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anti-diabetics

oral hypoglycemics, insulin

QuestionAnswer
hormone of the pancreas insulin
promotes the conversion of glucose to glycogen insulin
insulin is not given with hypoglycemia
metformin lowers blood glucose by increasing endogenous insulin by beta cells and increasing insulin sensitivity. Must have intact pancreas.
miglitol delays the digestion of ingested carbs... and lowers blood glucose especially after meals
when a patient has hypoglycemia give sugar
discontinue metformin if DKA or lactic acidosis
monitor these for effectiveness Blood sugar and hbA1c
Sulfonylureas glimiperide, Glipizide, Glyburide
TZD pioglitazone, rosaglitazone
biguanide Metformin
Meglitides repaglinide
do not use these with BB b/c they mask signs of hypoglycemia sulfonylureas
taken daily with first main meal sulfonylureas
action of these only are short lived and action only lasts during digestion Meglitinides
Prandin and Starlix are examples of meglitinides
take within 30 minutes ac meals meglitinides
does not cause hypoglycemia b/c does not promote insulin release biguanides (Metformin)
Glucophage biguanide
take with food at breakfast and dinner, tid max biguanide (Metformin, Glucophage)
can take these without regard to food TZD (Avandia, rosiglitazone)
can be taken once or in divided doses TZD
side effects can include fluid retention, hepatotoxicity, elevation in LDLs TZD
acarbose (Precose) or miglitol (Glyset) Alpha - Glucosidase inhibitors
slows carb absorption and digestion AGI
side effects of AGI include intestinal effects, risk of anemia, hepatotoxicity with long term use
monitor closely for hypoglycemia if mixing AGI with these sulfonylureas, metformin, or insulin
use in case of insulin overdose Glucagon
short rapid acting insulins Lispro (Humalog) or Aspart (Novolog)
take 5- 15 minutes ac meals, 10-30 meal onset, and peaks between 0.5 to 3 hours short rapid acting insulins (Lispro and Aspart)
Short-Slower Acting Insulin Regular (Humulin R and Novolin R)
only insulin can give IV regular
duration of regular insulin 6-10 hours
give 20-30 minutes before meals regular
onset is 30-60 minutes regular Insulin (Humulin R and Novolin R)
peaks in 1 to 5 hours Regular Insulin
Intermediate Acting Insulin NPH (Humulin -N, Novolin - N)
duration is 16-24 hours and take twice daily at same times NPH
one to two hours onset NPH
6-14 hours peak time NPH (Humulin-N, Novolin-N)
Long Acting Insulin Glargine, Lantus
no peak time, and lasts all day long!!! Lantus
Only have to take once a day! Lantus
Always draw this first when mixing insulin clear shorter acting insulin
the color of long acting insulin cloudy
clear before cloudy
target preprandial BS 90-130 mg/dL
target postprandial BS <180 mg/dL
glycosylated hemoglobin target level <7
this oral drug is good for irregular eating patterns meglitinides
this drug group keeps the liver from releasing too much glucose biguanides
causes lactic acidosis in clients with renal impairment biguanides
safe for pregnancy and pediatrics biguanides (glucophage, metformin)
work in the small intestine to slow digestion of carbs alpha-glucosidase inhibitors
hypoglycemia can occur with insufficeint food intake with this drug group alpha glucosidase inhibitors (acrabose, miglitol)
must be treated with oral glucose and not complex carbs acrabose and miglitol
check LFTs every two months for a year and interacts with cholesterol lowering drugs by decreasing its own effects TZDs
inhaled rapid acting insulin Exubera (absorption effected by URI, COPD, smoking)
Glucagon-like peptide given sub-q in multidose pen
synthetic amylin (hormone released by beta cells) Symlyn
promotes insulin synthesis and release, and inhibits glucagon secretion Januvia
local allergic reaction to insulin therapy rash, urticaria, other skin reactions
systemic allergic reaction to insulin therapy anaphylaxis; serum sickness - fever, myalgias, enlarged spleen and lymph nodes,
Created by: hong204
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