Sulfonylureas

Glucotrol (glipizide), Micronase, DiaBeta, Glynase (glyburide), Amaryl (glimepiride)

Action: Stimulates release of insulin from pancreatic islets; decreases glycogenolysis and gluconeogenesis; enhances cellular sensitivity to insulin

Nursing Intervention:

• Monitor patient for weight gain
• Check blood sugar frequently to monitor for hypoglycemia
• More effective early in the treatment of diabetes and some patients experience decreased effectiveness of medication after prolonged use

Meglitinides

Prandin (repaglinide), Starlix (nateglindine)

Action: Stimulates a rapid and short-lived release if insulin from pancreas

Nursing Intervention

• Monitor patient for weight gain
• Check blood sugar frequently to monitor for hypoglycemia
• Taken just before meals to mimic normal release of insulin
• DO NOT TAKEIF MEAL IS SKIPPED

Biguanide

Glucophage, Riomet, Fortamet (metformin)

Action: Decrease rate of hepatic glucose production; augments glucose uptake by tissues/muscles

Nursing Intervention:

• Diarrhea, lactic acidosis
• DISCONTINUE BEFORE AND HOLD MEDICATION FOR 48 HRS AFTER ADMINISTRATION OF IV CONTRAST MEDIA (KIDNEY DAMAGE)
• Can be used with other oral diabetic medications
• Does not typically promote weight gain
• Can be used in patients with "prediabetes" to help prevent diabetes

Thiazolidinediones (TZDs)

Actos (pioglitazone), Avandia (rosiglitazone)

Action: Increase glucose uptake in muscle; decrease endogenous glucose production

Nursing Interventions

• Risk for weight gain, edema
• Not recommended for patients with heart failure
• "Insulin sensitizers"
• Most effective for people with insulin resistance
• Will not cause hypoglycemia when used alone
• May improve lipids and blood pressure
• Increased risk for bone fracture and macular edema
• Increased risk for liver impairment

Alpha Glucosidase Inhibitors

Precose (acarbose) Glyset (miglitol)

Action: Delay absorption of glucose from GI tract

Nursing Interventions

• Gas, abdominal pain, diarrhea
• Also known as "starch blockers"
• Take with first bite of meal
• Effective in lower post prandial glucose levels
• Not effective against fasting hyperglycemia

Incretin Mimetics

Exenatide & Liraglutide

Developed from the saliva of the Gila monster

Stimulates insulin resistance

Decrease glucagon secretion

Increased satiety

Decreased gastric emptying

Increased risk for pancreatitis

Increased risk for thyroid cancer

Dipeptidyl Peptidase-4 (DDP-4) Inhibitors

Januvia (sitagliptin),

Action: Enhances the incretin system, stimulates release of insulin from pancreatic B cells and decreases hepatic glucose production

Nursing Intervention:

• Increased risk for acute pancreatitis
• Drug is glucose dependent
• Lower potential for hypoglycemia

Amylin Analog

Pramlintide: amylin is a hormone that is released into the bloodstream by the beta cells of the pancreas along with insulin, after a meal. Like insulin, amylin is deficient in individuals with Type 1 diabetes. It slows down the movement of food through the stomach. Researchers developed the drug from rat amylin

Pramlintide is approved for use in type 1 diabetes

Decreased gastric emptying

Decreased glucagon secretion

Decreased hepatic glucose output

Increased satieity

Side effects:

• Severe hypoglycemia
• Nausea and Vomitting

Sodium-Glucose Co-Transport Inhibitors

Lower blood glucose levels by preventing kidney reabsorption of the glucose that was filtered from the blood into the urine. Glucose is excreted in the urine rather than moved back into the blood.

Drugs: Canagliflozin (Invokana) and dapagliflozin (Farxiga)

Hypoglycemia (hunger, headache, tremors, sweating, confusion) can occur because these drugs lower blood glucose levels even when they are not elevated

Dehydration (increased thirst, lightheadedness, dry mouth, and mucous membranes, orthostatic hypotension) can occur because these drugs increase urine output and increase dehydration risk

Hyponatremia (muscle weakness, decreased ability to concentrate, abdominal cramping, rapid heart rate, orthostatic hypotension) can occur because these drugs increase sodium excretion

Urinary Tract Infection (frequency, pain and burning on urination, foul urine odor) can occur because the increased glucose in the urinary tract predisposes to infection

GENITAL ITCHING AND VAGINAL DISCHARGE CAN OOCUR BECAUSE THESE DRUGS INCREASE THE RISK FOR GENITAL YEAST INFECTION

Rapid Acting

Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)

Starts to work in: 15-30 minutes

Peak Action: 1-2 hours

Duration of Action: 3-6 hours

Maximum Duration: 4-6 hours

Short Acting

Regular

Starts to work in: 30 min - 1 hour

Peak Action: 2-4 Hours

Duration of Action: 3-6 hours

Maximum Duration: 6-8 hours

Intermediate-Acting

NPH

Starts to work in: 2-4 hours

Peak Action: 8-10 hours

Duration of Action: 10-18 hours

Maximum Duration: 14-20 hours

Long Acting

Glargine (Lantus) and Detemir (Levemir)

Starts to work in: 1-2 hours

Peak Action: NONE

Duration of Action: 19-24 & 19-20 hours

Maximum Duration: 24 & 20 hours