Oral Hypoglycemic Medication

Name 3 types of Secretogogues

Sulfonylureas

Megletinide

Amino Acid Derivatives

Name the 4 Sulfonylureas

Diabeta

Glunase

Glucotrol

Amaryl

Sulfonylureas:

Diabeta

Glynase

Glucotrol

Amaryl

have a slow onset, last up to 24hours

s/e: hypoglycemia and wt gain

Meglatinide

Prandin used to decrease post prandial blood glucose

has a rapid onset, short duration

admin 30m before meal

s/e: hypoglycemia, wt gain

Amino Acid Derivatives

Starlix

rapid onset, short duration

take 30m before meal

s/e: hypoglycemia

Insulin Sensitizers

What is there action?

1) decrease excessive glucose release by decreasing gluconogenesis

2) increase uptake of glucose by the muscle to decrease serum glucose

Insulin Sensitizers

Biguinides: Glucophage

Can cause lactic acidosis

500-2500mg qd

s/e: anorexia, diarrhea, nausea, bloating, lactic acidosis, hypoglycemia

monitor renal fx, d/c med @ 24h prior to iv contrast studies and hold x48h

contraindications: renal insufficiency, liver dz,chf

helps w/fluid vol.def, helps w/ postprand bs,wt loss

Thiazolindinediones:

Avandia(may increase chance of MI)

Actos

monitor fluid retention,hepatic toxicity, monitor LFT(AST,ALT)

contraindicated: heart failure, liver probs

Alpha-glucosidase inhibitors:

Dealys the breakdown of carbs to slow absorption from the intestinal tract. Primary effect is to decrease Post Prandial Blood glucose

Precose

Glyset

Alpha-Glucosidase Inhibitors

take w/ first bite of each meal

s/e: hypoglycemia, diarrhea, flatulence, rash

check liver enzymes, H&H, blood glucose and HbA1C

Precose may cause anemia and CNS problems

Novolog

Humalog

10-15m onset, 45-90m peak, 3-4h duration

must have quick access to a meal

What is the onset, peak and duration of NPH

1-3h onset, 6-12h peak(8h gold standard) 20h duration

note: not for controlling Postprandial glucose, most likely to have hypoglycemic episode

Lantus

Levemir

Name the combination insulins?

Humline 70/30

Novolog Mix

when givin insulin....?

always have 2 nurses check the dose

only give reg insulin iv, never give cloudy insulin iv

always stay in the same body part but different sites to prevent lipodistrophy

room temp, insulin does not have to be fridged

Hypoglycemia

cold, clammy, need some candy

Hypoglycemia:

TIRED:

T:tachycardia

I:iritability

R:restlessness

E:excessive hunger

D:diaphoresis and depression

DKA

(diabetic ketoacidosis)

Hot and dry sugar high

DKA

relative or absolute lack of insulin

fats and proteins are used for energy

dehydrated

the breakdown of fats for energy results in:

ketosis and acidosis

dehydration

electrolyte and acid base imbalances

DKA

Primarily occurs in Type 1 can occur in Type 2 if periods of extreme stress

s/s:dry skin, acetone breathe(fruity), confusion,coma, tachy,low B/P, dysrhythmia caused by hyperkalemia or hypokalemai, weak, Kussmaul resp, polyuria then oliguria, vomiting, serum glucose as high as 1500,serum acetone+,ABG's acidic

HHS

(hyperglycemia Hyperosmolar Syndrome)

Not Acidic!!!!

Glucose is usually higher than in DKA