Unit 8 chapter 44 diabetes mellitus
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Unit 8 chapter 44 diabetes mellitus






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    Unit 8 chapter 44 diabetes mellitus Unit 8 chapter 44 diabetes mellitus Presentation Transcript

    • Unit 8: The Endocrine System Chapter 44: Drugs for Diabetes Mellitus
    • Pancreas
      • Describe the secretory function of the pancreas.
      • Which pancreatic cells are essential to the endocrine function?
      • Why is the endocrine function of the pancreas so important?
    • Insulin
      • Secretion regulated by chemical, hormonal, and neural factors
      • Key to metabolic process in most body cells
      • Transport vehicle for glucose (except brain)
      • Why does glucose not need a transport vehicle into brain cells?
      • What is the most important regulator of insulin secretion? (Think about the negative feedback loop)
    • Contributors to Glucose Homeostasis
      • Hyperglycemic effects
      • Hormones
        • Epinephrine
        • Thyroid hormone
        • Growth hormone
        • conticosteroids
      • Drugs
        • Phenytoin
        • NSAIDs
        • Diuretics
        • Steroids
      • Hypoglycemic effects
      • Drugs
        • Alcohol
        • Lithium
        • ACE Inhibitors
        • Beta-adrenergic blockers
    • Diabetes Mellitus
      • Chronic metabolic disorder characterized by hyperglycemia
      • Etiology: combination of genetic and environmental factors
      • Increasing incidence
      • Group of disorders caused by:
        • Deficient to absent insulin secretion
        • Decreased insulin receptor sensitivity
    • Type I Diabetes Mellitus
      • Usually presents during childhood
      • Aka: insulin dependent diabetes mellitus
      • Etiology:
        • autoimmune destruction of pancreatic beta cells
        • Interaction of genetic, immunologic, and environmental factors
      • Consistent presenting signs/symptoms
        • Hyperglycemia, polyuria, polyphagia, polydipsia, glycosuria, weight loss, fatigue
    • Potential Complications
      • Arterial damage
      • Altered peripheral circulation
      • Nerve degeneration
      • Impaired lipid metabolism
    • Pharmacotherapy for Type I Diabetes Mellitus
      • What are the current options for Insulin therapy?
      • What is the therapeutic goal and desired outcome of insulin therapy?
      • What additional measures are used with insulin pharmacotherapy to control Type 1 DM?
    • Insulin Therapy
      • Fundamental Principle:
      • “ the right amount of insulin must be available to cells when glucose is available in the blood.”
      • What is the consequence of administering insulin when glucose is not available?
      • What is the consequence of forgetting or skipping scheduled insulin dosage?
    • Insulin Therapy
      • What is the primary adverse effect of insulin therapy?
      • Other adverse effects include:
        • Localized allergic reaction
        • Generalized urticaria
        • Swollen lymph glands
    • Hypoglycemia (Insulin Reaction)
      • Symptoms occur when there is more insulin in the blood than needed.
      • Causes:
        • Insulin levels peak during exercise
        • Received too much insulin
        • Skipped meal after taking dose of insulin
      • May be treated with glucagon
        • Can cause response in ≤ 20 min
    • Somogyi Phenomenon
      • Rapid decrease in blood glucose (typically at night)
      • Stimulates release of hormones that increase blood glucose
      • Morning blood glucose is elevated
    • Types of Insulin
      • Most insulin given today is human insulin
      • Human insulin has been modified to produce a more rapid onset or longer duration. (Insulin Analogs)
      • Classified as rapid, short, intermediate, or long acting
    • Nursing Considerations
      • What are nursing considerations for insulin therapy?
      • What must the nurse be familiar with?
      • What teaching must be included?
    • Type 2 Diabetes Mellitus
      • Major type of diabetes mellitus
      • Endogenous insulin present in deficient amounts
      • Fundamental problem
        • Insulin resistance
      • Poor management results in same complications as Type 1 diabetes mellitus
      • Recommendation: preprandial glucose < 110 mg/dl
    • Oral Hypoglycemics
      • Lower blood sugar
      • Some may cause hypoglycemia
      • Classified based on structure and mechanism of action
      • Initially monotherapy
      • Insulin may need to be added to regimin
      • Some combination drugs are available. Why?
    • Classes of Hypoglycemic Agents
      • Sulfonylureas
      • Biguanides
      • Alpha-glucosidase Inhibitors
      • Thiazolidinediones
      • Meglitinides
      • New drugs
      • Develop a table to compare and contrast
    • Incretin-Glucose Control Mechanism
      • Incretin is a hormone secreted by the intestines in response to a meal when blood glucose is elevated.
      • Increased incretin levels signals the pancreas to increase insulin secretion and the liver to stop producing glucagon.
      • Why is this important?
    • exenatide (Byetta)
      • Mimics the action of incretin
      • Causes increased secretion of insulin, slows absorption of glucose, and reduces action of glucagon
      • Subcutaneously 1-2 times per day
      • Adverse effects:
        • Significant nausea, vomiting, diarrhea
    • Additional New Drugs
      • Dipeptidyl peptidase – 4 (DPP4) Inhibitors
        • Sitagliptin phosphate (Januvia)
        • Inhibits destruction of incretin
      • pramlinitide (Symlin)
        • Resembles pancreatic hormone amylin
        • Assists with glucose regulation
          • Slows absorption of glucose
          • Inhibits action of glucagon
    • Nursing Considerations
      • What are the nursing considerations for hypoglycemic agents?
      • What needs to be included in teaching?