Diabetes: Medications Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (APS HCQU) May 2008 sh Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies. 2 1
Objectives Identify information a caretaker needs to know when administering medications Recognize signs and symptoms of low blood sugar (hypoglycemia) List considerations when planning daily activities for a person taking medication for diabetes 3 What is Diabetes? A disorder of metabolism A condition where the body has a shortage of insulin or decreased ability to use insulin, resulting in high blood sugar levels A leading cause of disability A growing epidemic in the US A manageable condition 4 2
Types of Diabetes Medications Insulin Oral Other 5 Insulin Therapy Is a protein, and must be injected or inhaled Insulin the mainstay of treatment for individuals with Type I diabetes Combinations of Insulin are frequently ordered to allow for better blood glucose control May be prescribed in some with Type II diabetes 6 3
Characteristics of Insulin Onset (starts working) Peak (maximum effect) Duration (length of time active in blood) 7 Types of Insulin Rapid acting Short acting Intermediate acting Long acting Very long acting Premixed 8 4
Rapid Acting Lispro (Humalog) Onset: 5 15 minutes Peak: 45 90 minutes Duration: 3 4 hours Aspart (Novalog) Onset: 10 20 minutes Peak: 1 3 hours Duration: 3 5 hours 9 Short Acting Regular (R) Insulin Onset: 30 minutes Peak: 2 5 hrs. Duration: 5 8 hrs 10 5
Intermediate Acting NPH (N) or Lente(L) Onset: 1 3 hrs Peak: 6 12 hrs Duration: 16 24 hrs 11 Long Acting Ultralente (U) insulin Onset: 4 6 hrs Peak: 8 20 hrs Duration: 24 28 hrs 12 6
Very Long Acting Insulin Glargine (Lantus) Onset: 1 hr Peak: works evenly for 24 hrs Duration: 24 hrs Taken once a day at bedtime Should not be mixed together in a syringe with any other form of insulin before use 13 Premixed NPH and Regular Insulin Mixture two types of insulin mixed together in 1 bottle Onset: 30 minutes Peak: 7 12 hrs Duration: 16 24 hrs 14 7
Insulin Pump Controls the exact amount of insulin being delivered Closest device on the market to an artificial pancreas 15 Hypoglycemia Less than normal amount of glucose in the blood 16 8
Signs of Hypoglycemia Shakiness Nervousness Weakness Cold, clammy skin Hunger Irritability Headache Confusion Rapid heart beat Fainting Passing out Slurred or hard to understand speech 17 Hypoglycemia Response Observe Plan Ahead Have a Plan of Action in Place Document and Report 18 9
Insulin: Review Know response to Insulin Onset, peak and duration Avoid exercise at peak time of insulin Know the individual s response to medication and exercise 19 Storing Insulin If using entire bottle within 30 days, store at room temperature. Write date on bottle label when opened. If you do not plan to use entire bottle within 30 days, store in refrigerator Do not keep too hot or too cold Keep extra bottle on hand and store in refrigerator. 20 10
Oral Medications (Classifications) Sulfonylureas Biquanides Alpha Glucosidase Inhibitors Thiazolidinediones Meglitinides D Phenylanine derivatives (DPP 4) Combination 21 Oral Medications: Need to Know Potential for low blood sugar reactions Time of day With/without meals? Side effects and special precautions of the medication Any special instructions 22 11
Considerations: Sulfonylureas Increases the production of insulin May cause hypoglycemia Can cause allergic reactions in individual who has allergies to sulfa medications 23 Considerations: Biguanides Can cause diarrhea, when taken on empty stomach Not ordered if history of kidney or liver disease Notify doctor of surgery or medical test using contrast dye Increases sensitivity to insulin Decreases production of glucose 24 12
Considerations: Alpha Glucosidase Inhibitors Taken 3xday Each meal, with the first bite of the meal Should not be taken by people with severe bowel or kidney disease or liver disorders Decreases the absorption of carbohydrates 25 Considerations: Thiazolidinediones Possible liver problems liver function needs to be assessed regularly ( Blood Tests) Report signs of liver problems to doctor that may include: weight gain, swelling. unusual nausea, vomiting, abdominal pain, dark urine Increases the sensitivity to insulin 26 13
Considerations: Meglitinides May cause hypoglycemia Effect is much stronger if taken 3 times a day Taken before meals Fast acting, allowing greater flexibility in meal timing 27 Combination May cause hypoglycemia 28 14
Recently Approved Injectable Drugs Symlin (Brand Name) Pramlintide (Generic) Byetta (Brand Name) Exenatide (Generic) 29 Medication Management Review More than administration Involves knowledge Maximizes benefits Achieves therapeutic outcomes 30 15
Drug Actions: A Review Once administered, all drugs go through these processes: Absorption Distribution Metabolism Excretion 31 Why is Review Important? What we already know: 1. People with Diabetes frequently have many co existing medical diagnoses 2. Therefore, they are at higher risk of delayed absorption, distribution, metabolism, and excretion 3. Additionally, they are at higher risk for drug to drug interactions due to these delays 32 16
Use Medications Wisely Be alert for interactions Check with Doctor Be informed 33 Important Things to Consider Risk of hypoglycemia Activities throughout day 34 17
Remember Medications help lower blood glucose levels to help reduce risk for long term complications Medications work best when combined with supervision from the doctor and an appropriate meal plan and exercise program 35 Remember Hand washing is the single most effective way to prevent the spread of illness and germs ALWAYS wash your hands before, and after contact with every person for whom you provide care Including between medication administration to more than one individual 36 18
References http://www.diabetes.org/diabetesmedications (retrieved 10/19/2007) http://diabetes.niddk.nih.gov.dm/medications (retrieved 9/12/2007) National Institute of Health; Fact Sheet Diabetes Type 2 37 Suggested Supplemental Training Diabetes: Basics Diabetes: Complications Diabetes: Nutrition 38 19
To register for future trainings, or for more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com 39 40 20
Evaluation Please take a few moments to complete the evaluation form found in the back of your packets. Thank You! 41 Test Review There will be a test review after all tests have been completed and turned in to the Instructor. 42 21
Diabetes: Oral Medications Sulfonylureas Generic Name Glimepiride Glyburide Chlorpropamide Acetohexamide glipizideglucotrol, tolbutamidetolinase, Brand Name Amaryl Diabeta, glynase, micronase Diabinese Dymelor Glucotrol XL Orinase Increase the production of insulin and help the body to use insulin. Side effects: hypoglycemia (low blood sugar), and more rarely, weight gain, upset stomach and allergic reactions in people who have allergy to sulfa medications. Pancreas has to make some insulin for these pills to work. Can make the blood glucose too low. (hypoglycemia) If taken 1xday, take before first meal, if taken 2xday the second just before the last meal of the day. Take same time everyday. Biguanides Generic Name Metformin Brand Name Glucophage, Glucophage XL Increases the potency of insulin secreted by the pancreas, and decreases the amount of sugar made by the liver. Not likely to cause hypoglycemia. Can cause diarrhea, when taken on empty stomach. Lactic acidosis. Tell the doctor you are on this medication if you are having surgery or any medical test using dye It can also improve blood fat and cholesterol levels.
Alpha-Glucosidase Inhibitiors Generic Name miglitol acarbose Brand Name Glyset Precose Slow down the absorption of sugar in the blood Side Effects: Gastrointestinal distress, including gas and diarrhea Should not be taken by people with severe bowel or kidney disease or liver disorders. These are taken 3xday, at each meal, with the first bite of the meal. Thiazolidinediones Generic Name Pioglitazone Brand Name Actos By making the cells more sensitive to insulin the insulin can then move glucose from the blood where levels are high, into the cells to be used for energy. Take the same time each day, usually once a day, with or without a meal. This will not cause blood glucose to drop, but if taken with other diabetes medicines with this group, blood glucose might drop too low. Birth control pills may be less effective with this medicine in preventing pregnancy May gain weight with this medicine. May be at risk of developing anemia, and congestive heart failure. This medicine usually works well with a sulfonylurea, metformin or insulin.
Meglitinides Generic Name Repaglinide Nateglinide Brand Name Prandin Starlix Stimulates the pancreas to produce more insulin Effect is much stronger if taken 3 times a day before meals. Fast acting, allowing greater flexibility in meal timing. Some people develop hypoglycemia with this drug. Should not be used by people with Type I diabetes This medicine is taken before eating a meal. If a meal is skipped, the dose should not be given. Taken no more than 30 minutes before the meal. D-Phenylalanine Derivatives DPP-4 Generic Name Sitaglipin Brand Name Januvia This medicine helps the pancreas to make more insulin quickly and for a shout time. The insulin then lowers the blood glucose after you eat a meal Taken once a day, either alone or with diet and exercise and/or other oral diabetes medications.
Combination Oral Medication: Generic Name glyburide+metformin hydrochloride Brand Name Glucovance A single pill that combines a sulfonylurea with a biguanide Can increase both supply and effectiveness of insulin Side effect: can cause hypoglycemia. Not to be used by Type I Diabetes Mild diarrhea or upset stomach, but usually goes away within a few weeks May cause blood glucose to drop too low. May not be ordered if have kidney problems If having tests requiring dye, or surgery, will be instructed to stop for a short time Should not be used if frequently drink alcohol
Recently Approved Injectable Drugs ( Non-Insulin) pramlintide (generic) Symlin (Brand name) exenatide (generic)- Byetta (Brand name) Symlin: Cannot be combined in vial or syringe with insulin and must be injected separately. Approved for individuals with type I diabetes who are not achieving their a1c goals, and for individuals with type 2 who are using insulin and not achieving a1c goals Byeta: Works to lower glucose levels by increasing insulin secretion, only when blood glucose levels are elevated. Injected with meals. Moderate weight loss noted. Reviewed 4-10-08/sh