Chapter 36
Agents Used to Treat
Hyperglycemia and
Hypoglycemia
Diabetes Mellitus

Disorder of the pancreas


Treatment


36 - 2
Results in hyperglycemia
Insulin
Oral hypoglycemics
(continues)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
(continued)
Diabetes Mellitus

Pancreatic beta cells


Excrete an insufficient amount of insulin, or no
insulin at all
Flawed carbohydrate, fat, and protein
metabolism
36 - 3
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Insulin

Promotes:




Glucose transport across cell membranes
Conversion of glycogen into glucose
Utilizes fatty acids and inhibits lipolysis
Enhances protein synthesis and
inhibits protein breakdown
36 - 4
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Symptoms of Diabetes Mellitus



Polyuria (increased urine output)
Polydipsia (excessive thirst)
Polyphagia (excessive hunger)
36 - 5
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Diabetes Mellitus

Two types:
1.
2.
36 - 6
Type 1 (formerly known as insulindependent diabetes mellitus, IDDM)
Type 2 (formerly known as noninsulindependent diabetes mellitus, NIDDM)
(continues)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
(continued)
Diabetes Mellitus

Type 1 diabetes mellitus


Treated with insulin subcutaneous injections
Type 2 diabetes mellitus

Treated with oral hypoglycemic agents
36 - 7
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Insulin

Synthetic human insulin

Produced either by:



Human in origin


Recombinant DNA synthesis of human insulin
Conversion of pig to human insulin
Humulin, Novolin, and Lispro
Older versions

Pig or cow in origin
36 - 8
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Four Preparations of Insulin
RapidActing
FastActing
IntermediateActing
LongActing
Lispro
Aspart

Regular
Humulin-R
Novolin-R

NPH
Lente
Humulin-L


Ultralente
Humulin-U
GlargineLantus
Note the differences in onset, peak, and duration of action.
36 - 9
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Effects of Insulin



Allergic reactions
Lipodystrophy
Insulin resistance
36 - 10
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Nursing Implications


Several drugs antagonize the
hypoglycemic effects of insulin.
Check your drug manual before
administering any drug agent.
36 - 11
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Hypoglycemia

Blood glucose is low (< 40 mg/dL)

Produced from



Skipped or irregularly scheduled meals
Excessive exercise
Insulin administration errors
36 - 12
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Signs and Symptoms of
Hypoglycemia





Sweating
Confusion
Tachycardia
Headache
Hunger




Weakness
Poor muscle
control
Emotional
instability
Coma and death
36 - 13
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Hypoglycemia Treatment


Glucagon (intramuscular, intravenous, or
subcutaneous)
IV dextrose 50%, also known as D50W
36 - 14
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Treatment for Type 2 Diabetes

Oral antidiabetic agents

Five classes
1.
Sulfonylureas (oldest category)
•
•
2.
3.
4.
5.
First generation
Second generation
Biguanides
Meglitinides
Alpha-glucosidases
Thiazolidinediones
36 - 15
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Sulfonylureas

Action: stimulate the beta cells of the
pancreas to secrete more insulin
36 - 16
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Biguanides


Action: inhibit hepatic glucose production
and increase the sensitivity of peripheral
tissue to insulin
May be given with sulfonylureas
36 - 17
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Meglitinide

Action

Stimulate the beta cells of the pancreas to
secrete insulin

Minimal risk of hypoglycemia
36 - 18
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Alpha-glucosidase Inhibitors



Action: inhibit an enzyme called alphaglucosidase (enzyme responsible for the
hydrolysis of saccharides to be
converted to glucose)
Must be taken with meals
May be given with sulfonylureas
36 - 19
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Thiazolidinediones (Glitazones)

Action



Decrease insulin resistance by decreasing
gluconeogenesis, glucose output, and
triglyceride synthesis in the liver
Monitor for hepatic toxicity.
May be given with sulfonylureas
36 - 20
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Side Effects of Sulfa

Hematology


Hemolytic anemia, thrombocytopenia, and
jaundice
Gastrointestinal

Nausea, epigastric fullness, and heartburn
36 - 21
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Side Effects

Biguanides


Alpha-glucosidase inhibitors


Abdomen bloating, nausea, cramping, and
diarrhea
Flatulence, diarrhea, and abdominal pain
Thiazolidinediones

Hepatic toxicity, weight gain, edema, and
mild anemia
36 - 22
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.