Unit 8 chapter 44 diabetes mellitus
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  • 1. Unit 8: The Endocrine System Chapter 44: Drugs for Diabetes Mellitus
  • 2. 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?
  • 3. 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)
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. Potential Complications
    • Arterial damage
    • Altered peripheral circulation
    • Nerve degeneration
    • Impaired lipid metabolism
  • 8. 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?
  • 9. 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?
  • 10. Insulin Therapy
    • What is the primary adverse effect of insulin therapy?
    • Other adverse effects include:
      • Localized allergic reaction
      • Generalized urticaria
      • Swollen lymph glands
  • 11. 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
  • 12. Somogyi Phenomenon
    • Rapid decrease in blood glucose (typically at night)
    • Stimulates release of hormones that increase blood glucose
    • Morning blood glucose is elevated
  • 13. 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
  • 14. Nursing Considerations
    • What are nursing considerations for insulin therapy?
    • What must the nurse be familiar with?
    • What teaching must be included?
  • 15. 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
  • 16. 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?
  • 17. Classes of Hypoglycemic Agents
    • Sulfonylureas
    • Biguanides
    • Alpha-glucosidase Inhibitors
    • Thiazolidinediones
    • Meglitinides
    • New drugs
    • Develop a table to compare and contrast
  • 18. 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?
  • 19. 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
  • 20. 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
  • 21. Nursing Considerations
    • What are the nursing considerations for hypoglycemic agents?
    • What needs to be included in teaching?