Hypoglycaemics

16 Hypoglycaemics


These are agents that reduce the excessive level of glucose in the blood that is a feature of diabetes. Insulin and oral hypoglycaemics play a key role in the regulation of carbohydrate, fat and protein metabolism. Insulin is a polypeptide hormone of complex structure. There are differences in the amino acid sequence of animal insulins, human insulins and the human insulin analogues. Sources of insulin are bovine, porcine or human.


Insulin is a fuel-regulating hormone that controls the amount of glucose in the blood. People with diabetes have a deficiency of insulin and therefore a raised blood glucose level. Four types of insulin are available: fast, short, intermediate and long acting.


Women with insulin-treated diabetes who are planning to become pregnant must be informed that evidence is lacking about the use of long-acting insulin analogues during pregnancy. Therefore, isophane insulin (also known as NPH insulin) remains the first choice for long-acting insulin during pregnancy (NICE, 2008, p13).


Women with diabetes may be advised to use metformin or glibenclamide as an adjunct or alternative to insulin in the preconception period and during pregnancy, when the likely benefits from improved glycaemic control outweigh potential harm. All other oral hypoglycaemic agents (exenatide and liraglutide) should be discontinued before pregnancy and insulin substituted, as they cross the placenta and may cause severe hypoglycaemia in the neonate.


Hypoglycaemic therapy for women with gestational diabetes may include regular insulin, rapid-acting insulin analogues (aspart and lispro) and/or hypoglycaemic agents (metformin and glibenclamide) should be individualized to each woman.


Women who have been diagnosed with gestational diabetes should discontinue hypoglycaemic treatment immediately after the birth. Women with pre-existing type 2 diabetes who are breastfeeding can resume or continue to take metformin and glibenclamide immediately after birth, but other oral hypoglycaemic agents should be avoided while breastfeeding.


A medical diabetic consultant as well as a consultant obstetrician should care for women who have either insulin-dependent or gestational diabetes. Mixtures of insulin preparations may be required and appropriate combinations have to be determined for the individual patient.


The student should be aware of:



image the physiology and pathology of glucose metabolism


image the treatment of diabetes


image the methods for diagnosing ‘gestational diabetes’ and methods of treating the condition


image the sequelae of pregnancy complicated by diabetes


image local protocols for the care and treatment of mothers with diabetes during antenatal, intrapartum and postpartum periods, and during operative procedures such as LSCS (lower-segment caesarean section)


image care of the neonate after a diabetic pregnancy.



Short-Acting Insulin (Soluble)




image Usually administered 15–30 min before meals


image Effective after 30–45 min


image Peak effect after 1.5–4 h


image Duration 5–8 h



Rapid Acting Insulin




image Before or as soon as possible after meals


image Onset 5–20 min (depending on whether type 1 or 2 diabetes)


image Peak effect after 0.5–0.17 h (depending on whether type 1 or 2 diabetes)


image Duration 3–5 h



Intermediate Insulin




image Set times of the day


image Onset 1–2h


image Peak effect 6–12 h


image Duration 12–24 h



Long-Acting Insulin




image Once daily, at same time


image Onset 2 h (may vary considerably)


image Peak effect 5–24 h (no peak)


image Duration 12–24 h


NB: Human preparations have more rapid onset and shorter durations.


When injected intravenously, soluble insulin has a very short half-life of about only 5 min and its effect disappears within 30 min.




BP

Insulin rapid acting

Proprietary

NovoRapid® (insulin aspart) (Novo Nordisk Ltd), Humalog® (insulin lispro) (Eli Lilly and Company Ltd), Apidra® (insulin glulisine) (Sanofi-Aventis)

Group

Rapid-acting analogue

Uses/indications

Insulin-dependent diabetes mellitus, insulin-dependent gestational diabetes

Type of drug

POM

Presentation

Varied: vial, cartridge, prefilled pen

Dosage

Dosing is individual and determined in accordance with the needs of the patient

Route of admin

S.C.
Some may be administered by continuous subcutaneous insulin infusion (CSII), intravenously or intramuscularly (see manufacturers’ guidance)

Contraindications

Hypersensitivity to the active substance or to any of the excipients
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Jul 11, 2016 | Posted by in MIDWIFERY | Comments Off on Hypoglycaemics

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