Diabetes Medications


Published on

Grand Rounds presentation I gave at Saratoga Hospital on Diabetes Meds and the effect glucose control has on outcomes

  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Diabetes Medications

    1. 1. Diabetes Management: Medications, Diet, and Comorbidities By: Katie Welter, BS, RN
    2. 2. Objectives <ul><li>The RN will be able to verbalize onset, peak and duration of the 7 insulins used at Saratoga Hospital. </li></ul><ul><li>The RN will be able to list appropriate nursing actions and patient education r/t the action and side effects of diabetes medications. </li></ul><ul><li>The RN will be able to verbalize appropriate times to administer diabetes medications to aide in avoiding hypo and hyperglycemia. </li></ul>
    3. 3. ADA 2005 Diabetes Facts <ul><li>20.8 million children and adults in the United States, or 7% of the population, have diabetes. </li></ul><ul><li>6.2 million people (or nearly one-third) are unaware that they have the disease. </li></ul><ul><li>Approximately 5-10% of those who are diagnosed have Type I </li></ul><ul><li>41 million Americans have pre-diabetes, and are at high risk for developing Type 2 diabetes. </li></ul><ul><li>The total annual economic cost of diabetes in 2002 was estimated to be $132 billion , or one out of every 10 health care dollars spent in the United States. </li></ul>
    4. 4. Evidence Base for Better Inpatient Glycemic Control <ul><li>Diabetes added an average of $11,500 to the cost of hospital admissions in 1997 dollars. </li></ul><ul><li>In patients who are s/p MI, BG above 144mg/dL had a three-fold increase in mortality, and higher risk of CHF. </li></ul><ul><li>A 2001 prospective, randomized, controlled study of 1,548 patients in a SICU found that patients whose BG was controlled to be between 80-100 vs 180-200, reduced: </li></ul><ul><ul><li>Mortality by 34% </li></ul></ul><ul><ul><li>Septicemia by 46% </li></ul></ul><ul><ul><li>Acute renal failure by 41% </li></ul></ul>
    5. 5. Humalog = Novolog <ul><li>Onset: 5-15 minutes </li></ul><ul><li>Peak: 1 hour </li></ul><ul><li>Duration: 2-3 hours </li></ul><ul><li>Key Facts: </li></ul><ul><ul><li>Novolog is what we carry at Saratoga Hospital and can be substituted for Humalog. </li></ul></ul><ul><ul><li>If a patient is hypoglycemic prior to a meal and has a poor appetite, it may be given immediately after the meal to make sure BG levels are normal again. </li></ul></ul>
    6. 6. Regular <ul><li>Onset: 1 hour </li></ul><ul><li>Peak: 2-4 hours </li></ul><ul><li>Duration: 5-8 hours </li></ul><ul><li>Key Facts </li></ul><ul><ul><li>Must be given half hour before meals to give the insulin time to start acting. </li></ul></ul>
    7. 7. Novolin N (NPH) <ul><li>Onset: 2 hours </li></ul><ul><li>Peak: 6-8 hours </li></ul><ul><li>Duration: 18-24 </li></ul><ul><li>Key fact: </li></ul><ul><ul><li>Dose should be evaluated/decreased if pt is NPO. </li></ul></ul><ul><ul><li>Must be rolled prior to being drawn up. </li></ul></ul>
    8. 8. Novolog 70/30 <ul><li>Onset: 30 minutes </li></ul><ul><li>Peak: 4-8 hours </li></ul><ul><li>Duration: up to 24 hours </li></ul><ul><li>Key facts: </li></ul><ul><ul><li>Like Novolog and Regular, should be given prior to meals so that the insulin can work on the patients meal. </li></ul></ul><ul><ul><li>It is a mix of rapid and intermediate acting insulin. </li></ul></ul>
    9. 9. Lantus (Glargine) <ul><li>Onset: Slow </li></ul><ul><li>Peak: None </li></ul><ul><li>Duration: 10.8-24 hours </li></ul><ul><li>Key facts: </li></ul><ul><ul><li>Do Not mix Lantus with any other insulins </li></ul></ul><ul><ul><li>Usually started at 10 units qhs for Type 2 patients, though may be given in am. </li></ul></ul>
    10. 10. Insulin Pumps <ul><li>Provide patients with continuous infusion of fast acting insulin adjusted to meet individual insulin requirements. </li></ul><ul><li>Basals: are the hourly rate of insulin that is programmed to give the patient. </li></ul><ul><li>Boluses: an amount of insulin calculated based on the ratio of 1 unit of insulin/# of carbohydrates. </li></ul>Minimed Pump
    11. 11. Inhaled insulin will be available for use this summer! Exubera is a fast acting insulin to be taken 10 minutes prior to meals. Patients requiring long acting insulin will still need to take injections. Side effects include hypoglycemia, dry mouth, chest discomfort, decreased lung capacity, dry cough
    12. 12. Glimepiride (Amaryl) <ul><li>Drug Class: Sulfonylurea </li></ul><ul><li>Action: stimulates release of insulin from pancreatic beta cells; increases sensitivity of peripheral tissues to insulin. </li></ul><ul><li>Recommended administration time: </li></ul><ul><ul><li>With the first meal of the day. </li></ul></ul>
    13. 13. Glipizide (Glucotrol, XL form also) <ul><li>Drug Class: Sulfonylurea </li></ul><ul><li>Action: May stimulate release of insulin from pancreas, reduce glucose output by liver, and increase peripheral sensitivity to insulin. </li></ul><ul><li>Possible interaction with Coumadin: </li></ul><ul><ul><li>Elevated PT/INR levels or increased hypoglycemic effect. </li></ul></ul><ul><li>Recommended administration time: </li></ul><ul><ul><li>30 minutes before meals </li></ul></ul><ul><ul><li>Some patients may need twice daily dosing. </li></ul></ul>
    14. 14. Pioglitazone hydrocloride (Actos) <ul><li>Drug Class: Thiazolidinedione </li></ul><ul><li>Action: Decreases insulin resistance in the liver and periphery. This causes insulin to use glucose more effectively and decreases the amount of glucose released by the liver. </li></ul><ul><li>Potential side effects to watch for: </li></ul><ul><ul><li>Excessive fluid volume; monitor pts with heart failure </li></ul></ul><ul><ul><li>Pts with Class III or IV CHF should not take it. </li></ul></ul><ul><li>Recommended administration: </li></ul><ul><ul><li>Once daily, with or without meals </li></ul></ul>
    15. 15. Rosiglitazone maleate (Avandia) <ul><li>Drug Class: Thiazolidinedione </li></ul><ul><li>Action: Improves insulin sensitivity </li></ul><ul><li>Potential side effects to watch for: </li></ul><ul><ul><li>Excessive fluid volume; monitor pts with heart failure </li></ul></ul><ul><ul><li>Pts with Class III or IV CHF should not take it. </li></ul></ul><ul><ul><li>Discontinue if deterioration in cardiac status occurs. </li></ul></ul><ul><li>Recommended administration: </li></ul><ul><ul><li>Once daily, with or without meals </li></ul></ul>
    16. 16. Metformin (Glucophage,Glucophage XR) <ul><li>Drug Class: Biguanide </li></ul><ul><li>Action: ↓ liver production of glucose and absorption of glucose, also improves insulin sensitivity. </li></ul><ul><li>Potential side effects: </li></ul><ul><ul><li>With increased age and renal impairment can lead to lactic acidosis and then ARF. </li></ul></ul><ul><ul><li>Must be stopped the day before IV contrast use and restarted no sooner than 48 hours later with monitoring of renal function. </li></ul></ul><ul><li>Recommended Administration: Before breakfast and dinner if BID is ordered. </li></ul>
    17. 17. Common Side Effects to Monitor <ul><li>Labs: </li></ul><ul><ul><li>Elevated BUN, creatine, liver enzymes </li></ul></ul><ul><ul><li>Sulfonylureas: Monitor CBC for ↓ H/H and granulocyte and platelet counts. </li></ul></ul>• Interaction with Beta Blockers: Possible prolonged hypoglycemic effect, masked symptoms of hypoglycemia.
    18. 18. Hypoglycemia- S&S <ul><li>Sympathetic : </li></ul><ul><ul><li>Shaking </li></ul></ul><ul><ul><li>Fast heart rate </li></ul></ul><ul><ul><li>Diaphoresis </li></ul></ul><ul><li>Other S&S: </li></ul><ul><li>Dizziness </li></ul><ul><li>Hunger </li></ul><ul><li>Weakness/Fatigue </li></ul><ul><li>Headache </li></ul><ul><li>Impaired Vision </li></ul><ul><li>Emotional : </li></ul><ul><ul><li>Anxious </li></ul></ul><ul><ul><li>Irritable </li></ul></ul><ul><ul><li>Change in Personality </li></ul></ul>
    19. 19. Hypoglycemia- Causes <ul><li>Too little food for insulin taken </li></ul><ul><li>Too much insulin or oral medication </li></ul><ul><li>Exercise </li></ul><ul><li>Stress </li></ul>
    20. 20. Hyperglycemia- S&S <ul><li>Drowsiness </li></ul><ul><li>Frequent urination </li></ul><ul><li>Thirst </li></ul><ul><li>Hunger </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul>
    21. 21. Hyperglycemia- Causes <ul><li>Corticosteroids </li></ul><ul><li>Stress Hormones </li></ul><ul><li>Infection </li></ul><ul><li>Too much food </li></ul><ul><li>Too little insulin </li></ul><ul><li>Insulin resistance </li></ul><ul><li>Release of stored glucose </li></ul><ul><li>Medications </li></ul>
    22. 22. Nutrition and Diabetes <ul><li>Two of our Registered Dietitians are also Certified Diabetes Educators- use Meditec to refer patients to them for teaching. </li></ul><ul><li>Carbohydrates should make up 45-65% of the total daily intake. </li></ul><ul><li>Low Carb diets are NOT appropriate for patients with diabetes. There are safer weight-loss strategies. </li></ul><ul><li>Some patients use carbohydrate counting- they eat a certain number of carbohydrates for the amount of insulin they give themselves. This helps maintain the right balance between intake and insulin. </li></ul><ul><li>Evaluate the appropriateness of a patient’s size, weight and their ordered calorie intake. </li></ul>
    23. 23. Review <ul><li>Evaluate effectiveness of current diabetes treatment and possible causes of hyperglycemia in the hospital setting. </li></ul><ul><li>Remember that patients are more than the number on the meter- their complex, individual physical and psychological make-up influences their diabetes. </li></ul><ul><li>A motto to pass on: “ Diabetes doesn’t mean deprivation, it means living in moderation” </li></ul>
    24. 24. Questions? <ul><li>References: </li></ul><ul><li>http://www.diabetes.org/- ADA website </li></ul><ul><li>Diabetes Forecast </li></ul>