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Metabolic Regulation
Class 2

Jill Kerrigan
BSNC 2000
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Assessment & Management of Diabetes

Diabetes Diagnosis
Management of Hyperglycemia
Pharmocology #4: adverse reactions etc
Diabetes Pharmacotherapy
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Manifestations of Diabetes
Breakout room
15 min

Begin Part 3 of Rosa Li Case Study

Questions 1-3
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Manifestations of Diabetes
 What manifestations of impaired metabolic
regulation (hyperglycemia) does Rosa exhibit?

Manifestation Cause
 POLYURIA ↑ glucose
filtration

normally 100%
of filtered
 when blood glucose glucose is
levels are higher than reabsorbed

normal, filtered glucose

↑ osmolality
exceeds the capacity for ↓ water
tubular reabsorption reabsorptio
n
 increased filtrate
osmolality decreases
water reabsorption
 increased water loss in polyuria &
the urine (osmotic glucosuria

diuresis)
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Polydipsia
 polydipsia (thirst) is caused by:

1. dehydration due to polyuria

2. hyperosmolarity of blood due to

hyperglycemia (pulls water out of the
interstitial and intracellular spaces)
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What additional manifestations are

specific to type 1 diabetes?

Why do some people with diabetes have

poor circulation related to
hyperglycemia?
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Manifestations of Type 1
Diabetes
 polyphagia (increased appetite)
 glucose can’t enter cells  insulin dependent
cells are ‘starved’
 stimulates appetite

 unexplained weight loss

 breakdown of fat and protein for energy (due to
insulin deficiency and relative glucagon
excess)
 causes muscle wasting
 hyperglycemia

polyuria

↑ blood ↓ blood
viscosity volume

poor
circulation
(perfusion)
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Breakout room
5 min
Diabetes Assessment Questions 4&5

Plan out how you will assess Rosa for

diabetes:

 History (focused interview questions):

 On Examination (s/s to assess for):

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Why might Rosa become hyperglycemic

when hospitalized?
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Breakout room
10 min

Work on Part 4 of Case Scenario

Diagnostic Test Normal Value Pre-Diabetes Value Diabetes Value
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Diabetes in a Hospitalized
Patient
 How would Rosa’s blood sugars be monitored
and managed in the hospital?

 Why is it important to control hyperglycemia in

the hospitalized client?
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In group of 4: have 2 people share what

they know about metformin, then 2 people
share what they know about glyburide.
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Diabetic Medications
 Insulin
 Sulfonylureas (glyburide)
 Biguanide (metformin)
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Insulin
 Exogenous replacement of insulin (sub-cut/IV)
 Pancreas non functioning
 All type 1 clients and some type 2 clients
 Pharmacokinetics: short and long acting
 Contraindications: hypoglycemia
 Adverse effects: hypoglycemia, local reactions
wt gain
 Drug-drug: care with beta-blockers
 Nursing considerations: glucose level, site
rotation, monitor for hypoglycemia at peak times,
diabetes education.
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http://guidelines.diabetes.ca/docs/cpg/Appendix-6.pdf
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Biguanide (metformin)
 Decr hepatic glucose production, decr
intestinal absorption of glucose and increases
sensitivity to insulin by increasing peripheral
glucose uptake
 Does NOT cause hypoglycemia
 Adjunct to diet and exercise for type 2
 Pharmacokinetics: eliminated by kidneys, 12-
24hr duration of action
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Metformin (cont)
 Contraindications: renal impairment, contrast
dye, hepatic impairment
 Drug-drug:
 Metformin-Lasix
 Lasix may incr effects of metformin
 Metformin-calcium channel blockers,
morphine, digoxin, vancomycin
 Compete for same elimination pathway
 Adverse effects: lactic acidosis, D, N & V
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 There are cardiovascular benefits to

metformin:
 Decreases lipid profile (triglycerides)
 Decreases body weight
 Modulation of endothelial function

Metformin therapy significantly reduces any

diabetes related deaths compared to dietary
interventions, insulin and sulfonylureas…thus
first line therapy for all T2DM patients.
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Sulfonylureas (glyburide)
 Requires a functional pancreas
 Stimulation of the pancreas to release insulin
by binding to potassium channels of beta cells
 Improves insulin binding to receptors
 Adjunct to diet control for type 2
 Pharmacokinetics: metabolized in liver,
excreted in bile and urine, onset 1h peak 3-4h
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Glyburide (cont)
 Contraindications: pregnancy, type 1 diabetes,
sulfa allergy? major renal/hepatic disease
 Adverse effects: hypoglycemia, n & v, wt gain
 Drug-drug:
 drugs that acidify urine as excretion will
decrease (citric acid)
 Beta blockers, alcohol
Widely used to treat T2DM patients because of
once-daily dosing, inexpensive, reduce glucose
and patients tolerate well…but not alone as CV
protection conflicting
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Other Diabetic Meds

 Thiazolidinediones
 Alpha glucosidase inhibitors
 Meglitinides
 Incretin-based therapies
 GLP-1 receptor agonists
 Sodium glucose cotransporter-2 inhibitors
 References
 Adams, M.P., Holland, L.N. & Urban, C.Q. (2014).
Pharmacology for Nurses: A pathophysiological
approach (4th ed.) New Jersey: Pearson
 Aschenbrenner, D. S., & Venable, S. J. (2012). Drug
therapy in nursing (4th ed.) Philadelphia, PA: Lippincott
Williams & Wilkins.
 Karch, A.M. (2017). Focus on Nursing Pharmacology (6th
ed.). Philadelphia, PA: Wolters Kluwer Lippincott
Williams & Wilkins
 Yandrapalli, G., Horblitt, A., Sanaani, A. & Aronow, W.
(2017) Cardiovascular benefits and safety of non-insulin
medications used in the treatment of type 2 diabetes
mellitus. Postgraduate Medicine, 129:8, 811-821, DOI:
10.1080/00325481.2017.1358064