Deliver boluses and continuous basal infusion Advantages Fewer hypoglycemic

Deliver boluses and continuous basal infusion

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Deliver boluses and continuous (basal) infusion Advantages: Fewer hypoglycemic episodes Better control of blood glucose Contraindications/Cautions Lack of knowledge and/or compliance Need to know: Regular insulin only Jet injectors shoot insulin directly through skin into fatty tissue Contraindicated for children Very expensive Adverse Reactions/Side Effects: May cause burning, stinging, pain, bruising Oliver Grundmann, [email protected] 17
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Type 2 diabetes mellitus Insulin-independent diabetes mellitus → does not necessarily require insulin substitution Develops later in life (although young people are now affected as well) Often as part of metabolic disorders or deregulation Insulin sensitivity is reduced Oliver Grundmann, [email protected] 18
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Type 2 diabetes progression Oliver Grundmann, [email protected] 19
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Oral antidiabetics Oliver Grundmann, [email protected] 20 Oral antidiabetic drugs First generation Tolbutamide (Orinase®) Tolazamide (Tolinase®) Chlorpropamide (Diabinese®) Second generation Glipizide (Glucotrol®) Glyburide (Glynase®, Micronase®) Glimepiride (Amaryl®) Non-sulfonylureas Metformin (Glucophage®) Alpha-Glucosidase inhibitors Acarbose (Precose®) Miglitol (Glyset®) Insulin-enhancing agents Pioglitazone (Actos®)
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Oral antidiabetics - sulfonylureas 1 st generation : tolbut amide (Orinase®), tolaz amide (Tolinase® ), chlorprop amide (Diabenese®) 2 nd generation : glipiz ide (Glucatrol®), glybur ide (Diabeta®, Micronase®), glimepir ide (Amaryl®) Action: Stimulate pancreatic beta cells to produce more insulin Onset: 60 min. Peak: 4 - 6 hrs. Duration of action: 6 – 24 hrs. Indication: Type 2 diabetes mellitus Contraindications/Cautions: Type 1 diabetes mellitus, sulfa allergy, severe renal or hepatic disease, uncontrolled infection, serious burns, trauma, pregnancy, lactation Adverse reactions/Side Effects: Similar to those of insulin, hypoglycemia Oliver Grundmann, [email protected] 21
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Oral antidiabetics – non-sulfonyl ureas Metformin (Glucophage®) Action: affects hepatic and GI production of glucose Contraindications/Cautions: stress, surgery, infection, alcoholism, pregnancy, lactation Adverse Reactions/Side Effects: abdominal bloating, diarrhea, N/V, others similar to insulin Nursing Considerations/Patient Teaching Given after meals, not before May be given alone or with other oral antidiabetics Should be held for 48 hours before and after IV contrast to avoid renal impairment Oliver Grundmann, [email protected] 22
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Oral antidiabetics - glitazones Rosiglitazone (Avandia®), pioglitazone (Actos®) Action: ↓ insulin resistance and improve BG control Indication: as adjunct or monotherapy Contraindications/Cautions: Liver and renal disease, pregnancy & lactation Adverse Reactions/Side Effects: same as metformin Nursing Considerations/Patient Teaching
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