulin in UK is 100 units/ml

Short Acting

Regular- Humulin R

ALWAYS USED FOR SLIDING SCALE COVERAGE!!!!!!

Intermediate Acting

NPH-Humulin N

 

Mixtures

70/30= 70 Units NPH & 30 Units Regular

Long Acting

Lantus

 

Soluble

Clear

Onset 30 minutes

Peak 1 - 3 hours

Duration up to 8 hours

Crystals in suspension
(need re-suspending)

Cloudy

NPH or Isophane (NPH = Neutral Protamine Hagedorn)

Onset 1 ¹/₂ hours

Peak 4 - 12 hours

Duration up to 24 hours

 

 

Pre-mixed combinations of
short and intermediate acting
insulins (biphasic)

Cloudy (needs re-suspending)

5 different combinations (10, 20, 30, 40, 50)

e.g. 30/70 Mixture = 30% fast acting

+ 70% intermediate acting

Onset 30 minutes

Peak 2 - 8 hours

Duration up to 24 hours

 

Synthetic Human Insulin

Do not mix with any other insulin

Long Acting Up to 24 hours

NO PEAK

Given at BEDTIME

 

Human - Genetically engineered using either
yeast (pyr) or e.coli (prb)

Animal

Beef - Increased incidence of allergic problems

Pork - Less antigenic than beef (Kurtz et al. 1980)

- Available as purified insulin

Before use Store in fridge

In-use vials Store in fridge (3 months)

Out of fridge at max 25 C

(4-6 weeks)

In-use pens Out of fridge at max 25 C (4 weeks)

Insulin devices (pens)

Durable (replace insulin cartridge)

Disposable (no need to replace cartridge)

 

 

Insulin vials and syringes

Advantages

Improved dose accuracy

More convenient

Easy to use

Portable

Quick and discreet

May improve client self-management/compliance

Preferred by patients

Disadvantages

Cannot mix insulin in a free-mixing regimen

Continuous subcutaneous insulin infusion (CSII)

Battery operated

Programmable computer

Basal insulin throughout day

Bolus insulin before meals

Needles/catheters changed

every 2-3 days

By increasing the uptake of glucose by body muscles, exercise does what to Blood Glucose?

Lowers it by

increasing the

number of insulin

receptors!!!!

 

Stress increases Blood Glucose

Never OMIT normally ordered insulin!!!

Check Blood Glucose q4 hr >240? Check for ketones!!!

Ketones: call MD!!!!

Sick Day Guidelines…

Autoimmune Process: Beta cells destroyedà Insulin deficiency

Has no insulin

Idiopathic

Genetic predisposition

< Age 30

Insulin resistanceà has some insulin

Obesity is risk factor

Physical inactivity

Genetic predisposition

Adult onset

There is abnormally high level of glucose

Pancreas does produce insulin

Body resists the insulin’s effects

As a result, the glucose circulating cannot enter the cells, so that the glucose cannot be used for energy!!!!!!

INSULIN RESISTANCE!!!

Type 2 Diabetes
Signs and Symptoms

Hyperglycemia

Polyuria

Polydipsia

Blurred vision

Fatigue

Paresthesias

Skin infections

80% are obese

10% non-obese

10% unstable: may look more like a Type 1 Diabetic

Sulfonylureas

Biguanides

Glitazones

 

Increase secretion of insulin in the pancreas

Hematologic effects

GI effects

Hypoglycemia

Increase the use of glucose by muscles and fat cells

GI

Metallic Taste

Decreased Vitamin B12

Rare Lactic Acidosis

DOES NOT CAUSE Hypoglycemia

Decrease Insulin Resistance

Stimulate receptors on muscle, fat and liver cells

Increase effectiveness of circulating insulin

Weight Gain

Hepatic Toxicity

What time will the insulin/oral agent act?

What carbohydrates are available?

Observe for Therapeutic Effects

What are the Adverse Effects?

Blood tests

1. Fasting Blood Glucose

Test (Cavenaugh pg. 105)

2. Blood Glucose

Monitor Systems

2. Oral Glucose

Tolerance Test

(Cavenaugh pg. 109)

3. Glycosylated Hemoglobin

Assays (Cavenaugh pg. 112)

4. Glycosylated Serum

Proteins and Albumin

(Cavenaugh pg. 114)

CBGs

AccuChecks

Glucometer

Glucoscan

Hgb A1C maintained at 7% or below

Premeal blood glucose level 70 to 110mg/dl

Blood glucose at bedtime 100-140mg/dl

Observe for Therapeutic Effects

Observe for Adverse Effects

Observe Injection Site

Signs of Hypoglycemia

(see handout)

Nursing Interventions

Signs of Hyperglycemia

(see handout)

Nursing Interventions

 

 

Hypoglycemic protocol

Mild hypoglycemia (BG < 60 and symptomatic)

- 10 to 15g of carbohydrate

- Recheck BG in 15minutes

Moderate (BG < 40 and symptomatic)

-15 to 30g of rapidly absorbed CHO

Severe (BG < 20 and unable to swallow)

- 1mg of glucagon IM/SQ or amp of D50 IVP

 

Frequent assessment of client: LOC, V/S, blood glucose levels, fluid and electrolyte status

Correct fluid volume deficit

1 liter of isotonic saline over 1 hour

1 liter of hypotonic saline over 6 to 8 hrs

1 liter of hypertonic solution (D51/2NS) over 8 to 12 hrs.

Insulin therapy: lower BG by 75-150mg/dl/hr

Regular insulin IV bolus dose of .1u/kg followed by IV drip of .1u/kg/hr.

SQ insulin when client can eat and ketosis has ended.

Electrolyte replacement

Potassium

Bicarbonate