Antidiabetics



Antidiabetics







TERMS



  • □ acarbose (Precose)


  • □ chlorpropamide (Diabenese)


  • □ glyburide (Diabeta, Micronase)


  • □ insulin injection, regular



QUICK LOOK AT THE CHAPTER AHEAD

Insulin and oral hypoglycemics are used to treat diabetes mellitus (DM) by preventing hyperglycemia. Insulin is used to treat Type I (insulin-dependent-diabetes mellitus IDDM). Insulin can be extracted from domesticated animals or synthesized in the laboratory using recombinant DNA technology.1 Recombinant or human insulin is identical to insulin produced by the pancreas.1

There are five categories of insulin, including rapid-acting, short-acting, intermediate-acting, long-acting, and combination insulin. The dose of insulin is based on individual client needs.

Oral antidiabetics are used to treat Type 2 (non-insulin-dependent-diabetes mellitus NIDDM). Diet and exercise are also included in treating NIDDM and, when needed, insulin. The three categories of oral antidiabetics include first– and second-generation sulfonylureas and miscellaneous group, which include alpha-glucosidase inhibitors, biguanides, meglitinides, and thiazolidinediones. Two new injectable drugs include pramlintide acetate (Symlin), anmylin mimetic, and exenatide (Byetta), an incretin mimetic.










Table 52-1 Antidiabetics

































































































Prototype Drug

Related Drugs

Drug Classification


acarbose (Precose)

miglitol (Glyset)

Alpha-glucosidase inhibitor


chlorpropamide (Diabenese)

acetohexamide (Dymelor)

Oral antidiabetics: First-generation sulfonylureas


tolazamide (Tolinase)


tolbutamide (Orinase)


glyburide (Diabeta, Micronase)

glimepiride (Amaryl)

Second-generation sulfonylureas


glipizide (Glucotrol)


glyburide micronized (Glynase)


insulin injection, regular

(Humulin R)

Short-acting insulin


There is no prototype for this classification

insulin glulisine (Apidra)

Rapid-acting insulin


insulin lispro (Humalog)


There is no prototype for this classification

Insulin detemir (Levemir)

Intermediate-acting insulin


isophane insulin suspension (NPH Insulin, Humulin N, Novolin N)


There is no prototype for this classification

extended insulin zinc suspension (Humulin U Ultralente)

Long-acting insulin


glargine insulin (Lantus)


There is no prototype for this classification

isophane human insulin (70%)

Combination insulin


and human insulin (30%) (Humulin 70/30, Novolin 70/30)


isophane human insulin 50% and human insulin 50% (Humulin 50/50)


70% insulin protamine/30% insulin aspart (Novolog Mix 70/30)


75% insulin lispro protamine/25% insulin lispro (Humalog mix 75/25)


Inhalational (Exubera)


There is no prototype for this classification

metformin (Glucophage)

Biguanides


There is no prototype for this classification

nateglinide (Starlix)

Meglitinide


repaglinide (Prandin)


There is no prototype for this classification

pioglitazone (Actos)

Thiazolidinediones


rosiglitazone (Avandia)


There is no prototype for this classification

exenatide (Byetta)

Incretin mimetics


glipizide/metformin (Metaglip)


glyburide/metformin (Glucovance)

Combination/oral agents


pioglitazone/metformin (Actoplusmet)


pramlintide acetate (Symlin)

Amylin mimetics


rosiglitazone/glimepiride (Avandaryl)


rosiglitazone/metformin (Avandamet)



ANTIDIABETICS CLIENT TEACHING


Insulin and Oral Agents



  • Carry medical identification and MedicAlert identification.


  • Teach client to include nutrition, exercise, glucometer testing, and type of diabetes with specific management.


  • Maintain follow-up care with health care provider, which may include periodic laboratory testing.


  • Carry a supply of glucose in case of hypoglycemic reaction.


  • Avoid alcohol, as it can cause hypoglycemia.


  • Do not take over-the-counter or herbal medications without consulting with health care provider.


  • Notify dentist, specialists, and other health care providers of disease.


  • Teach symptoms of hypoglycemia and hyperglycemia.



  • Notify health care provider if you experience jaundice, dark urine, sore throat, bruising or unusual bleeding, secondary illness, inability to eat, or inability to control glucose levels.


  • If ill, more frequent testing of glucose is indicated.



image Teach client to include nutrition, exercise, glucometer testing, and type of diabetes with specific management.


Insulin



  • Teach client about rotating injection sites, syringe disposal, storage of insulin, checking expiration date, type and administration of insulin, and when mixing insulin not to shake the vial but to gently agitate vial.


  • Runners and walkers should be aware that exercise accelerates absorption, especially in the injected limb.



image Runners and walkers should be aware that exercise accelerates absorption, especially in the injected limb.


ACTION


Insulin

Decreases hyperglycemia and controls the storage and metabolism of carbohydrates, protein, and fat that bind to receptor sites on cellular plasma membrane.1


Oral Antidiabetics


First- and Second-Generation Sulfonylureas



  • Stimulate insulin release from beta cells in the pancreas


  • Second-generation sulfonylureas have fewer adverse effects than first-generation sulfonylureas and have a longer duration of action.


  • The miscellaneous agents may be used in combination with the sulfonylureas.


Alpha-Glucosidase Inhibitor



  • Inhibit alpha-glucosidase and delay glucose absorption


Biguanides



  • Decrease the production of glucose and increase its uptake, and do not produce hypoglycemia as seen in the sulfonylureas

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Oct 21, 2016 | Posted by in NURSING | Comments Off on Antidiabetics

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