Diabetes: Medications Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU) April 10, 2008/sh

Diabetes: MedicationsPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU)

April 10, 2008/sh

© 2010 APS Healthcare, Inc. 2

Disclaimer

Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented.

Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.


Note of Clarification

While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.


Objectives

Upon completion of the session the participant will:– Identify information a caretaker needs to know when

administering medications

– Recognize signs and symptoms of low blood sugar (hypoglycemia)

– List considerations when planning daily activities for a person taking medication for diabetes


Diabetes Is…

A disorder of metabolism A condition where the body has a shortage of insulin

or decreased ability to use insulin, resulting in high blood sugar levels

A leading cause of disability A growing epidemic in the US A manageable condition


Types of Diabetes Medications

Insulin Oral Other


Insulin Therapy

Is a protein, and must be injected or inhaled Insulin- the mainstay of treatment for individuals

with Type I diabetes Combinations of Insulin are frequently ordered to allow for better blood glucose control

May be prescribed in some with Type II diabetes


Characteristics of Insulin

Onset (starts working) Peak (maximum effect) Duration (length of time active in blood)


Types of Insulin

Rapid-acting Short-acting Intermediate-acting Long-acting Very long acting Premixed


Rapid-Acting

Lispro (Humalog)– Onset: 5-15 minutes

– Peak: 45-90 minutes

– Duration: 3-4 hours

Aspart (Novalog)– Onset: 10-20 minutes

– Peak: 1-3 hours

– Duration: 3-5 hours


Short-Acting

Regular (R) Insulin– Onset: 30 minutes

– Peak: 2-5 hrs.

– Duration: 5-8 hrs


Intermediate-Acting

NPH (N) or Lente(L)– Onset: 1-3 hrs

– Peak: 6-12 hrs



Long-Acting

Ultralente (U) insulin– Onset: 4-6 hrs

– Peak: 8-20 hrs



Very Long-Acting

Insulin Glargine (Lantus)– Onset: 1 hr

– Peak: works evenly for 24 hrs

– Duration: 24 hrs

– Taken once a day at bedtime

– Should not be mixed together in a syringe with any other form of insulin before use


Premixed

NPH and Regular Insulin Mixture- two types of insulin mixed together in 1 bottle– Onset: 30 minutes

– Peak: 7-12 hrs



Insulin Pump

Controls the exact amount of insulin being delivered Closest device on the market to an artificial pancreas


Hypoglycemia

Less than normal amount of glucose in the blood


Signs of Hypoglycemia

Shakiness Nervousness Weakness Cold, clammy skin Hunger Irritability

Headache Confusion Rapid heart beat Fainting Passing out Slurred or hard to

understand speech


Hypoglycemia Response

Observe Plan Ahead Have a Plan of Action in Place Document and Report


Insulin: Review

Know response to Insulin – Onset, peak and duration Avoid exercise at peak time of insulin Know the individual’s response to medication and

exercise


Storing Insulin

If using entire bottle within 30 days, store at room temperature. Write date on bottle label when opened.

If you do not plan to use entire bottle within 30 days, store in refrigerator

Do not keep too hot, or too cold Keep extra bottle on hand. Store in refrigerator.


Oral Medications (Classifications)

Sulfonylureas Biquanides Alpha-Glucosidase Inhibitors Thiazolidinediones Meglitinides D-Phenylanine derivatives (DPP-4) Combination


Oral Medications: Need to Know

Potential for low blood sugar reactions Time of day With/without meals? Side effects and special precautions of the medication Any special instructions


Considerations: Sulfonylureas

Increases the production of insulin May cause hypoglycemia Can cause allergic reactions in individual who has

allergies to sulfa medications


Considerations: Biguanides

Can cause diarrhea, when taken on empty stomach Not ordered if history of kidney or liver disease Notify doctor of surgery or medical test using contrast

dye Increases sensitivity to insulin Decreases production of glucose


Considerations: Alpha-Glucosidase Inhibitors

Taken 3xday Each meal, with the first bite of the meal Should not be taken by people with severe bowel or

kidney disease or liver disorders Decreases the absorption of carbohydrates


Considerations: Thiazolidinediones

Possible liver problems - liver function needs to be assessed regularly ( Blood Tests)

Report signs of liver problems to doctor that may include: weight gain, swelling. unusual nausea, vomiting, abdominal pain, dark urine

Increases the sensitivity to insulin


Considerations: Meglitinides

May cause hypoglycemia Effect is much stronger if taken 3 times a day Taken before meals Fast acting, allowing greater flexibility in meal timing


Combination

May cause hypoglycemia


Recently Approved Injectable Drugs

Symlin (Brand Name) Pramlintide (Generic) Byetta (Brand Name) Exenatide (Generic)


Medication Management Review

More than administration Involves knowledge Maximizes benefits Achieves therapeutic outcomes


Drug Actions: A Review

Absorption

Distribution

Metabolism

Excretion

Once administered, all drugs go through these processes:


Why is Review Important?

What we already know:

1. People with Diabetes frequently have many co-existing medical diagnoses

2. Therefore, they are at higher risk of delayed absorption, distribution, metabolism, and excretion

3. Additionally, they are at higher risk for drug to drug interactions due to these delays


Use Medications Wisely

Be alert for interactions Check with Doctor Be informed


Important Things to Consider

Risk of hypoglycemia Activities throughout day


Remember

Medications help lower blood glucose levels to help reduce risk for long term complications

Medications work best when combined with supervision from the doctor and an appropriate meal plan and exercise program


Reminder!!!!

Hand-washing is the single most effective way to prevent the spread of illness and germs

ALWAYS wash your hands before, and after contact with every person for whom you provide care

Including between medication administration to more than one individual


References

http://www.diabetes.org/diabetesmedications

(retrieved 10/19/2007) http://diabetes.niddk.nih.gov.dm/medications

(retrieved 9/12/2007) National Institute of Health; Fact Sheet Diabetes Type 2


Suggested Supplemental Training

Diabetes Basics - This training should be a pre-requisite to both Diabetes: Complications and Diabetes: Medications trainings

Diabetes Complications


To register for future trainings,

or

for more information on this or any other physical or behavioral health topic, please visit our website at

www.hcqu.apshealthcare.com


Evaluation

Please take a few moments to complete the evaluation form found in the back of your packets.

Thank You!

Test Review

There will be a test review after all tests have been completed and turned in to the Instructor.

Documents

Diabetes: Medications Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU) April 10, 2008/sh