Control Blood Sugar Levels

Agents to Control Blood Glucose
Levels
Chapter 38
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Function 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

Insulin
• 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
• 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 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 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 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
• Fatigue
• Lethargy
• Irritation
• Glycosuria
• Polyphagia
• Polydipsia
• Itchy Skin

Signs 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

Hypoglycemia
• Definition
– Blood sugar concentration lower than 40 mg/dL
• Occurrence
– Starvation
– Lowering the blood sugar too far with treatment of
hyperglycemia

Question
Which of the following is a clinical manifestation of
hyperglycemia?
A. Edema
B. Lack of thirst
C. Itchy skin
D. Hyperexcitability

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

Types of Insulin

Insulin
• 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.)
• 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

Insulin (cont.)
• Contraindications
– There are no contraindications
• Caution
– Pregnancy and lactation
• Adverse Effects
– Hyperglycemia and ketoacidosis

Insulin (cont.)
• Drug-to-Drug Interactions
– When given with any drug that decreases glucose
levels
– Beta blockers

Site of Action of Drugs Used to Treat
Diabetes

Sulfonylureas
• 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.)
• 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
– Allergy
– Diabetic complications
– Type 1 diabetes mellitus

• Adverse Effects
– Hypoglycemia
– GI distress
– Allergic skin reactions
– Drugs that acidifies the urine
– Beta blockers
– Alcohol

Question
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.

Answer
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
• Actions, Indications, Pharmacokinetics, Contraindications,
Caution, Adverse Effects, Drug-to-Drug Interactions
– Vary with the drug that is given

Glucose 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.)
– 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

Question
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

Answer
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 Insulin

Prototype Sulfonylureas – First
Generation

Prototype Sulfonylureas – Second
Generation

Prototype Nonsulfonylureas

Nursing Considerations for Insulin
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for Oral
Antidiabetic Agents
• Implementation
• Evaluation

Nursing Considerations for Glucose
Elevating Agents
• Implementation
• Evaluation

Control Blood Sugar Levels

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