Drugs Affecting Blood Glucose

Nur 312 Fall 2004

Statistics• Incidence increasing• 1 out of 3 diabetics mellitus (DM) -have not

been diagnosed• Type 2 – 90-95%• Complication from DM – 6th leading cause of

death• Leading cause of kidney failure, adult

blindness & lower extremity amputation

Types

• Type 1 – result of lack of sufficient insulin or a total absence of insulin

• Type 2 – result of insulin resistance by the tissues & usually a decrease in insulin production

Insulin

• Different types• Some may be mixed• Some are premixed• Dosage is in units

Regular Insulin (Humulin R)• Classification – short acting• Give subcut. or IV• Give with intermed. acting insulin• Used with sliding scale (1 unit per 25 mg over

180) & insulin pumps• Onset – 30-60 minutes, peak 2-4 hours &

duration 6-8 hours• Stable at room temp for 1 month• AEs – hypoglycemia, lipodystrophy

Teaching & Administration

• Teaching points – how to, know signs of hypo & hyper, skin care, etc.

• Administer 30-60 minutes before eating – use same anatomic location to promote regular absorption – must eat after insulin

• No cold insulin – stable at room temp for 1 month

• Double check dosage, roll gently if suspension, clear to cloudy

• Monitor blood glucose & A1c

Lispro (Humalog)

• Rapid acting• Onset 10-15 minutes, peak 1-2

hours, duration 3.5 hours• Can use with insulin pump• Administer 10-15 minutes before

meals

Innovative Insulin Delivery Systems & Monitoring Devices

• Insulin pump• Jet injector• Insulin pen• Different modes of

delivery – e.g. intranasal

• GlucoWatch Biographer

Intermediate Acting Insulins

• NPH & Lente• Onset 1-4 hours, peak 6-10 hours,

& duration 24 hours• Administer subc. 1-2x/day• When would you look for

hypoglycemia if give early morning dose?

Long Acting Insulin

• Ultralente• Onset 4-6 hours, peak 18 hours,

duration 36 hours

Long Acting Analog

• glargine (Lantus)• Peakless• One dose, cannot be mixed,

with type 2 start dose at bedtime

Oral Hypoglycemics

• Sylfonylureas – glyburide (Diabeta)• Increase prod. of insulin & increase

number of insulin receptors• Onset 2 hours, peak 3-4 hours, duration

24 hours• Give 1-2 times daily• AEs – hypoglycemia, nausea, heartburn• Contraindicated if allergic to sulfa

Meglitinides

• repaglinide (Prandin)• Increase release of insulin• Take within 15 minutes of meals

– do not take if not going to eat• Less risk of hypoglycemia

Biguanides• Decreases hepatic glucose production &

enhance insulin stimulated glucose transport

• metformin (Glucophage)• AEs – GI - so take drugs with meal• Contraindicated with liver & kidney

disease• Available in combination tablets

(metformin & glyburide)

Alpha Glucosidase inhibitors• “starch blockers” – delays glucose absorption• acarbose (Precose)• Can be administered alone or in combination

with insulin, metformin or sulfonylureas• AEs – primarily GI• If hypoglycemia occurs must use dextrose,

oral glucose, absorption of candy/sugar is inhibited thus ineffective

Thiazolidinediones• Fights insulin resistance• rosiglitazone (Avandia)• AEs – edema, weight gain, URI• Contraindicated with liver disease – need to

monitor liver enzyemes – can cause liver failure

• Expensive• Takes time to work (weeks for some patients)

Glucose Elevating Agents

• Glucagon – hyperglycemia hormone – stimulates glyconeogenesis

• Usually given to reverse severe hypoglycemia (pt. unconscious)

• Given IM, subc., or IV• AE – N&V

Drugs affecting the Reproductive System

• Glands and hormones affecting the reproductive system include the pituitary gland: FSH, LH, Prolactin, Oxytocin

• Ovaries; estrogen and progesterone• Placenta: Human chorionic

gonadotropin and human placental lactogen

• Testes: Testosterone

Estrogen• Promoting and maintaining female

organs and secondary sexual characteristics

• Capillary dilatation and fluid retention, enhances protein anabolism, stimulates epiphyses of long bones. Normal bone density

• Inhibits or promotes ovulation, thinning of cervical mucous, growth of pubic hair

Progesterone

• Change the endometrial form a proliferative to secretory one

• Promotes maturation of the ovarian follicle

• Inhibits uterine contractions• Anabolic or androgenic activity

Hormone Replacement Therapy

• Hot flashes• Osteoporosis• Cardiovascular disease• Decreased cognitive functions• Conjugated Estrogens “Premarin”• Estrace, patches or pill form

Progestins

• Used to treat amenorrhea or stop abnormal bleeding

• Used in combination with estrogen as contraceptives (progesterone, provera, depo-provera

• Menopausal treatment

Oral Contraceptives• Combination (estrogen and progestin)-

inhibit ovulation by suppressing FSH,LH, alter cervical mucous

• Monophasic, Biphasic, Triphasic,Progestin Only

• AE: dose-related, thromboembolism, stroke, MI, hepatic lesions, gallbladderdisease

• Mortality in 35 year olds, smokers

Androgens &Anabolic Steroids

• Androgen-male hormone produces masculization and tissue building

• Testoterone Produced by the testes in response to LH.

• FSH (sperm Cells)• Responsible for normal growth and

development of male sex organs• Male secondary sex characteristics