Diabetes mellitus is a condition where the body doesn't produce enough insulin or can't use it
properly, leading to high blood sugar levels. This can damage blood vessels and organs over
time. There are two main types:
Type 1 diabetes (T1DM): The pancreas stops making insulin, usually starting before age
30. People with T1DM need lifelong insulin treatment.
Type 2 diabetes (T2DM): The body doesn't make enough insulin or becomes resistant to
it, often linked to lifestyle factors.
Diabetes can cause serious health problems like heart disease, kidney disease, nerve damage, and
vision loss. It can also lead to sudden complications like low blood sugar (hypoglycemia) and
diabetic ketoacidosis (DKA).
insulin resistance can lead to type 2 diabetes (T2DM), which is more common in adults,
especially those who are overweight or have a family history of the disease. Early treatment
includes diet and exercise, but as the condition worsens, oral medications may be needed.
Sometimes, multiple medications are combined for better blood sugar control. In severe cases,
insulin may be required. A temporary form of diabetes, called gestational diabetes, can occur
during pregnancy and is usually managed with diet and insulin until it resolves after childbirth.
The adrenal glands sit on top of the kidneys and have two parts: the cortex and the medulla. The
cortex makes steroid hormones like cortisol, aldosterone, and sex hormones. The medulla
releases adrenaline and noradrenaline when the body needs a quick response to stress.
The pancreas helps with digestion and blood sugar control. It makes enzymes for digestion and
hormones to balance glucose.
Beta cells produce insulin, which lowers blood sugar by helping cells absorb glucose and
store it as glycogen or fat. They also make amylin, which slows digestion and helps
control hunger.
Alpha cells make glucagon, which raises blood sugar by breaking down stored glycogen
and making new glucose.
Delta cells produce somatostatin, which regulates other hormones like insulin and
glucagon.
Epsilon cells make ghrelin, which can reduce insulin release.
There are three types of medications for managing diabetes:
1. Oral hypoglycemics: These are pills used to treat type 2 diabetes (T2DM).
2. Injectable hypoglycemics: These are shots for treating both type 1 (T1DM) and type 2
diabetes.
3. Hyperglycemic: These are used to raise blood sugar if someone has low blood sugar due
to taking too much of the other medications.
,When giving any hypoglycemic medication, monitor the client for manifestations of
hypoglycemia, including diaphoresis, tachycardia, fatigue, excessive hunger,
tremors, nausea, shakiness, irritability, anxiety, cold and clammy give candy
If the client is conscious, administer carbohydrates, such as 2 to 3 tsp of sugar, 4 oz
of orange juice, honey, or corn syrup dissolved in water. Oral glucose tablets may
be administered as well.
If the client loses consciousness and an IV access is available, give intravenous
glucose in the form of D50W (50% dextrose in water). If the client does not have an
intravenous device, parenteral glucagon is an alternative. Check the client’s blood
glucose every 15 to 20 minutes and continue treatment until the blood glucose has
returned to the expected reference range
Administration
Give glipizide orally 30 minutes before a selected meal,
Metformin—Medication Classification: Biguanides (antidiabetic)
Metformin is the only medication in this class. It can, however, be combined with
other hypoglycemics such as glipizide and repaglinide.
Metformin lowers blood sugar in three ways: it reduces glucose
absorption in the intestines, decreases glucose production in the
liver, and helps the body respond better to insulin. Unlike other
diabetes medications like sulfonylureas or meglitinides, combining
metformin with these can be more effective at controlling blood
sugar.
Adverse Drug Reactions/ Side Effects
nausea, diarrhea, vomiting, and an unpleasant metallic taste in the mouth.
Monitor clients for vitamin B12 and folic acid deficiency because metformin can
decrease their absorption.
metformin may result in lactic acidosis due to its effect on mitochondrial oxidation
of lactic acid.
Who cannot take metformin: clients who have renal insufficiency or another disorder
that can increase lactic acid production in the body should not take metformin.
, Monitor clients on metformin for signs of lactic acidosis, like
weakness, fatigue, muscle pain, and rapid breathing. If these
symptoms appear, stop the medication and test for acidosis. Severe
cases may need dialysis. Also, track fluid intake, watch for digestive
issues (nausea, vomiting, diarrhea), and check for vitamin B12 or
folic acid deficiencies. If deficiencies are found, recommend
supplements. Monitor kidney function when starting treatment and
yearly after. Stop metformin before surgeries that involve IV
contrast media.
Prototype and Other Medications
Pioglitazone—Medication Classification: Thiazolidinediones (antidiabetic-oral)
The prototype medication for the glitazone category of medications is pioglitazone
Glitazones help improve how the body responds to insulin.
However, insulin needs to be present for them to work, so people
may also need insulin injections or other medications like
metformin or sulfonylureas that increase insulin release.
Glitazones can cause side effects like fluid retention, which is risky
for those with heart failure. They may also harm the liver, so
regular liver function tests are needed. Other risks include
increased bladder cancer, ovulation in women who don't usually
ovulate, respiratory infections, headaches, muscle pain, and higher
fracture rates in women on long-term, high-dose pioglitazone. They
can also raise cholesterol and triglyceride levels, which is
concerning for people with diabetes who are already at higher risk
for heart problems
For patients taking a glitazone, watch for signs of fluid retention
(like swelling, weight gain, difficulty breathing, or unusual
tiredness) and report these to the doctor. Regularly check liver
function (ALT levels) and lipid levels (triglycerides, HDL, LDL). If
liver damage signs appear, stop the medication and inform the
doctor. An increase in LDL is a concern because it can lead to heart
problems. Make sure to check liver function every 3 to 6 months.
properly, leading to high blood sugar levels. This can damage blood vessels and organs over
time. There are two main types:
Type 1 diabetes (T1DM): The pancreas stops making insulin, usually starting before age
30. People with T1DM need lifelong insulin treatment.
Type 2 diabetes (T2DM): The body doesn't make enough insulin or becomes resistant to
it, often linked to lifestyle factors.
Diabetes can cause serious health problems like heart disease, kidney disease, nerve damage, and
vision loss. It can also lead to sudden complications like low blood sugar (hypoglycemia) and
diabetic ketoacidosis (DKA).
insulin resistance can lead to type 2 diabetes (T2DM), which is more common in adults,
especially those who are overweight or have a family history of the disease. Early treatment
includes diet and exercise, but as the condition worsens, oral medications may be needed.
Sometimes, multiple medications are combined for better blood sugar control. In severe cases,
insulin may be required. A temporary form of diabetes, called gestational diabetes, can occur
during pregnancy and is usually managed with diet and insulin until it resolves after childbirth.
The adrenal glands sit on top of the kidneys and have two parts: the cortex and the medulla. The
cortex makes steroid hormones like cortisol, aldosterone, and sex hormones. The medulla
releases adrenaline and noradrenaline when the body needs a quick response to stress.
The pancreas helps with digestion and blood sugar control. It makes enzymes for digestion and
hormones to balance glucose.
Beta cells produce insulin, which lowers blood sugar by helping cells absorb glucose and
store it as glycogen or fat. They also make amylin, which slows digestion and helps
control hunger.
Alpha cells make glucagon, which raises blood sugar by breaking down stored glycogen
and making new glucose.
Delta cells produce somatostatin, which regulates other hormones like insulin and
glucagon.
Epsilon cells make ghrelin, which can reduce insulin release.
There are three types of medications for managing diabetes:
1. Oral hypoglycemics: These are pills used to treat type 2 diabetes (T2DM).
2. Injectable hypoglycemics: These are shots for treating both type 1 (T1DM) and type 2
diabetes.
3. Hyperglycemic: These are used to raise blood sugar if someone has low blood sugar due
to taking too much of the other medications.
,When giving any hypoglycemic medication, monitor the client for manifestations of
hypoglycemia, including diaphoresis, tachycardia, fatigue, excessive hunger,
tremors, nausea, shakiness, irritability, anxiety, cold and clammy give candy
If the client is conscious, administer carbohydrates, such as 2 to 3 tsp of sugar, 4 oz
of orange juice, honey, or corn syrup dissolved in water. Oral glucose tablets may
be administered as well.
If the client loses consciousness and an IV access is available, give intravenous
glucose in the form of D50W (50% dextrose in water). If the client does not have an
intravenous device, parenteral glucagon is an alternative. Check the client’s blood
glucose every 15 to 20 minutes and continue treatment until the blood glucose has
returned to the expected reference range
Administration
Give glipizide orally 30 minutes before a selected meal,
Metformin—Medication Classification: Biguanides (antidiabetic)
Metformin is the only medication in this class. It can, however, be combined with
other hypoglycemics such as glipizide and repaglinide.
Metformin lowers blood sugar in three ways: it reduces glucose
absorption in the intestines, decreases glucose production in the
liver, and helps the body respond better to insulin. Unlike other
diabetes medications like sulfonylureas or meglitinides, combining
metformin with these can be more effective at controlling blood
sugar.
Adverse Drug Reactions/ Side Effects
nausea, diarrhea, vomiting, and an unpleasant metallic taste in the mouth.
Monitor clients for vitamin B12 and folic acid deficiency because metformin can
decrease their absorption.
metformin may result in lactic acidosis due to its effect on mitochondrial oxidation
of lactic acid.
Who cannot take metformin: clients who have renal insufficiency or another disorder
that can increase lactic acid production in the body should not take metformin.
, Monitor clients on metformin for signs of lactic acidosis, like
weakness, fatigue, muscle pain, and rapid breathing. If these
symptoms appear, stop the medication and test for acidosis. Severe
cases may need dialysis. Also, track fluid intake, watch for digestive
issues (nausea, vomiting, diarrhea), and check for vitamin B12 or
folic acid deficiencies. If deficiencies are found, recommend
supplements. Monitor kidney function when starting treatment and
yearly after. Stop metformin before surgeries that involve IV
contrast media.
Prototype and Other Medications
Pioglitazone—Medication Classification: Thiazolidinediones (antidiabetic-oral)
The prototype medication for the glitazone category of medications is pioglitazone
Glitazones help improve how the body responds to insulin.
However, insulin needs to be present for them to work, so people
may also need insulin injections or other medications like
metformin or sulfonylureas that increase insulin release.
Glitazones can cause side effects like fluid retention, which is risky
for those with heart failure. They may also harm the liver, so
regular liver function tests are needed. Other risks include
increased bladder cancer, ovulation in women who don't usually
ovulate, respiratory infections, headaches, muscle pain, and higher
fracture rates in women on long-term, high-dose pioglitazone. They
can also raise cholesterol and triglyceride levels, which is
concerning for people with diabetes who are already at higher risk
for heart problems
For patients taking a glitazone, watch for signs of fluid retention
(like swelling, weight gain, difficulty breathing, or unusual
tiredness) and report these to the doctor. Regularly check liver
function (ALT levels) and lipid levels (triglycerides, HDL, LDL). If
liver damage signs appear, stop the medication and inform the
doctor. An increase in LDL is a concern because it can lead to heart
problems. Make sure to check liver function every 3 to 6 months.
