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Glipizide Usally gets prescribed with metformin.

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Onset 30 minutes

Peak 1 to 3

Duration 10 to 24 hours

Action: Stimulates beta cells in pancreas to release insulin

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Off lable weight loss not FDA approved (people are not knowing diffrence between the glp 1 for weightloss and glp-2) Glp 2 is not usually associated with weightloss or supress apatite but people are taking off lable and using it causing hormonal imblances and intestinal damage as well as other complications.

type two diabeates

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Constipation

Stomach pain

Diareaha

Loss of apatite

Renal damage

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hypoglycemia,

itching

rash

fecal impaction

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Alcohol usage should be limited can cause hypoglycemia

Kidney or liver issues

take 30 minutes before meals, to prevent hypoglycemia.

Weight gain

This is usually have to buy into lifestyle changes (diet exercise)

Allergies - SULFA

Monitor labs:

GFR and Cr (kidney damage)

A1c (3-6 months)

monitor wt (same time, every day, in the morning)

triglycerides and cholesterol

LFT, ALT, AST (liver - assess for jaundice - slows the bile flow)

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Take stool softners,

Exercise

Diet

Take only for intended usage

Not for weightloss FDA approved- can cause rental damage hypoglycemia kidney and liver damage

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Metformin(Fortamet, Glucophage, Glumetza)

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Decreases hepatic production of glucose(gluconeogenesis) and reduces insulin resistance

this does not alter the insulin

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Type 2 diabetes after diet and exercise have failed

A1c <9%

PCOS

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Nausea, Vomiting, diarrhea

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Lactic acidosis - fatigue, diaphoresis, hot flashes, happens in kid and liver disease pt.

agitation

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Caution to

CKD

Liver disease

severe infection

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Pt should stop taking this medication 2days prior to and 2 days after receiving radiographic contrast - kidneys!!

Contraindication if kidneys - GFR < 60 and Cr > 1.5

Swallow extended release whole not crushed

Interacts with alcohol

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Pioglitazone

rosiglitazone - not as Rx'd due to cardiovascular events

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MOA: Increase insulin sensitivity by acting on adipose tissue and muscle to increase glucose utilization.

Onset: 30 min

Peak: <2 hrs

Duration: Unknown

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For type 2 diabetes.

Rosiglitazone is rarely used and no longer widely available due to concern of increased risk for CV events.

Pioglitazone is used for pts who have contraindication to other oral agents (metformin, sulfonylureas), and who decline injectable therapies.

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Weight gain

Edema

Hypoglycemia

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HF/Fluid retention - monitor cardiac function

Skeletal fractures

Bladder cancer

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Monitor patient response: stabilization of blood glucose levels.

Monitor for adverse effects

Monitor pt compliance

A1C should be measure 2x yearly in pts meeting glycemic goals and if not meeting goals then every 3 months

weigh daily do assess for HF

Labs:

A1c

Liver biochemical test - LFT, AST, ALT

Ca++/Phos ---> decrease (skeletal fxs and heart)

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-Instruct pt to adhere to dietary instructions and to have glucose and HbA1C levels tested regularly.

-Teach s/s of hypoglycemia

-Advise pt to notify prescriber during periods of stress, such as fever, trauma, infection, or surgery, as dosage may need adjustment.

- Advise pt to report blood in the urine, red-colored urine, new or worsening urge to urinate, or pain when urinating: may indicate bladder cancer.

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end in "tide"

albiglutide, exenatide, dulaglutide, liraglutide

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Enhance insulin secretion in response to food intake

Reduce hepatic glucagon production

Slow gastric emptying,

Mimics the action of the incretin hormone

Albiglutide: Subq inj, once a week, 30-50mg, peak of 3-5 days with a steady streak reached in 4-5 week

Exenatide: Subq inj, once a week, steady peak reached in 6-7 weeks

Dulaglutide: Subq inj, once a week, steady peak reached in 48-72 hours

Liraglutide: Subq inj, once a day, peak in 8-12 hours

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type 2 diabetes that are having difficulties managing with diet alone

off label uses:

weight loss

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nausea

diarrhea or constipation

nervousness

headaches

dizziness

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antibody formation

pancreatitis

thyroid tumor

hypoglycemia

gi motility down - obstruction, --> ileus, --> perforation

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monitor for s/sx of hypoglycemia

monitor for s/sx of pancratitis

monotir injection site

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Educate on hypoglicemia

Educate on rotating the injection site every couple of weeks

Encourage f/u every 3-6 months

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end in "gliptin"

alogliptin, linagliptin, sitagliptin

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Enhance insulin secretion in response to food intake

reduces hepatic glucagon production

Slows gastric emptying

enhances endogenous incretin hormone, and lowers glucose levels

Alogliptin: PO, 25mg daily, with/without food, peak of 1-2 hours, and a half-life of 21 hours

Linagliptin: PO, 5mg daily, with/without food, peak of 1.5 hours, and a half-life of >100 hours

Sitagliptin: PO, 100mg daily, with/without food, peak of 1-4 hours, and a half-life of 12 hours

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nausea

upset stomach

diarrhea/constipation

headaches

dizziness

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loss of appetite

weight loss

upper respiratory infection

hypoglycemia

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monitor for S/Sx of hypoglycemia

assess patients' medication list (interacts with insulin, glyburide, glipizide, or glimepiride, digoxin, oral contraceptives)

monitor for s/sx of pancriatitis

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ensure the patient understands hypoglycemia

encourage f/u every 3-6 months

encourage proper foot care

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Lispro & ...logs

Other types of Rapid-acting insulin:

Insulin aspart (NovoLog, Fiasp)

Insulin glulisine (Apidra)

Insulin lispro (Humalog, Admelog)

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Facilitates the movement of glucose into the cells, promotes glycogenesis, and inhibits production of glucose from fats and proteins

Onset: 5-30 min

Peak: 0.5-1 h

Duration: 3-5 h

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Hypoglycemia

Injection site irritation

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-Hypoglycemia

-Hypokalemia

-Allergic reaction (severe): angioedema, hypotension, dyspnea, urticaria

-Overdose (reversal: admin rule of 15)

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-Assessment: monitor for hypoglycemia

-Administration/Monitoring: check blood glucose regularly (4-6 h) and administer 10 min before meals

-Can only be mixed/given with NPH, no other insulins, and must be administered immediately after being drawn up

labs:

a1c

kidney

liver

thyroid function

K+ (makes it go down) Hypokalemia

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Subcutaneous; 5-10 min before meals

Can give w/ NPH (intermediate insulin)

DON'T reuse needles

Educate & follow sliding scale as prescribed by provider

Exogenous insulin IS excreted into the breast milk

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Humulin R. Novolin R.

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Insulin coordinates glucose & free fatty acids to meet body's demands during eating, fasting, & exercise

Onset:30-60min

Peak: 2-3 hr

Duration: 8 hr

pump, IV, IM and SQ

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Weight gain

Potential changes in vision

Euglycemia

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Hypo or Hyperglycemia (depending on amount administered)

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Check BG and figure out what their normal range (ac/hs) is

Phosphate (normal adult=2.5-4.5 mg/dL)

Potassium (normal adult=3.5-5.2 mmol/dL)

Magnesium (normal adult= 1.3-2.1 mEq/L)

Check if they had A1C (nondiabetic=<5.7%, diabetic=<7%)

Check current & past medications

Current Diet/Alcohol intake

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Best if given 30min b/f meals

Rotate injection site to avoid lipodystrophy

Educate on proper dosage (prescribed by provider)

Educate how to check & monitor BG

Educate S/S of hyper/Hypo glycemia & diet that can effect each

This insulin works fast, caution overdose

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insulin isophane(NPH,Humalin N, Novalin N, ReiliOn N)

Cloudy in color

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Intermediate action increase insulin, decrease glucose production by liver

Protamine added which is a protein that delays inulin absorption which gives this drug its basal effect.

Onset 1-2hr

Peak 4-6hr

Duration 18-24hr

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Weight gain

Injection site pain redness or swelling

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Hypoglycemia

Coma

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30min before breakfast

30 minutes before dinner if needed

Do not mix with glargine

Draw NPH up last

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Teach clients importance of diet

Teach clients to take same time every day

Teach clients to report symptoms of hypoglycemia low b/p, clammy skin

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Glargine, Lantus, Levemir

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BASAL glycemic control

Onset: 1-2hr

Peak: N/A

Dur: 24hr

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Weight gain

Potential changes in vision

Euglycemia

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Hypo or Hyperglycemia (depending on amount administered)

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Check BG and figure out what their normal range is

Phosphate (normal adult=2.5-4.5 mg/dL)

Potassium (normal adult=3.5-5.2 mmol/dL)

Magnesium (normal adult= 1.3-2.1 mEq/L)

Check if they had A1C (nondiabetic=<5.7%, diabetic=<7%)

Check current & past medications

Current Diet/Alcohol intake

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Administer around the same time each day

Rotate injection site to avoid lipodystrophy

Educate on proper dosage (prescribed by provider)

Educate how to check & monitor BG

Educate S/S of hyper/Hypo glycemia & diet that can effect each

Insulin works SLOWER & last LONGER

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glucagon

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Helps the body to create more sugar to put in the blood

Onset: SC 5 – 10 min, IM 8 – 10 min, IV 45 seconds

Peak: SC 10 – 13 min, IM 30 min, IV 5 – 20 min

Duration: SC 42 min, IM 12 - 27 min, IV 9 – 17 min

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Tachycardia

Hypertension

Dizziness

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Hyperglycemia

Hypokalemia

Secondary Hypoglycemia

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Rule of 15- Blood glucose

Be aware of airway- hypoglycemic pts can have seizures and aspirate on any meds, foods, and their own tongues

Be cautious in patients with lactose allergies- glucagon often contains lactose in drug composition

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Only in crisis < 50 mg/dL - DONT MISS THE BOAT with pts, provide juice, milk, etc if able to- again be aware of airways & cognitive state

Slowly raising blood sugar is key, so that rebound hypoglycemia does not occur

Keep snacks on self to help prevent severe hypoglycemia from occurring