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Drugs for Diabetes Mellitus:
Let's first talk about the different types of Diabetes Mellitus
What are some important facts about Type 1?
Type 1 = Insulin dependent diabetes mellitus IDDM
- Destruction of pancreatic beta cells
– No insulin produced
– Typically begins in childhood
– Short-term complications include hypo/hyperglycemia, ketoacidosis (in hyperglycemia)
What are some important facts about Type 2?
Type 2 = non-insulin dependent diabetes mellitus NIDDM
-Insulin resistance
-Impaired insulin secretion
-More prevalent; typically involves obesity
Long term complications include what?
Long Term complications include: macrovascular disease (hypertension, stroke, heart disease), microvascular disease, nephropathy, neuropathy, amputations, impotence, gastroparesis, retinopathy
What are goals of therapy for Diabetes?
*Maintain glucose levels w/in an acceptable range
Take 1 oral hypoglycemic drug or 2 different oral drugs (Oral+insulin, insulin alone, insulin+ thiazolidindione)

-Make changes in one's lifestyle
Types of Insulin:
Short-Duration: _____ Acting
LISPRO [Humalog] (AA switch)
Often taken with ______acting insulin
Short-Duration: Rapid Acting
Lispro [Humalog] (AA switch)
Insulin aspart [NovoLog] (AA switch)
Often taken with longer acting insulin
Short-Duration: Slower Acting
_______ (natural) insulin
Only form given __ (SC most common)
Short-Duration: Slower Acting
REGULAR (natural) insulin
Only form given IV (SC most common)
____________ Duration
Lente insulin (____-modified)
Neutral _________ Hagedorn (NPH) insulin
Intermediate Duration
Lente insulin (zinc-modified)
Neutral Protamine Hagedorn (NPH) insulin
Long Duration
Ultralente (zinc-modified)
Insulin ________ [Lantus] (AA switch)
Less risk of ____glycemia
Intermediate and ____ duration insulin have prolonged effects
Long Duration
Ultralente (zinc-modified)
Insulin glargine [Lantus] (AA switch)
Less risk of hypoglycemia
Intermediate and long duration insulin have prolonged effects
Insulin Administration:
Specialized insulin syringes (U100) *Usually has an orange tip*
Complications of Insulin Therapy

Tell about some Hypoglycemia and DDI issues:
Hypoglycemia =
Low blood glucose (<50 mg/dl)
Insulin levels > Insulin demand
Treatment is by increasing blood sugar
Glucagon (opposite effects of insulin)
Tell about some DDI issues:
Hypoglycemic agents (drugs that lower glucose levels). Include sulfonylureas, meglitinides, beta-blockers, and alcohol
Beta-blockers may conceal

hypoglycemia
Hyperglycemic agents
Include TZDs, GCs, and sympathomimetics
ORAL Hypoglycemics
Often for Type 2 diabetes
One, Two, Three......
Three Drugs
TOLBUTAMIDE [Orinase]
Class - Sulfonylureas
Stimulates release of insulin
For lean pts insulin deficient
Tolbutamide [Orinase]

What is it's Class?

This drug is given to lean of obese pts who have diabetes?
(HInt: Assume that all tall people are lean people. TOLbutamide. This drug is for "Tall" people)
Metformin [Glucophage]
Class - Biguanides
Decreases glucose production
SE = lactic acidosis
For obese pts insulin resistant
Possibly for NIDDM prevention
Metformin [Glucophage]

What is it's class again?
Decreases _______ production

For lean of obese pts?
(Hint: BIGuanides & METformin. You MET a BIG person for this drug)
ROZIGLITAZONE [Avandia]
Class - Thiazolidinediones (Glitazones)
Increase insulin sensitivity
Rosiglitazone [Avandia]

What is it's class again?
This drug ______ insulin sensitivity
Think about what these drugs do, what is a major Side effect for these drugs?
hypoglycemia
Nursing intervention:

How do you treat insulin deficiency?
TREATMENT:
Insulin replacement
Bicarbonate for acidosis
Water and sodium replacement
Potassium replacement
Normalization of glucose levels
In relation to diabetes,
what sort of diabetes can pregnant mothers get? It often appears during pregnancy and then rapidly subdues after birth.
Gestational diabetes

Does pregnant mothers and diabetes make sense?
This is the end of your Diabetes note-cards!
Great Job!