PHARMEXAM1(diabetes)

a disorder of carbohydrate metabolism

deficiency of insulin (NOT PRODUCING)

resistance to action of insulin

• may produce → but insulin doesn’t work as well

Most common in children

• destruction of pancreatic beta cells

• decrease insulin levels (early in disease) → soon they will fall to zero

  • RISK FOR KETOACIDOSIS

• insulin resistance/impaired insulin secretion (making it & NOT releasing it)

• overtime hyperglycemia leads to reduced beta cell function

  • little risk for ketoacidosis

• hyperglycemia & hypoglycemia

• Heart Disease

• hypertension

• stroke

bc of the amount of glucose → makes blood more viscous

• retinopathy

• nephropathy

• gastroparesis

• amputations

• neuropathy

  • erectile dysfunction

• check glucose levels

• x-cessive plasma glucose

  • PT must be tested on 2 separate days and must be (+) on both

• fasting plasma glucose (FPG) ≥126mg/dL

• causal plasma glucose ≥200mg/dL (plus symptoms of diabetes)

  • take after eating

• oral glucose tolerance (OGTT): 2 Hr plasma glucose ≥200mg/dL

avg. blood glucose level over a period of time/long terms glycemic control

• (2-3months)

≥ 6.5%

• prevention of complications

• maintain glycemic control (70-130mg/dL b4 meals)

• Target A1C levels 6.5%

• diet

• exercise

• insulin replacement

• monitoring treatment

  • self-monitoring blood glucose level

Starts working in 5-15min

• insulin lispro (humalog)

• insulin aspart (novalog)

• insulin glulisine (apidra)

regular insulin

Starts working in 30 min

• Humulin R

  • Novalin R

Takes 90 min to work

• insulin glargine

• U100 (lantus)

• insulin detemir (levemir)

starts working in 6 hrs

lasts 24hr

• insuluin glargine

• U300 (toujeo)

• insulin degludee (tresiba)

@ risk for hypoglycemia

• NHP & Regular

• NHP & lispro

• NPH & aspart

• NPH & glulisine

draw clear to cloudy

• short acting can go into long acting

• SQ: syringe & needle, pen injectables, jet injectors

• SQ Infusion: portable insulin pump, implantable insulin pump

• IV infusion

  • Inhalation

onset: 15 min

peak: 1 hr

duration: 3 hr

onset: 30 min

peak: 2 hr

duration: 8 hr

onset: 2 hrs

peak: 8 hrs

duration: 16 hrs

onset: 2 hr

peak: NONE

duration: 24 -48 hrs

• Unopened Vial: stored in fridge

• Open vials: can be stored up to 1 mo. w/o significant loss of activity

• always write time & date when vial is opened

• prefilled syringe should be kept in fridge

tight glucose control

• attention

• motivation

• education

• defined glycemic target

• increased calorie intake

• infection

• obesity

• stress

• adolescent growth spurt

• pregnancy (after 1st trimester)

• decrease calorie intake

• increase physical activity

• 1st trimester of pregnancy

• hypoglycemia

• hypokalemia

• lipodystrophy (A loss and/or redistribution of body fat)

  • rotate injection site

Metformin (glucophage)

• type of choice for INITIAL therapy

• started immediately

• used alone of in combo

• lowers blood sugar

• inhibits glucose production in liver

• increases cell ability to take in glucose whenever insulin is present

• decreases the amount of blood sugar that the liver produces and that the intestines or stomach absorb.

• absorbed from small intestine

• excreted (unchanged) by the kidney

• ↓ appetite

• nausea

• diarrhea

• ↓ B12 absorption

• ↓ folic acid absorption

lactic acidosis

• alcohol (dangerously lowers BS)

• iodinated Radiocontrast Media

tolbutamide (orinase)

• Glipizide (glucontrol)

• Glyburide (diabeta, micornase)

• Glimepiride (amaryl)

• stimulates release of insulin from pancreatic islets

• insulin release is glucose dependent

• type II

• can be combined Sulfonylureas

• w/ other hypoglycemic agents

• metabolized in liver

• excreted in the kidney

• hypoglycemia

• CV toxicity

• alcohol

• beta blockers

• other hypoglycemic agents

• CONTRAINDICATED in pregnancy

• sustained hypoglycemia for neonate if taken close to birth

administer w/meals

• Repaglinide (Prandin)

• Nateglinide (Starlix)

• promotes insulin release

• faster peak & shorter duration of action (vs sulfonylureas)

  • works faster, lasts less

• metabolized in the liver

• biliary excretion

Gemfibrizol (lopid)

• Rosiglitazone (avandia)

• Pioglitazone (Actos)

↓ insulin resistance and improving insulin sensitivity, allowing the insulin that the body produces to work more effectively.

• metabolism: hepatic

• excretion: fecal (main) & urinary

• administer with or without meals

• fluid retention

• bladder cancer

• unintended pregnancy

Acarbose (precose)

• taken @ start of meal

• works by slowing the action of certain chemicals that break down food to release glucose (sugar) into your blood

• Slowing food digestion helps keep blood glucose from rising very high after meals

• flatulence, cramps, abd. distension, diarrhea

• may cause liver dysfunction

• Monitor liver function every 3 mo. for the first yr

• Sitiglipin (Januria)

  • give med B4 the first meal of the day

• blocks reabsorption of glucose in the kidney

• ↑ urinary glucose excretion

• yeast infection

• UTI’s

• risk of dehydration

• postural hypotension & dizziness

poor interaction with diuretics

• Exenatitde (byetta)

• Liraglutide (victoza)

• adjunctive therapy to improve glycemic control in PT’s w Type II

• used to improve glucose control in PT’s taking metformin or sulfonylureas

  • GIVEN SQ B4 MORNING & EVENING MEALS

• hypoglycemia w/sulfonylurea

• GI effects

• renal impairment

• pancreatitis

• reduces post prandial levels of glucose

• delays gastric emptying

• suppress glucogen secretions

  • GIVEN SQ

  • GIVEN B4 major meals containing @ least 250kcal or 30 g of CHO

• hypoglycemia

• nausea

• injection site reactions

body doesn't have enough insulin to allow blood sugar into your cells for use as energy.

• hyperglycemia

• water loss

• hemoconcentration

leads too ketoacids (inc. ketons)

• death

• coma

• acidosis

• 8-10L ) 0.9% NSS

• IV insulin replacement

• correct hyperglycemia & acidosis

• Potassium replacement (drive K+ back into cells)

• Bicarbonate (for acidosis)

• diarrhea

• overdose of insulin

• increased insulin levels exceeds insulin needs

• vomiting

• reduced food intake

• intense exercise/childbirth

• tachycardia

• palpitations

• sweating

• nervousness

• fatigue

• HA

• Confusion

• drowsiness

can lead to irreversible brain damage

fast acting oral sugars

• 3 glucose tabs

• 8ox of OJ/Juice

• 2 sugar packets

• non-diet soda

• 6-7 hard candies

• 1tablespoon of sugar

• IV glucose (D50)

• parenteral glucagon

1. Check Blood Sugar

2. eat 15g of carbs

3. wait 15 min for sugar to get into blood

hormone produced by alpha of the pancreas

• breaks down glycogen stores

• opposite effects of insulin

• used in emergencies if IV glucose cannot be given

• GIVEN IV, SQ, IM