McKenna's Pharmacology for Nursing, 2e

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Agents to control blood glucose levels

Learning objectives Upon completion of this chapter, you should be able to: 1. Describe the pathophysiology of diabetes mellitus, including alterations in metabolic pathways and changes to basement membranes. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug–drug interactions associated with insulin and other hypoglycaemic agents and glucose-elevating agents. 3. Discuss the use of hypoglycaemic agents and glucose-elevating agents across the lifespan. 4. Compare and contrast the prototype drugs insulin, glibenclamide and metformin with other hypoglycaemic agents in their class. 5. Outline the care considerations, including important teaching points, for people receiving a hypoglycaemic or glucose-elevating agent.

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Glossary of key terms adiponectin: hormone produced by adipocytes that acts to increase insulin sensitivity, decrease the release of glucose from the liver and protect the blood vessels from inflammatory changes diabetes mellitus: a metabolic disorder characterised by high blood glucose levels and altered metabolism of proteins and fats; associated with thickening of the basement membrane, leading to numerous complications dipeptidyl peptidase-4 (DPP-4): enzyme that quickly metabolises glucagon-like polypeptide-1 endocannabinoid receptors: receptors found in the adipose tissue, muscles, liver, satiety centre in the hypothalamus and GI tract that are part of a signalling system within the body to keep the body in a state of energy gain glucagon-like polypeptide-1 (GLP-1): a peptide produced in the GI tract in response to carbohydrates that increases insulin release, decreases glucagon release, slows GI emptying and stimulates the satiety centre in the hypothalamus glycogen: storage form of glucose; can be broken down for rapid glucose level increases during times of stress glycosuria: presence of glucose in the urine glycosylated haemoglobin: a blood glucose marker that provides a 3-month average of blood glucose levels hyperglycaemia: elevated blood glucose levels >8.0 mmol/L (106 mg/dL) leading to multiple signs and symptoms and abnormal metabolic pathways hypoglycaemia: lower-than-normal blood sugar <4.4 mmol/L (40 mg/dL); often results from imbalance between insulin or oral agents and person’s eating, activity and stress incretins: peptides that are produced in the GI tract in response to food that help to modulate insulin and glucagon activity insulin: hormone produced by the beta cells in the pancreas; stimulates insulin receptor sites to move glucose into the cells; promotes storage of fat and glucose in the body ketosis: breakdown of fats for energy, resulting in an increase in ketones to be excreted from the body polydipsia: increased thirst; seen in diabetes when loss of fluid and increased tonicity of the blood lead the hypothalamic thirst centre to make the person feel thirsty polyphagia: increased hunger; sign of diabetes when cells cannot use glucose for energy and feel they are starving, causing hunger Simulation-based learning On completion of the chapter, explore the scenario of Skyler Hanson (Part 1) who has been taken to the emergency department with diabetic ketoacidosis. Continue onto the second scenario (Part 2) where Skyler is brought at a different time to the emergency department by his friends. Consider the medication management of Skyler’s condition throughout his episode of care. What learning from the chapter can be applied to the case?