Diabetes
DIABETES
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Introduction
·
Diabetes
mellitus is a chronic metabolic disorder characterized by hyperglycemia
resulting from defects in insulin secretion, insulin action, or both.
·
Management
of diabetes involves lifestyle changes and pharmacotherapy, primarily through
insulin and oral hypoglycemic agents.
Definition
·
Insulin: A peptide hormone produced by the beta
cells of the pancreas, essential for the regulation of blood glucose levels.
·
Oral Hypoglycemics: Medications taken orally to lower
blood glucose levels, used primarily in the treatment of Type 2 diabetes
mellitus.
Classification
1.
Insulin:
o Rapid-acting
Insulin:
Lispro, Aspart, Glulisine
o Short-acting
Insulin:
Regular insulin
o Intermediate-acting
Insulin:
NPH (Neutral Protamine Hagedorn)
o Long-acting
Insulin:
Glargine, Detemir
o Ultra Long-acting
Insulin:
Degludec
2.
Oral Hypoglycemics:
o Sulfonylureas: Glipizide,
Glyburide, Glimepiride
o Biguanides: Metformin
o Thiazolidinediones: Pioglitazone,
Rosiglitazone
o Dipeptidyl
Peptidase-4 Inhibitors (DPP-4 inhibitors): Sitagliptin, Saxagliptin
o Sodium-Glucose
Cotransporter 2 Inhibitors (SGLT2 inhibitors): Canagliflozin, Dapagliflozin
o Alpha-glucosidase
Inhibitors:
Acarbose, Miglitol
o Meglitinides: Repaglinide,
Nateglinide
Pharmacokinetics
·
Insulin:
o Absorption: Injected
subcutaneously, absorption varies by type and injection site.
o Distribution: Widely
distributed, primarily in liver, muscle, and adipose tissue.
o Metabolism: Metabolized in
liver and kidneys.
o Excretion: Excreted via
kidneys.
·
Oral Hypoglycemics:
o Absorption: Varies by class;
generally well-absorbed orally.
o Distribution: Protein binding
varies; generally widely distributed.
o Metabolism: Primarily
hepatic metabolism.
o Excretion: Excreted via
urine and feces.
Mechanism of Action
·
Insulin: Facilitates cellular glucose uptake,
promotes glycogen storage, inhibits gluconeogenesis, and enhances lipogenesis
and protein synthesis.
·
Oral Hypoglycemics:
o Sulfonylureas: Stimulate
insulin secretion from pancreatic beta cells.
o Biguanides
(Metformin):
Decrease hepatic glucose production, increase insulin sensitivity.
o Thiazolidinediones: Improve insulin
sensitivity in muscle and adipose tissue.
o DPP-4 inhibitors: Prolong the
action of incretin hormones, increasing insulin release and decreasing glucagon
levels.
o SGLT2 inhibitors: Reduce glucose
reabsorption in the kidneys, increasing glucose excretion.
o Alpha-glucosidase
inhibitors:
Delay carbohydrate digestion and absorption.
o Meglitinides: Stimulate rapid,
short-duration insulin secretion.
Uses
·
Insulin: Primary treatment for Type 1 diabetes
and advanced Type 2 diabetes.
·
Oral Hypoglycemics: Primarily used in the management
of Type 2 diabetes.
Adverse Effects
·
Insulin:
o Hypoglycemia
o Weight gain
o Injection site
reactions
o Lipodystrophy
·
Oral Hypoglycemics:
o Sulfonylureas: Hypoglycemia,
weight gain.
o Biguanides
(Metformin):
Gastrointestinal upset, lactic acidosis (rare).
o Thiazolidinediones: Weight gain,
fluid retention, risk of heart failure.
o DPP-4 inhibitors: Nasopharyngitis,
pancreatitis (rare).
o SGLT2 inhibitors: Genital
infections, urinary tract infections, dehydration.
o Alpha-glucosidase
inhibitors:
Gastrointestinal discomfort.
o Meglitinides: Hypoglycemia,
weight gain.
Contraindications
·
Insulin: Hypersensitivity to insulin,
hypoglycemia.
·
Oral Hypoglycemics:
o Sulfonylureas:
Hypersensitivity, severe renal or hepatic impairment.
o Biguanides
(Metformin):
Renal impairment, metabolic acidosis.
o Thiazolidinediones: Heart failure,
hepatic impairment.
o DPP-4 inhibitors:
Hypersensitivity.
o SGLT2 inhibitors: Severe renal
impairment.
o Alpha-glucosidase
inhibitors:
Inflammatory bowel disease, bowel obstruction.
o Meglitinides: Hepatic
impairment.
Role of Nurse
1.
Assessment:
o Monitor blood
glucose levels regularly.
o Assess for signs
and symptoms of hypo- or hyperglycemia.
o Evaluate patient's
adherence to medication regimen and lifestyle modifications.
2.
Administration:
o Educate patients
on proper insulin injection techniques.
o Instruct on timing
and dosing of oral hypoglycemics.
o Ensure patients
understand how to use blood glucose monitoring devices.
3.
Patient Education:
o Educate on the
importance of diet and exercise in diabetes management.
o Inform about
potential side effects and the importance of reporting adverse reactions.
o Teach patients how
to recognize and manage hypoglycemia.
4.
Monitoring:
o Regularly check
for signs of complications such as diabetic neuropathy, nephropathy, and
retinopathy.
o Monitor adherence
to follow-up appointments and lab tests.
5.
Support:
o Provide
psychological support and counseling.
o Encourage
participation in diabetes education programs and support groups.
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