Chapter 38

Antidiabetic Agents

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 Function of the Pancreas Gland

• Endocrine gland
– Produces hormones in the islets of Langerhans
• Exocrine gland
– Releases sodium bicarbonate and pancreatic
enzymes directly into the common bile duct to
be released into the small intestine
– Neutralizes the acid chyme from the stomach
and aids digestion
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 Insulin
• Definition
– Hormone produced by the beta cells of the
islets of Langerhans
• Action
– Released into circulation when the levels of
glucose around these cells rise
– Stimulates the synthesis of glycogen, the
conversion of lipids into fat stored in the
form of adipose tissue, and the synthesis of
needed proteins from amino acids
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 Metabolic Changes Occurring When
Insufficient Insulin Is Released
• Hyperglycemia: increased blood sugar
• Glycosuria: sugar is spilled into the urine
• Polyphagia: increased hunger
• Polydipsia: increased thirst
• Lipolysis: fat breakdown
• Ketosis: ketones cannot be removed effectively
• Acidosis: liver cannot remove all of the waste
products
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 Diabetes Mellitus
• Characteristics

– Complex disturbances in metabolism

– Affects carbohydrate, protein, and fat metabolism

• Clinical signs

– Hyperglycemia (fasting blood sugar level greater

than 126 mg/dL)

– Glycosuria (the presence of sugar in the urine)

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 Disorders Associated With Diabetes
• Atherosclerosis: heart attacks and strokes related to
the development of atherosclerotic plaques in the
vessel lining
• Retinopathy: loss of vision as tiny vessels in the eye
are narrowed and closed
• Neuropathies: motor and sensory changes in the feet
and legs, and progressive changes in other nerves as
the oxygen is cut off
• Nephropathy: renal dysfunction related to changes in
the basement membrane of the glomerulus

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 Classifications of Diabetes Mellitus

• Type 1, insulin-dependent diabetes mellitus (IDDM)

– Usually a rapid onset; seen in younger people
– Connected in many cases to viral destruction of
the beta cells of the pancreas
• Type 2, non-insulin–dependent diabetes mellitus
(NIDDM)
– Usually occurs in mature adults
– Has a slow and progressive onset

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Clinical Signs and Symptoms of
Hyperglycemia

• Fatigue • Polyphagia
• Lethargy • Polydipsia
• Irritation • Itchy skin
• Glycosuria

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 Signs of Impending Dangerous
Complications of Hyperglycemia

• Fruity breath as the ketones build up in the

system and are excreted through the lungs
• Dehydration as fluid and important electrolytes
are lost through the kidneys
• Slow, deep respirations (Kussmaul’s respirations)
as the body tries to rid itself of high acid levels
• Loss of orientation and coma

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 Hypoglycemia

• Definition

– Blood sugar concentration lower than 40 mg/dL

• Occurrence

– Starvation

– Lowering the blood sugar too far with treatment

of hyperglycemia

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Types of Insulin

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 Insulin
• Actions
– It is a hormone that promotes the storage of the
body’s fuels
– Facilitates the transport of various metabolites and
ions across cell membranes
– Simulates the synthesis of glycogen from glucose
– Reacts with specific receptor sites on the cells
• Indications
– Treatment of type 1 diabetes mellitus
– Treatment of type 2 diabetes mellitus in patients
whose diabetes cannot be controlled by diet or
other agents

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 Insulin (cont.)

• Pharmacokinetics
– Various insulins available are processed within
the body like endogenous insulin
– Peak, onset, and duration vary based on
preparation
• Contraindications
– There are no contraindications

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 Insulin (cont.)
• Cautions
– Pregnancy and lactation
• Adverse effects
– Hyperglycemia and ketoacidosis
• Drug-to-drug interactions
– When given with any drug that decreases
glucose levels
– Beta blockers
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Site of Action of Drugs Used to
Treat Diabetes

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 Sulfonylureas

• First generation
– Associated with increased risk of cardiovascular
disease
• Second generation
– Advantage over 1st generation drugs
 Excreted in the urine and bile
 Do not interact with as many protein-bound drugs
 Longer duration of action
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 Sulfonylureas (cont.)

• Actions

– Stimulate insulin release from the beta cells

in the pancreas

– Improve binding to insulin receptors

• Indications

– Adjunct to diet and exercise to lower blood

glucose levels in type 2 diabetes mellitus

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 Sulfonylureas (cont.)
• Pharmacokinetics
– Rapidly absorbed from the GI tract and undergo
hepatic metabolism
– Excreted in the urine
– Peak and duration vary with each drug
• Contraindications
– Allergy
– Diabetic complications
– Type 1 diabetes mellitus
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 Sulfonylureas (cont.)
• Adverse effects
– Hypoglycemia
– GI distress
– Allergic skin reactions
• Drug-to-drug interactions
– Drugs that acidify the urine
– Beta blockers
– Alcohol
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 Nonsulfonylureas

• Actions, Indications, Pharmacokinetics,

Contraindications, Caution, and Adverse
Effects
– Same as for sulfonylureas
• Drug-to-drug interactions
– Vary with the drug that is given

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 Glucose Elevating Agents
• Action
– Increase the blood glucose levels by decreasing
insulin release and accelerating the breakdown of
glycogen in the liver to release glucose
• Indication
– Treatment of hypoglycemia
• Pharmacokinetics
– Rapidly absorbed and distributed throughout the body
– Excreted in the urine

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 Glucose Elevating Agents (cont.)
• Contraindications
– Known allergy
– Pregnancy and lactation
• Caution
– Hepatic dysfunction or cardiovascular disease
• Adverse effects
– GI upset
– Vascular effects
• Drug-to-drug Interactions
– Thiazide diuretics
– Anticoagulants
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Use of Antidiabetic Agents
Across the Lifespan

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Prototype Insulin

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Prototype Sulfonylureas—First Generation

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Prototype Sulfonylureas—
Second Generation

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Prototype Nonsulfonylureas

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Nursing Considerations for Insulin

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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 Nursing Considerations for
Oral Antidiabetic Agents

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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 Nursing Considerations for
Glucose Elevating Agents

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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