NCLEX® Diabetes Drug Class Review - Easy Nursing (2023)

Introduction to medication for diabetes.

In 2018, there was an estimate34.2 million Americans(approx. 10.5% of the population) had type 2 diabetes mellitus (T2DM). an additional of1.6 million AmericansYou have type 1 diabetes mellitus (DM1). It goes without saying that the number of diabetes patients is increasing rapidly, leading to a host of serious health complications, including heart disease and high blood pressure.

Fortunately, scientific advances have dramatically improved outcomes for patients with T1DM and T2DM. Without the invention of insulin, patients with type 1 diabetes and those with virtually no endogenous insulin production could not live long. In recent decades, oral and injectable therapies have been developed that allow T2DM patients to live a life independent of insulin.

Indications of medications for diabetes.

Diabetes medications are only indicated for patients with advanced diabetes. This includes all clients with DM1 because their insulin production is zero, as well as clients with DM2 with chronically high blood glucose levels. However, one important exception is that metformin may be prescribed for clients with prediabetes, a condition in which blood sugar levels are above normal but not high enough to lead to a T2DM diagnosis.

Diabetes Medication Table Indications

diabetes medication courses

Insulin:

• MOA:
  • regular
    • Start: 30 minutes
    • Peak: 2-4 hours
    • Duration: 5-8 hours
  • Quick action:
    • Start: 3-15 minutes
    • Peak: 45-75 hours
    • Duration: 2-4 hours
  • Intermedio (NPH):
    • Start: 2 hours
    • Peak: 4-12 hours
    • Duration: 8-18 hours
  • long effect:
    • Start: 2 hours
    • Peak: 3-9 hours (insulin detemir only)
    • Duration: ~24 hours
  • Collateral damage:
    • hypoglycemia: Taking too much insulin or insulin without carbohydrate intake can cause hypoglycemia, defined as blood glucose (blood glucose) < 70 mg/dL. Signs and symptoms include tremors, irritability, loss of concentration.
    • weight gain
    • Injection site reactions
  • Precautions
    • Avoid insulin on a sliding scale, as it can increase the risk of hypoglycemia
    • Taking insulin with other diabetes medications (eg, sulfonylureas) may increase the risk of hypoglycemia
  • Care Consideration:
    • Injection technique for new insulin users:

• • • • Insulin can be injected into the abdomen, leg, arm, or buttocks.
      • When moving from one injection site to another, the rate at which insulin is absorbed may differ (eg, from the abdomen to the leg). Patients should avoid changing the general injection site and change it at this time. (for example, rotation of the injection site in the abdomen)
      • It is recommended to alternate the injection site to avoid scarring and side effects.
      • Pens must be primed before use to ensure the correct dose of insulin is delivered.
      • When insulin is injected before meals, it is imperative that the patient remember to eat to avoid hypoglycemia.

• • • Control of hypoglycemia:

• • • • Signs and symptoms include tremors, irritability, loss of concentration.
      • In general, patients with hypoglycemia (blood glucose < 70) can be controlled by taking glucose tablets or eating and drinking carbohydrates (1 serving of juice, sweets, fruits).
      • The goal is to consume 15 grams of carbohydrate every 15 minutes until hypoglycemia resolves (>70 mg/dL).
      • Patients in a coma or who are not awake may need glucagon (more common in T1D) to raise blood sugar.
      • Severe hypoglycemia may warrant a hospital visit
• Common key generics (brand):
  • Regular:
    • Humulina (R)
    • Novolina (R)
  • Quick action:
    • Lispro (Humalog)
    • Aspart (Novolog)
    • Glulisina (Apidra)
  • Intermedio (NPH)
    • Humulin (N)
    • Novolina (N)
  • long performance
    • Insulin glargine (Basaglar, Lantus, Toujeo)
    • Insulindetemir (Levemir)
    • Insulina deglusina (Tresiba)

Metformin:

• MOA:
  • Decreases hepatic glucose production.
  • Decreases intestinal glucose absorption
  • Improves insulin sensitivity
• Collateral damage:
  • gastrointestinal upset
    • Diarrhea
    • nausea
    • To vomit
  • weight gain/loss
  • Lactatazidosis
• Precautions:
  • Black box warning: risk of fatal lactic acidosis. Risk factors include renal dysfunction, concomitant use of certain drugs (eg, topiramate), age > 65 years, excessive alcohol consumption.
• Care Consideration:
  • This is the preferred first-line treatment for clients with DM2
  • Clients may need a titration on this medication to mitigate side effects.
  • Avoid if you have chronic kidney disease (eGFR < 45)
• Common Key Generics (Brand)
  • Metformin (glucophage)

GLP-1 receptor agonists:

• MOA:
  • Mimics the hormone glucagon-like peptide 1 (GLP-1)
  • Binds to GLP-1 receptors and stimulates glucose-dependent insulin release
  • Delays gastric emptying - increases satiety
• Collateral damage:
  • weightloss
  • Greater saturation (fullness)
  • acute pancreatitis
  • Injection site reactions
• Precautions
  • Avoid in patients with pancreatitis
• Care Consideration:
  • This can be considered before treating patients with insulin to lower HbA1c when oral diabetes medications are inadequate.
  • These drugs are associated with cardiovascular benefits; patients with cardiovascular disease may be good candidates for these drugs.
  • Some of these drugs may not be safe for people with severe kidney disease.
  • Clients with potential compliance issues should avoid GLP-1 agonists that require daily dosing (eg, liraglutide, exenatide).
  • Currently, most of these drugs are administered by subcutaneous injection (Rybelsus) was a recently approved oral formulation.
• Common key generics (brands)
  • Liraglutide (Saxenda)
  • Exenatida (Byetta)
  • Dulaglutido (Victoza)
  • Semaglutida (Ozempic, Rybelsus)

DPP-4 inhibitors:

• MOA:
  • Prevents DPP-4 enzymes from breaking down the GLP-1 hormone
• Collateral damage:
  • neutral weight
  • acute pancreatitis
  • liver dysfunction
  • Serious skin reactions (vildagliptin, saxagliptin)
• care consideration
  • These drugs should be used with caution in patients with kidney disease.
• Common key generics (brands)
  • Saxagliptina (Onlyza)
  • Sitagliptina (Januvia)
  • Linagliptin (Thirty)

Sulfonilharnstoffe:

• MOA:
  • Stimulates the release of insulin from the beta cells of the pancreas
• Collateral damage:
  • Hypoglycemia: These drugs stimulate insulin release independent of glucose uptake. Taking insulin at the same time dramatically increases the risk of hypoglycemia.
  • weight gain
  • sulfa allergy
  • light sensitivity
• Precautions:
  • The sulfa fraction contained in these compounds: avoid these drugs in patients with sulfa allergies
  • Increased risk of hypoglycemia in patients with chronic kidney disease
• Care Consideration:
  • Hypoglycemia less common with glipizide
  • Use with caution in patients on insulin
  • Use with caution in patients with “sulfa allergy”.
  • Use with caution in patients with severe kidney disease
  • Common key generics (brands)
  • Glyburide (Glinasa)
  • Glipizida (Glucotrol)
  • Glimepirida (Amaryl)

Tiazolidindiona:

• MOA:
  • Increases insulin sensitivity by acting on adipose tissue
  • Increases musculoskeletal glucose utilization
  • Decreases the production of glucose in the liver.
• Collateral damage:
  • weight gain
  • Fluid retention: worsening heart failure
  • maculoedema
• Precautions:
  • Increased risk of myocardial infarction and cardiovascular death: avoid in patients with heart failure.
• Care Consideration:
  • Avoid these medicines if you have heart failure.
  • These medicines cause weight gain.
• Common key generics (brands)
  • Pioglitazone (Akte)
  • Rosiglitazona (Avandia)

SGLT2 inhibitors:

• MOA:
  • Inhibits SGLT2 to reduce glucose reabsorption by up to 90%, which promotes glucose removal from the body.
• Collateral damage:
  • weightloss
  • hypotension
  • acute kidney injury
  • Increased risk of bone fractures
  • diabetic ketoazidose
• Precautions
  • Avoid in patients at increased risk of fractures (eg, osteoporosis)
  • Avoid in patients prone to diabetic ketoacidosis
  • Avoid in patients with frequent urinary tract infections
• Care Consideration:
  • These drugs are associated with cardiovascular benefits, making candidates with advanced cardiovascular disease good candidates for these drugs.
  • These drugs increase the risk of urinary tract infections (especially yeast infections)
  • Avoid in patients with renal insufficiency
• Common key generics (brands)
  • Canagliflozina (Invokana)
  • Dapagliflozina (Farxiga)
  • Empagliflozina (Jardiance)

Important advice for the care of diabetic medication

• Insulin is always indicated in patients with DM1 and is more of a treatment for advanced DM2 when oral medications or GLP-1 injections are not enough to lower A1C.
• T1DM patients are mainly treated with insulin: oral diabetes medications are ineffective because the pancreas produces zero insulin.
• Insulin and sulfonylureas increase the risk of hypoglycemia, which can be severe and life-threatening.
• Metformin is usually the first-line treatment for patients with T2DM and a potential treatment for patients with prediabetes.
• Many diabetes medications should be used with caution in people with advanced kidney disease.
• GLP-1 agonists can sometimes be used instead of insulin as first-line injectable therapy for T2DM patients
• Many diabetes medications can increase weight gain; consider medications associated with weight loss properties in obese and overweight patients (eg, GLP-1 agonists, SGLT2 inhibitors).

Conclusion on the classes of drugs for diabetics.

Diabetes is a complex chronic disease that affects millions of Americans every day. Diabetes increases the risk of cardiovascular disease, including hypotension, heart disease, and cardiovascular events (eg, myocardial infarction, stroke). There are many important considerations when treating patients with diabetes, as there are many types of medications with different side effect profiles.

It is important to have a thorough understanding of diabetes medications because their prevalence is increasing rapidly each year for Americans today. I hope thatNCLEX^®Diabetic Medication Reviewaids in diabetes research and general practice.

references

1. Diabetic statistics. Diabetes Statistics | ADA. https://www.diabetes.org/resources/statistics/statistics-about-diabetes. Consulted on April 21, 2020.
2. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. diabetes treatment https://care.diabetesjournals.org/content/43/Supplement_1/S14.figures-only. Published on January 1, 2020. Accessed on April 21, 2020.
3. American Diabetes Association. 9. Pharmacological approaches to glycemic control: standards of medical care in diabetes-2020. diabetes treatment https://care.diabetesjournals.org/content/43/Supplement_1/S98. Published on January 1, 2020. Accessed on April 21, 2020.
4. Weinstock, RS. General principles of insulin therapy in diabetes mellitus. In: Post T, UpToDate editor. Waltham, MA: updated; 2020. www.uptodate.com. Consulted on April 21, 2020.
5. Metformin: drug information. In: Post T, UpToDate editor. Waltham, MA: UpToDate; 2020. www.uptodate.com. Consulted on April 21, 2020.
6. Dungan K, DeSantis A. Glucagon-like peptide 1 receptor agonists for the treatment of type 2 diabetes mellitus. In: Post T, UpToDate editor. Waltham, MA: UpToDate; 2020. www.uptodate.com. Consulted on April 21, 2020.
7. Dungan K, DeSantis A. Dipeptidyl peptidase 4 (DPP-4) inhibitors in the treatment of type 2 diabetes mellitus. In: Post T, UpToDate editor. Waltham, MA: UpToDate; 2020. www.uptodate.com. Consulted on April 21, 2020.
8. Wexler D. Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus. In: Post T, UpToDate editor. Waltham, MA: UpToDate; 2020. www.uptodate.com. Consulted on April 21, 2020.
9. Inzucchi S, Lupsa B. Thiazolidinediones in the treatment of type 2 diabetes mellitus. In: Post T, Hrsg. Updated. Waltham, MA: updated; 2020. www.uptodate.com. Access on April 21