Pharmacological Treatment of Diabetes Type 2

<6mmol/L

Pharmacological Treatment For

Type II Diabetes Mellitus

Type II Diabetes

(World Health Organisation, 2013)

(Metacure, 2012)

Which of the following would be best suited to Biaras Situation?

Biara

Metformin

a) Metformin

b) Insulin

c) Glipizide

d) Rosiglitazone

e) Acarbose

Pharmacological Treatment Options

Biguanides

Metformin Hydrochloride

Diabex, Glucophage, Formet, Diaformin

• Decreases liver production of Glucose

• Increases Insulin sensitivity

• Delays movement of glucose from GI Tract to the blood following a meal

First choice of pharmacotherapy for Type 2 Diabetics

Dose PO 500mg Daily - T.I.D

up to 1g T.I.D. with meals

Side Effects Heart Failure

(Kela et al., 2010; Barber & Robertson, 2012; McKenna, 2013; McKenna & Mirkov, 2012; Skidmore-Roth, 2013; Tiziani, 2013; Tahrani, Piya, Kennedy & Barnett, 2010)

• 40 year old
• Indigenous
• Busy Life
• Diet high in processed food & soft drink
• Rural
• BGL 27mmol
• Retinopathy

Glucagon Suppresants

Exanetide

Byetta

• Increases insulin synthesis
• Suppresses glucagon secretion
• Delays gastric emptying

(Hooten, 2014)

Dose 5mcg SC B.I.D. before meal

Side Effects Hypoglycaemia, Nausa, Vomitting

(Barber & Robertson, 2012; McKenna, 2013; McKenna & Mirkov, 2012; Skidmore-Roth, 2013; Tiziani, 2013; Tahrani, et al., 2010)

Normoglycaemia

What is the ideal range?

Normal Fasting

Blood Glucose Level

3.9-6mmol/L

(Turner & Wass, 2009)

(Joshi, 2008)

Sulfonylureas

Glibenclamide, Glipizide, Glicazide, Glimepiride

Daonil, Glimel, Diamicron, Glyade, Aylide, Diabeta, Nidem, Diapride, Dimirel, Minidias, Amaryl

• Stimulates insulin release from pancreatic beta cells
• Decreases glucose output by the liver

Dose PO 30 Minutes before meal

Side Effects Hypoglycaemia

Weight Gain

(Tumblr, n.d.)

(Kela et al., 2010; Barber & Robertson, 2012; McKenna, 2013; McKenna & Mirkov, 2012; Skidmore-Roth, 2013; Tiziani, 2013)

(Western & Northern Aboriginal Language Alliance, 2013)

Thiazolidinedione

Rosiglitazone, Pioglitazone

Actos, Avandia

• Improves sensitivity of insulin in muscles and adipose tissue (Insulin Sensitisers)

Dose PO Once Daily

Side Effects Oedema

Weight Gain

Caution in heart failure patients

(Getty Images, 2010)

(Kela, et al., 2010; Barber & Robertson, 2012; McKenna, 2013; McKenna & Mirkov, 2012; Skidmore-Roth, 2013; Tiziani, 2013; Tahrani, et al., 2010)

Learning Objectives

Aim of Treatment

References

• Pharmacology Treatment Related to diabetes mellitus and co-morbidities

Combination Drugs

American Accreditation HealthCare Commission. [Image] (2013). Pancreas Transplant. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/13992.jpg

Barber, P., & Robertson, D. (2012). Essentials of Pharmacology for Nurses (2nd ed.). Maidenhead: Open University Press.

Cartoonaday. [Image] (2012). Diabetes Cartoon. Retrieved from http://www.cartoonaday.com/images/cartoons/2012/04/type-2-diabetes-boy-cartoon-598x414.jpg

Diabetes Media Foundation [Image] (2014). Pills. Retrieved from http://asweetlife.org.s148351.gridserver.com/wp-content/uploads/2010/09/Pills.jpg

Endocrine Drugs. (2010). Nurse’s Handbook of Combination Drugs (2nd ed.). Sudbury: Jones and Bartlett Publishers.

Getty Images [Image] (2010). Retrieved from http://www.fda.gov/ucm/groups/fdagov-public/documents/image/ucm226990.jpg

Hooten, I. [Image] (2014). Retrieved from http://i.dailymail.co.uk/i/pix/2014/01/24/article-2545180-1AEC5FE200000578-824_634x333.jpg

Kela, R., Srinivasan, B., & Davies, M. (2010). Glycaemic management of type 2 diabetes [Electronic Version]. Medicine, 38(11), 618-625.

Joshi, M. [Image] (2008). Diabetes. Retrieved from http://www.topnews.in/health/files/diabetes_0.jpg

McKenna, K. (2013). Pharmacology made incredibly easy (1st ANZ ed.). Sydney: Lippincott Williams & Wilkins.

McKenna, K., & Mirkov, S. (2012). Australia New Zealand Nursing & Midwifery Drug Handbook (6th ed.). Sydney: Lippincott Williams & Wilkins.

Metacure [Image] (2012). What causes diabetes. Retrieved from http://www.metacure.com/wp-content/uploads/2011/02/What-causes-diabetes.png

NurseTip [Image] (2007). Acarbose (Precose). Retrieved from http://www.nursestip.com/files/Acarbose%20(Precose).jpg

Skidmore-Roth, L. (2013). Mosby’s Drug Guide for Nursing Students (10th ed.). St Louis: Elsevier.

Tahrani, A.A., Piya, M.K., Kennedy, A., & Barnett, A.H. (2010). Glycaemic control in type 2 diabetes: Targets and new therapies [Electronic Version]. Pharmacology & Therapeutics, 125(2), 328-361.

Tiziani, A. (2013). Havard’s Nursing Guide to Drugs (9th ed.). Chatswood: Elsevier-Mosby.

Tumblr. (n.d.) Retrieved from http://31.media.tumblr.com/9ae49619473b0bc274808738dd4e2b22/tumblr_n2brsc5i0e1rti9ilo1_400.jpg

Wass, J.A.H., & Turner, T. (2009). Oxford handbook of endocrinology and diabetes (2nd Ed.). New York: Oxford University Press.

Western & Northern Aboriginal Language Alliance [Image] (2013). Retrieved from http://wanala.batchelor.edu.au/wp-content/uploads/2013/06/karen-w-sm.jpg

Whitaker, J. (n.d.) Retrieved from http://www.alternativemedicine.com/sites/default/files/imagecache/article_photo/article/pillquestion.jpg

World Health Organisation. (2013). Diabetes. Geneva: World Health Organisation.

Alpha Glucosidase Inhibitors

Acarbose

Glucobay, Precose

• Delays digestion of carbohydrates

Dose PO 50mg with first bite of food

increasing dose up to 200mg T.I.D

Metaglip (Glipizide & Metformin)

Side effects GI upset

May increase hypoglycaemic potential

sulfonylurea & insulin

(NurseTip, 2007)

(Barber & Robertson, 2012; McKenna, 2013; McKenna & Mirkov, 2012; Skidmore-Roth, 2013; Tiziani, 2013)

• To reduce long-term co-morbidities
• To educate patient on the condition

Glucovance (Glyburide & Metformin)

(Diabetes Media Foundation, 2014)

Duetact (Pioglitazone & Glimepiride)

(American Accreditation HealthCare Commission, 2013)

Actoplus Met (Pioglitazone & Metformin)

(Kela, Srinivasan & Davies, 2010)

Avandamet (Rosiglitazone & Metformin)

(Endocrine Drugs, 2010)

Insulin

NovoRapid, Levemir, Lantus, Novomix

• Increases glucose transport across muscle and adipose tissue to reduce blood glucose level

Drug of choice throughout pregnancy

Range from

short-acting to long acting

0.5hrs - 24hrs via SC

(Barber & Robertson, 2012; McKenna, 2013; McKenna & Mirkov, 2012; Skidmore-Roth, 2013; Tiziani, 2013)

(cartoonaday, 2012)

Find Your Ideal pairing

Type II Diabetes accounts for around 90% of all diabetes worldwide

(World Health Organisation, 2013)

(Whitaker, n.d.)

• Decreases Liver production of glucose

• Increase insulin sensitivity

Metformin

Rosiglitazone

Exanetide

Insulin

Acarbose

• Delays Gastric Emptying

• Regulates carbohydre and fat metabolism

• Delays carbohydrate breakdown

Debby Lee