Ppt chapter 38-1

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Agents to Control Blood Glucose Levels

Agents to Control Blood Glucose Levels

Chapter 38


Function of the Pancreas GlandFunction of the Pancreas Gland

• Endocrine Gland

– Produces hormones in the islets of Langerhans

• Exocrine Gland

– Releases sodium bicarbonate and pancreatic enzymes directly into the common bile duct to be released into the small intestine

– Neutralizes the acid chyme from the stomach and aids digestion


InsulinInsulin

• Definition

– Hormone produced by beta cells of the islets of Langerhans

• Action

– Released into circulation when the levels of glucose around these cells rise

– Stimulates the synthesis of glycogen, the conversion of lipids into fat stored in the form of adipose tissue, and the synthesis of needed proteins from amino acids


Metabolic Changes Occurring When Insufficient Insulin is Released

Metabolic Changes Occurring When Insufficient Insulin is Released

• Hyperglycemia: Increased blood sugar

• Glycosuria: Sugar is spilled into the urine

• Polyphagia: Increased hunger

• Polydipsia: Increased thirst

• Lipolysis: Fat breakdown

• Ketosis: Ketones cannot be removed effectively

• Acidosis: Liver cannot remove all of the waste products


Diabetes MellitusDiabetes Mellitus• Characteristics

– Complex disturbances in metabolism

– Affects carbohydrate, protein, and fat metabolism

• Clinical Signs

– Hyperglycemia (fasting blood sugar level greater than 126 mg/dL)

– Glycosuria (the presence of sugar in the urine)


Disorders Associated With DiabetesDisorders Associated With Diabetes

• Atherosclerosis: Heart attacks and strokes related to the development of atherosclerotic plaques in the vessel lining

• Retinopathy: With resultant loss of vision as tiny vessels in the eye are narrowed and closed

• Neuropathies: With motor and sensory changes in the feet and legs and progressive changes in other nerves as the oxygen is cut off

• Nephropathy: With renal dysfunction related to changes in the basement membrane of the glomerulus


Classifications of Diabetes MellitusClassifications of Diabetes Mellitus

• Type 1, Insulin-Dependent Diabetes Mellitus (IDDM)

– Usually a rapid onset; seen in younger people

– Connected in many cases to viral destruction of the beta cells of the pancreas

• Type 2, Non–Insulin-Dependent Diabetes Mellitus (NIDDM)

– Usually occurs in mature adults

– Has a slow and progressive onset


Clinical Signs and Symptoms of Hyperglycemia

Clinical Signs and Symptoms of Hyperglycemia

• Fatigue

• Lethargy

• Irritation

• Glycosuria

• Polyphagia

• Polydipsia

• Itchy Skin


Signs of Impending Dangerous Complications of HyperglycemiaSigns of Impending Dangerous

Complications of Hyperglycemia

• Fruity breath as the ketones build up in the system and are excreted through the lungs

• Dehydration as fluid and important electrolytes are lost through the kidneys

• Slow, deep respirations (Kussmaul’s respirations) as the body tries to rid itself of high acid levels

• Loss of orientation and coma


HypoglycemiaHypoglycemia

• Definition

– Blood sugar concentration lower than 40 mg/dL

• Occurrence

– Starvation

– Lowering the blood sugar too far with treatment of hyperglycemia


QuestionQuestion

Which of the following is a clinical manifestation of hyperglycemia?

A. Edema

B. Lack of thirst

C. Itchy skin

D. Hyperexcitability


AnswerAnswer

C. Itchy skin

Rationale: Clinical signs and symptoms of hyperglycemia: fatigue; lethargy; irritation; glycosuria; polyphagia; polydipsia; itchy skin


Types of InsulinTypes of Insulin


InsulinInsulin

• Actions

– Hormone that promotes the storage of the body’s fuels

– Facilitates the transport of various metabolites and ions across cell membranes

– Simulates the synthesis of glycogen from glucose

– Reacts with specific receptor sites on the cells


Insulin (cont.)Insulin (cont.)

• Indications

– Treatment of type 1 diabetes mellitus

– Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents

• Pharmacokinetics

– Various insulins available are processed within the body like endogenous insulin

– Peak, onset, and duration vary based on preparation



• Contraindications

– There are no contraindications

• Caution

– Pregnancy and lactation

• Adverse Effects

– Hyperglycemia and ketoacidosis



• Drug-to-Drug Interactions

– When given with any drug that decreases glucose levels

– Beta blockers


Site of Action of Drugs Used to Treat Diabetes

Site of Action of Drugs Used to Treat Diabetes


SulfonylureasSulfonylureas

• First Generation

– Associated with increase risk of cardiovascular disease

• Second Generation

– Advantage over 1st generation drugs

• Excreted in urine and bile

• Do not interact with as many protein bound drugs

• Longer duration of action


Sulfonylureas (cont.)Sulfonylureas (cont.)

• Actions

– Stimulate insulin release from the beta cells in the pancreas

– They improve binding to insulin receptors

• Indications

– Adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes




– Rapidly absorbed from the GI tract and undergo hepatic metabolism

– Excreted in the urine

– Peak and duration varies with each drug

• Contraindications

– Allergy

– Diabetic complications

– Type 1 diabetes mellitus



• Adverse Effects

– Hypoglycemia

– GI distress

– Allergic skin reactions


– Drugs that acidifies the urine

– Beta blockers

– Alcohol


QuestionQuestion

Please answer the following statement as true or false.

Second generation sulfonylureas have several advantages over first generation sulfonylureas including the fact that

they interact with more protein bound drugs.


AnswerAnswer

False

Rationale: Second generation sulfonylureas: Advantage over 1st generation drugs would be they are excreted in

urine and bile; do not interact with as many protein bound drugs; longer duration of action


Nonsulfonylureas Nonsulfonylureas

• Actions, Indications, Pharmacokinetics, Contraindications, Caution, Adverse Effects, Drug-to-Drug Interactions

– Vary with the drug that is given


Glucose Elevating AgentsGlucose Elevating Agents• Actions

– Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose

• Indications

– Treatment of hypoglycemia


– Rapidly absorbed and distributed throughout the body

– Excreted in the urine


Glucose Elevating Agents (cont.)Glucose Elevating Agents (cont.)• Contraindications

– Known allergy

– Pregnancy and lactation

• Caution

– Hepatic dysfunction or cardiovascular disease

• Adverse Effects

– GI upset

– Vascular effects


– Thiazide diuretics

– Anticoagulants


Use of Antidiabetic Agents Across the Lifespan

Use of Antidiabetic Agents Across the Lifespan


QuestionQuestion

Which of the following is a primary action of glucose lowering agents?

A. Accelerate the breakdown of glycogen

B. Increase insulin release

C. Improve binding to insulin receptors

D. Decrease use of incretins


AnswerAnswer

A. Accelerate the breakdown of glycogen

Rationale: The action of glucose elevating agents is to increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose.


Prototype InsulinPrototype Insulin


Prototype Sulfonylureas – First Generation

Prototype Sulfonylureas – First Generation


Prototype Sulfonylureas – Second Generation

Prototype Sulfonylureas – Second Generation


Prototype Nonsulfonylureas Prototype Nonsulfonylureas


Nursing Considerations for InsulinNursing Considerations for Insulin

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


Nursing Considerations for Oral Antidiabetic Agents

Nursing Considerations for Oral Antidiabetic Agents



• Implementation

• Evaluation


Nursing Considerations for Glucose Elevating Agents

Nursing Considerations for Glucose Elevating Agents



• Implementation

• Evaluation

Ppt chapter 38-1

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