On completion of this chapter, the student will:
• Describe the two types of diabetes mellitus.
• Discuss the types, uses, general drug actions, adverse reactions, contraindications, precautions, and interactions of the antidiabetic drugs.
• Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking an antidiabetic drug.
• List some nursing diagnoses particular to a patient taking an antidiabetic drug.
• Discuss ways to promote an optimal response to therapy, how to manage common adverse reactions, and important points to keep in mind when educating patients about the use of the antidiabetic drugs.
I nsulin, a hormone produced by the pancreas, acts to maintain blood glucose levels within normal limits (60-120 mg/dL). This is accomplished by the release of small amounts of insulin into the bloodstream throughout the day in response to changes in blood glucose levels. Insulin is essential for the utilization of glucose in cellular metabolism and for the proper metabolism of protein and fat.
Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of the pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia. As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations.
Insulin and the oral antidiabetic drugs, along with diet and exercise, are the cornerstones of treatment for diabetes mellitus. They are used to prevent episodes of hypo-glycemia and to normalize carbohydrate metabolism.
There are two major types of diabetes mellitus:
• Type 1—Insulin-dependent diabetes mellitus (IDDM). Former names of this type of diabetes mellitus include juvenile diabetes, juvenile-onset diabetes, and brittle diabetes.
• Type 2—Noninsulin-dependent diabetes mellitus (NIDDM). Former names of this type of diabetes mellitus include maturity-onset diabetes, adult-onset diabetes, and stable diabetes.
Those with type 1 diabetes mellitus produce insulin in insufficient amounts and therefore must have insulin supplementation to survive. Type 1 diabetes usually has a rapid onset, occurs before the age of 20 years, produces more severe symptoms than type 2 diabetes, and is more difficult to control. Major symptoms of type 1 diabetes include hyperglycemia, polydipsia (increased thirst), polyphagia (increased appetite), polyuria (increased urination), and weight loss. Treatment of type 1 diabetes is particularly difficult to control because of the lack of insulin production by the pancreas. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home glucose testing several times a day, and multiple daily insulin injections.
Type 2 diabetes mellitus affects about 90% to 95% of individuals with diabetes. Those with type 2 diabetes mellitus either have a decreased production of insulin by the beta cells of the pancreas or a decreased sensitivity of the cells to insulin, making the cells insulin resistant. Although type 2 diabetes mellitus may occur at any age, the disorder occurs most often after the age of 40 years. The onset of type 2 diabetes is usually insidious, symptoms are less severe than in type 1 diabetes mellitus, and because it tends to be more stable, it is easier to control than type 1 diabetes. Risk factors for type 2 diabetes include:
• Family history of diabetes
• History of gestational diabetes (diabetes that develops during pregnancy but disappears when pregnancy is over)
• Impaired glucose tolerance
• Minimal or no physical activity
• Race/ethnicity (African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans)
Obesity is thought to contribute to type 2 diabetes by placing additional stress on the pancreas, which makes it less able to respond and produce adequate insulin to meet the body's metabolic needs.
Many individuals with type 2 diabetes are able to control the disorder with diet, exercise, and oral antidiabetic drugs. However, about 40% of those with type 2 diabetes do not have a good response to the oral antidiabetic drugs and require the addition of insulin to control the diabetes.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...