Drugs Affecting Blood Glucose

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

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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

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Insulin

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

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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

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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

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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

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Innovative Insulin Delivery Systems Monitoring
Devices

• Insulin pump
• Jet injector
• Insulin pen
• Different modes of delivery e.g. intranasal
• GlucoWatch Biographer

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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?

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Long Acting Insulin

• Ultralente
• Onset 4-6 hours, peak 18 hours, duration 36 hours

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Long Acting Analog

• glargine (Lantus)
• Peakless
• One dose, cannot be mixed, with type 2 start dose
  at bedtime

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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

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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

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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)

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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

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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)

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Glucose Elevating Agents

• Glucagon hyperglycemia hormone stimulates
  glyconeogenesis
• Usually given to reverse severe hypoglycemia (pt.
  unconscious)
• Given IM, subc., or IV
• AE NV

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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

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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

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Progesterone

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

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Hormone Replacement Therapy

• Hot flashes
• Osteoporosis
• Cardiovascular disease
• Decreased cognitive functions
• Conjugated Estrogens Premarin
• Estrace, patches or pill form

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Progestins

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

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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

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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