KEY TERMS: Mah he em with he comet dtm Detniign 25 -G _ scaconthon figura td gos 29. {isa protein he ‘produced by is rormone produced bythe pares rine 82 op that binds to insulin receptors on may ele nic ten promos ‘he movement of aco fom he How inte cle 30. I is acontiton of overshan normal bod glocos levels 31. {By isacommon chronic endorie problem in which the ack of slim or por faction ofan mp aces metab and les to protein ft nd potin eta 32, N\__ are a category of noninsuin antidiabetic drugs tat lower blood Alacose level by preventing the Kidney ro eating picoe that was eed rom the blo inthe wine Tis ose then remains inthe urine and i exeretd rather than moved back int the blood >, Msn nese saree vary fete er thantinding oan esepo tip we rns ut back tothe normal ange fis a category of noninsulin antidiabetic drugs that help prevent hhyperslycemia by reducing the amount ofthe DPP-t, which inac tivates the normal incretins GLP and GIP. This allows the naturally ‘produced incretns to be present and work with insulin to contol Dlood glucose levels 4. js an oral noninsulin aniiabetic drug tht lowers hood slacose levels by preventing enaymes inthe intestinal tract from braking down starches and more complex sugars into glucose. 36, is an injectable noninsolin antidiabetic drug similar to natura Amylin, which isa hormone produced by pancreatic beta cells and js cosecreted with insulin in response t blod glucose elevation I prevents hyperglycemia by delaying gastric emptying and making the patient fee ul. 37 is a category of noninsulin antidiabetic drog that ses ke he tu ral gut hormones (GLP!) that ae secreted in response to food in the stomach, They work with insulin to prevent blood glucose levels from becoming too high after meals by slowing the rate of strc emptying 38, £ isa sugar-based nutrient crcllyimporant for energy production incells and organs x0. C is an oral noninsulin antidiabetic drug that lowers blood glucose Tevels by reducing the glucose the liver releases and by reducing show much and how fas the intestines absorb the glucose in food 40, MK arescatgory oor noninstin atiibetc drags that lower blood locos eves by making Inula teceplor more ensive oi, ‘Shichincreates cellular uptake and we of glucose 41 are a category of oral noninsulin antidiabetic drugs that lower blood lucose levels by triggering the release of insulin stored i the beta Eells of the pancreas. The sulfonylureas and the meghtnides are the two classes of drugs inthis category 110 ‘on 18 rg Thaap for Dsbtes tem ‘Alpha-glucosidase inhibitors Biguanides Diabetes mellitus DDPP-* inhibitors Glucose yperelycemia Hypoglycemia Tncretin nimeties Insalia Insulin sensitizers Istlin simulators [Noninsolin antidiabetic drugs Sodium glucose cotransport inibitors ZEPREH Ep mmene> Coop 222, ern gn SIDE AN! 42. Com [cares Insulin Bigua Insul Alp IncPP ype AND ADVERSE EFFECTS OF DRUGS FOR DIABETES __—_——] “p_complete te table [ careGorIes 5 as IDE EFFECTS ‘ADVERSE EFFECTS atin stiltors " Hypoglycemia i Can cause the b pancreas to stop Pr ‘condition known as “se cell failure” Can affect the liver ant liver enzyme levels id increase piguanides Nausea Diarthea Flatulence Weight loss Insulin sensitizers Hypoglycemia Headache Sneezing Sore throat ‘Alpha-glucosidase inhibitors Inflammation of the bowel such as clit Crohn's disease or intestinal obstruction Hypoglycemia Liver impairment with elevated liver ‘enzyme levels Incretin mimetics Nausea, vomiting Diarthea Upper respiratory tract symptoms ‘Weight loss 7 Nausea Vomiting Headache ‘Abdominal pain ‘Weight loss and fatigue Dizziness Severe hypoglycemia Pancreatitis, amet © 2022, Eseries sone 1 (Crunter18_Orog Therapy for DiabetesCATEGORIES, ‘SIDE EFFECTS ‘ADVERSE EFFECTS DPP-4 inhibitors wyposiyeemia ‘Allergic reactions with symptoms of hhves, facial swelling, and itching ‘Acute and even fatal pancreatitis Severe arthralgia (joint pain) Bullous pemphigoid, a rare skin Condition that results in large, fluid-filled blisters that most often ‘occur in the lower abdomen, upper thighs, or armpits ore Increased need to urinate inhibitors Because glucose is excreted inthe ‘urine, patients using glucose strips to check for glucose inthe urine will see a positive result most ofthe time. ‘Weight loss initially through the Toss of fluid, followed by loss of fat mass iyceria leading to loss of, ess and even death ite infections LenS, asters rections suet as swelling, itching, or redness ros the injection site and changes (00 skin at injection sites MULTIPLE CHOICE a For each of the drug categories listed below, check all items that describe het shout wht patents and fame. 43, Insulin stimulators (seeretogogues) a Take these drugs at least 2 hours before meals b ‘Hypoglycemia symptoms include hunger pangs, nervousness, confusion, and tremors. © Check with he athens po ider before taking any over-the-counter or prescription drugs to ensure d, _____ Avoid exercise atleast 4 hours after taking these drugs. 44 ae a. _¥__ Avoid drinking aleohol as this increases chance of developing lactic acidosis +b. Common side effects include rashes, increased urine output, and headaches. © Check with healtheare providers about stopping and starting drugs if radiopaque dye is being used. 4. V__ Laboratory tests are important due to risk of cardiovascular disease and B,, deficiency. 112 (uct 18 rag Therapy for Dates Cri © 2022, Eseries seeYK sins «tnt ein ret ne nes cin eee of tibinin intense inal gee eee Due to the FDA black by . {—— ox warnings these drugs should nc et ents who have 5) tomatic Duet FDA black box warnings es dugshouldanbe ake Pan no have symp Atpha-glucosidase Inhibitors . ‘When taking these drugs, you should avoid all exercise. a “These drugs must be taken a the end of meals to get the most benefit } “The drug’ effet on blood sugar level flowing meas depends onthe amount of prose the meal. 4 Z ‘Avoid alcohol while taking these drugs as they increase risk of liver impairment: 44 Incretin mimetics r If you have difficulty breathing, a lump in your throat, or swelling of your mouth and tongue, call 911- b. ‘Alcohol inereases tisk of pancreatic inflammation é Ifa dose is missed, double your next dosage 4 ‘Administer subcutaneous injection in thigh, upper arm, or abdomen e Inject the drug 60 minutes after meals 48, Amylin gffalogs pens shouldbe refrigerated or used within 28 days a Opens vials and injectable b “phe deve should warm to room temperature efor injecting « ‘anise this drug right after your meal 4 “ao mx pranlitide with insulin in the same sTINEE « pispose ofall used syringes and nedlesin alas POE t. sept ive or pate machinery ani you ko wher is aus dizziness 49, DPP-4 inpibitors sdemally missed, donot double up onthe subsequent drug dose 1rhealtheare provider a Ifa dose is ace! 1y hypoglycemia incidents to You b Report an ‘. Report symptoms of allergic ration, angioe dems oF pancreatitis to your healtheare provider 4, _ These drugs are safe 10 use you are pregnant or breastfeeding eA ineeased isk for heart flor is 90 reported in patients receiving saxapliptin and alogliptin. has el have hee weight checked daly Report a weight gain ‘Therefore, patients receiving thes Therefor pounds ina day othe onset Of shortness of breath. 113 amp ©2022, Een. see Char 18 Drug Therapy fr DiabetesSoadiumglacose cotransport Inhibitors ar inervals % check your blood sugar at » aa Report any weight gain wo your heaibeare provider ‘ Report signs of UTT or sain inetion yt Limit Muids throughout the day Gilocose will be present in your urine while taking this drus SI. Insulin When symptoms of hypogly sia are present. avoid eating or dfinking anything until the symptoms pass When symptoms of hyperglycemia are present eat or dink something containing susar Seok emergency treatment for symptoms of ketoacidosis Keep appointments wit your healtheare provider to test your blood glucose levels Insulin vis my bbe store at room lemperature t Ae ‘Shake insulin vials vigorously before drawing the insulin up 8 Avoid alcohol because it can intensify hypoglycemia h Carry a readily available source of protein at alles in ease you develop symptoms of hypoglycemia GIVING INSULIN WITH A PEN DEVICE (CASE STUDY 52. Fill inthe missing eps Mr Antwan Spears is 69-year-old Native American male a. Wish your hands Wh has year history of type 2 diabetes. Mr Spears 1. Check the order and the dru label eres athispimary care provers office for afllon-op ¢: Remorethe exp amination His physician i concerned becuse of his eull \ family history of ype 2 diabetes, eat disease and stroke, us Me Spears ates i fasting bod glucose levels are T8313 Wig the tip af the pen whee the needle will 22) gf Healso stress hasbeen adherent his meal 1 Remout prot ab ball top ny levee He pcs ihe examiqaon wh da z Remove bo the plastic outer ap and ner nee- ness. shakes. sete. co. confusion” He as Been dleesp. " ting materi 5 rally three times dily n check doe window on fon dete wilh meals. Fom:h theres far, itis lnelear why Nis Sp elyeemie, 1. Holding the pen with the needle pointing upward, press the bolton nil at least a drop of insulin 1. In addition to di jppears. This is the “cold shot” “air shot." or contusion, whats ‘safety shot.” Repeat this sep if needed until a drop apps, Headache x @)iunger sensation [K, Hold the pen perpendicular 1 and press against, a ness, sweatiness, and coms of hypoglycemia » Me Spears? (Chose all that, es ‘ Fruity-smelling breath : Reepomseiaes 1, ee deoing Hinob all tee way, Gotten wiht a spicata needle is removed. hard plastic or met o. peplace cap an insulin pel 1 ind dispose of the needle in a (eto 18 ug Therap ribs Comin © 202 et eeser questioning Mr. Spears further, you find ou Mie con regularly taking ibuprofen or jin pane ha a other drugs interact with nateglnide (Star pote ‘cause hypoglycemia’? ix) 1 Aspirin and other nonsteroidal antinflamy sina inflammatories ‘Angiotensin II receptor antagonists (ARBs) ‘Angiotensin converting enzyme inhibit Angigemsin 7 tors (ACEI) ‘Antiretroviral protease inhibitors Warfarin Azole antifungal drugs. F Tmiavde diuretics GB Many anidicties TI. Corticosteroids PRACTICE QUIZ 1. What is the purpose of glucose, a sugar-based nutrient? ‘2, Binds insulin receptors on many cells ®Nerabolizes within the cells to generate the body's energy ¢, Prevents hyperglycemia @, Released within the body when energy is low 2, How does insulin, a protein hormone produced by the pancreas, prevent hyperglycemia? ‘2. Provides the muscles with energy b, Prevents the body from storing sugar c, Prevents the kidrey from eliminating glucose ows body cetls to take up, use, and store carbo- hydrate, fat. wn protein 3, How does glucazon work to prevent low blood glu- cose levels? AapTriggers the relesse of glucose from the liver and skeletal musc\s wlan blood glucose is lower than normal b. Prevents the release of insulin from the pancreas when blood glucose is lower than normal ¢. Protects cells from releasing too much energy when blood glucose is lower than normal 4d. Ensures sufficient insulin is released from the pan- creas when blood glucose is lower than normal 4, Why do the neurons and the brain require a continu- ‘ous supply of glucose from the blood? 2. The brain and neurons are continuously working to keep the body functioning. b. The brain stores only a minimal amount of fat which must be continuously replenished. ‘brain is unable to store any glucose. brain and neurons use significantly more glt- cose than other parts of the body: Cy © 20, over. A ahs eee tes mellitus? 5. What isthe primary cause of diab iiits glu a. An overproduction of insulin which ia ‘cose from functioning adequately b. Glucose is not released in adequate amounts inte the bloodstrea c. The brain and neurons do n supply of glucose and there Oo not operating eiciently jot receive an adequate fore the organs began Glucose movement from the blood into cells and organs is 6. What ae some ofthe complications of uncontrolled! Wes Sond bees nels? Sey Rea Ration a a organs and ses 5 lo rere lowe tan nom 1. what cases he tet fs conition kan a rots? Raton wit sei ay ass stored at fron pha sca rene an xs isin caing are te rt rene) Pe iabetes mellitus eats an excess OF place of of glucose. 4, A patient wit of aleotol. th diabetes mellitus drinks an excess 8. While type I diabetes onset is sudden and severe and quickly diagnosed, why is type 2 diabetes usually not ‘diagnosed as quickly? 4. Type 2 diabetes is only diagnosed if blood glucose levels are tested regulasly (Hrecause in type 2 diabetes the panereas still pro- aces some insulin, symptoms may not occur until complications begin. c, In some individuals, type 2 diabetes symptoms may eventually dissipate overtime. 4, Type? diabetes often presents as pancreatitis and the other symptoms are overlooked. 9, When patents first dlagnosed with type 2 diabetes, Mit the best fist line of treatment forthe chronic Uisease? stuf injections 10 replace the levels no longer produced by the panress o. Non-nsulin ancgiabetc drugs 10 control blood plucose levels e, No treatment is recommended until consistent tenting of blood plucose levels indicates a consis- ten, higher than-nrmal level [tients should try det and exercise fist to deter- ine if those measures wl help them maintain @ target blood glucose level. 115 Chg 18 brug Therapy or Diabetes10. What is necessary for insulin-stimulator oral drugs €© lower blood glucose levels? 4. The patient must take the drug consistently on & ‘daily basis to ensure effectiveness. 'b,) The patient must have some Funct within the pancreas ©. The patient must have a blood glucose level that is loser to normal range. 4. The patient must mai gram of exercise, ning beta cells in a healthy diet and pro- 11, Whats the only drug available inthe biguanides cat gory of drugs? GMetomin Migiitol ©. Exenatide 4. Saxagliptin 12. Which category of drug is most often recommended for patients who have high blood sugar following meals? a, Insulin sensitizers Ipha-glucosidase inhibitors . Incretin mimeties 4. Amylin analogs 116 Chapter 18 rug Therapy for Diabetes subcutaneous injections 13, Where should inistered? cram an pein les of lower abdom Rotate between both sides o en » Select upper arm, upper thigh, or abdomen ang Consistently use the same location Roiate among upper arm, upper thigh, ang abdomen 14, What is considered a normal fasting blood glucose level? 70 10 90 mg/dL, 60 to 100 mg/d ¢. 7510 115 mg/dL «. 80 to 90 mg/dL 15. Why should insulin be administered by the parenteral route? ‘a, Because insulin must be refrigerated, it can upset the stomach. b. Itis necessary to use a faster route of administra- tion for inslin (gBecause insulin is destroyed by stomach acids and intestinal enzymes 4. Prevents stress on the pancreas Cont © 2022, sre. Mra ee