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PRESENTATION ON AAN3: DIABETES NURSING

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St. Paul University Philippines
Tuguegarao City, Cagayan 3500
GRADUATE SCHOOL PROGRAM
Master of Science in Nursing
DIABETES NURSING

21ST CENTURY ANTI- DIABETEC DRUGS AND ALTERNATIVE DRUGS USED TO
MANAGE DIABETES MELLITUS

DONAH JANNIN MADRIAGA AGUSTIN, RN
MSN STUDENT

ELIZABETH C. BAUA, DNS
PROFESSOR

Available sulfonylureas include:          Amaryl (glimepiride) DiaBeta (glyburide) Diabinese (chlorpropamide) Glucotrol (glipizide) Glucotrol XL (glipizide long-acting) Glynase (glyburide) Micronase (glyburide) tolazamide tolbutamide o Possible side effects of the sulfonylureas are: o Low blood glucose o Skin rash o Upset stomach o Weight gain  2 Biguanides   These agents are considered the first choice for oral type 2 diabetes treatment.    .  But combining two kinds of diabetes pills can make it more likely that your blood sugar will drop too low (hypoglycemia).  Combining two different kinds of diabetes pills can work better to lower your blood sugar than a single medicine. which helps lower your blood glucose.  Agents used in diabetic therapy include the following: 1 Sulfonylureas  Stimulate your pancreas to make more insulin. They reduce hyperglycemia by decreasing hepatic gluconeogenesis (primary effect) and increasing peripheral insulin sensitivity (secondary effect). They are not metabolized and are rapidly eliminated by the kidneys.  Biguanides are absorbed from the intestines and are not bound to plasma proteins.PRESENTATION ON AAN3: DIABETES NURSING 1 21st Century Anti-Diabetic Drugs  Different kinds of diabetes pills work in different ways to control your blood sugar (blood glucose).

PRESENTATION ON AAN3: DIABETES NURSING 1  Available Biguanides include:   Glucophage (metformin) Glucophage XR (metformin long-acting)  Riomet (metformin liquid) .

 Available thiazolidinediones include:  Actos (pioglitazone)  Avandia (rosiglitazone)     NOTE: If you have heart failure. o Possible side effects of the biguanides are nausea and Diarrhea when you are first start taking this type of Medicine. potatoes.  Available alpha-glucosidase inhibitors include:  Glyset (miglitol)  Precose (acarbose)  o Possible side effects of the alpha-glucosidase inhibitors are: stomach pain. This type of pill can cause congestive heart failure.  3 Alpha-glucosidase inhibitors  .Alpha-glucosidase inhibitors work by slowing down the digestion of foods high in carbohydrate. more . or diarrhea – these symptoms usually go away gradually  4 Thiazolidinediones (TZDs)   Make you more sensitive to insulin. such as rice. o Anemia. bread. Studies have shown that Avandia is associated with an increased risk for heart attacks and chest pain or discomfort from blocked blood vessels. o an increased risk of getting pregnant even if you’re taking birth control pills o increased risk of bone fracture in women     5 Meglitinide derivatives - Meglitinides stimulate your pancreas to make insulin. o Possible side effects of include: o congestive heart failure is the most serious side effect. bloating. you should not take this type of pill. gas. milk and fruit.

especially right after meals. It also helps keep your liver from putting stored glucose into your blood. The only available Dphenylalanine derivative is: Starlix (nateglinide)  o Possible side effects of Starlix are: o low blood glucose o weight gain o dizziness 7 DPP-IV Inhibitors - -  Lower your blood glucose by helping your body make more insulin when it’ s needed. The only available DPP-IV Inhibitor is Januvia (sitagliptin) o Possible side effects of Januvia are: o runny nose o sore throat o Headache       How do they work? . Dipeptidyl Peptidase-4 (DPP-4) Inhibitors are usually prescribed for people with type 2 diabetes who have not responded well to drugs such as metformin and sulfonylureas. The only available meglitinide is:  Prandin (repaglinide)  o Possible side effects of Prandin are: o low blood glucose o weight gain o upset stomach o back pain or a headache   6 D-Phenylalanine Derivatives - Help your pancreas make more insulin quickly for a short period of time right after meals.

 They work by blocking the action of DPP-4. The precise mechanism by which colesevelam improves glycemic control is largely unknown. Avandaryl is a combination of Avandia (rosiglitazone) and Amaryl (glimepiride)  4.g. Janumet is a combination of Januvia (sitagliptin) and Glucophage (metformin)  7. Metaglip is a combination of Glucotrol (glipizide) and Glucophage (metformin)  9 Note: one pill helps your body make more insulin. This incretins help stimulate the production of insulin when it is needed (e. It is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. 10 Insulins   Antidiabetics. The other pill lowers the amount of glucose made by your liver and helps your insulin work the way it should. an enzyme which destroys a group of gastrointestinal hormones called Incretins. Actoplus Met is a combination of Actos (pioglitazone) and Glucophage (metformin)  2.  . DPP-4 inhibitors help regulate blood glucose levels.Colesevelam is FDA approved as an adjunctive therapy to improve glycemic control in adults with type 2 diabetes mellitus.g. Rapid-Acting Insulins  Rapid-acting insulins have a short duration of action and are appropriate for use before meals or when blood glucose levels exceed target levels and . during digestion). Avandamet is a combination of Avandia (rosiglitazone) and Glucophage (metformin)  3. Bile acid sequestrants  . So by protecting incretins from damage. Duetact is a combination of Actos (pioglitazone) and Amaryl (glimepiride)  5. They also slow down digestion and increase appetite. 8 Combination Diabetes Pills  1. Glucovance is a combination of Glucophage (metformin) and Micronase (glyburide)  6. after eating) and reduce the production of gucagon by the liver when it is not needed (e.Colesevelam is a high-capacity bile acid sequestrant.

Insulin aspart has a short onset of action of 5-15 minutes and a short duration of action of 3-5 hours.Preparations that contain a mixture of 70% neutral protamine Hagedorn (NPH) and 30% regular human insulin (ie.   Insulin glulisine (Apidra)  .   Insulin aspart (NovoLog)  .   Insulin inhaled (Afrezza)  .Insulin glulisine has a rapid onset of action of 515 minutes and a short duration of action of 3-5 hours. Short-Acting Insulins   .   Insulin lispro (Humalog)  . The peak effects are seen within 2-4 hours.Regular insulin has a rapid onset of action of 0. These agents are associated with less hypoglycemia than regular insulin.   Regular insulin (Humulin R.correction doses are needed.Short-acting insulins are commonly used when a slower onset of action or a longer duration of action is desired. when combined with rapid.Insulin lispro has a rapid onset of action of 5-15 minutes and a short duration of action of 4 hours. Novolin 70/30. Humulin 70/30) are also available    Antidiabetics.   . The peak effect occurs within 30-90 minutes.  Insulin detemir (Levemir) .Orally inhaled rapid-acting insulin in powder form. Insulin glulisine is FDA approved for use in insulin pumps.   Antidiabetics.These insulins provide a longer duration of action.51 hours and duration of action of 4-6 hours. Insulin aspart is FDA approved for use in insulin pumps. they provide better glucose control. The peak effect occurs within 30-90 minutes.or short-acting insulins. Novolin R)  . Long-Acting Insulins  . and.

1. 7. 6. Although there are several different types of ginseng. Peak effects occur within 16-18 hours.Insulin detemir is indicated for onceor twice-daily dosing in patients with type 1 or 2 diabetes mellitus.  Alternative Medicines  2.  Those studies have shown that North American ginseng may improve blood sugar control and glycosylated hemoglobin (a form of hemoglobin in the blood used to monitor blood glucose levels over time) levels. 3. 8.Insulin glargine has an onset of action of 4-8 hours and duration of action of 24 hours. In a small experiment involving nine diabetes patients and 10 people without diabetes. 5. . It's important to note that self-treating with alternative medicine and avoiding or delaying standard care may be harmful for your health. Here are some natural treatments that are being explored.   Insulin Glargine (Lantus)  . scientific support for the claim that any remedy can treat diabetes is lacking. according to a 2000 study published in Archives of Internal Medicine. most of the promising studies on ginseng and diabetes have used North American ginseng (Panax quinquefolius).  Health Benefits of American Ginseng  “American ginseng may help regulate blood sugar. researchers found . Ginseng -   So far. 4. The duration of action is up to 24 hours. Ginseng Cinnamon Aloe Vera Bitter Melon Fenugreek Ginger Okra Sambong/Banaba  1.

” . After four months.”  2. 79 people with type 2 diabetes (not on insulin therapy but treated with other diabetes medication or diet) took either a cinnamon extract (equivalent to 3 g of cinnamon powder) or a placebo capsule three times a day.Although aloe Vera gel is better known as a home remedy for minor burns and other skin conditions.  . there was a slight but statistically significant reduction in fasting blood glucose levels in people who took the cinnamon (10. Three groups took 1.“In another study. 3 or 6 g of placebo capsules. 3 or 6 g of cinnamon a day and the remaining three groups consumed 1. and total cholesterol. all three doses of cinnamon significantly reduced fasting blood glucose.”  3. After 40 days. Researchers isolated a number of active phytosterol compounds from the gel that were found to reduce blood glucose and glycosylated hemoglobin levels. some people with type 2 diabetes) and/or acute hepatitis (liver disease)  . however. g.that taking American ginseng supplements prior to eating helped keep post-meal blood sugar levels in check. LDL cholesterol.“A couple of studies have found that cinnamon improves blood glucose control in people with type 2 diabetes. 60 people with type 2 diabetes were divided into six groups.   Aloe has also been linked with:  • Decreased blood lipids (fats) in patients with abnormally high levels of these molecules in the blood (e.4%). there was no significant difference in glycosylated hemoglobin or lipid profiles. triglycerides. Aloe Vera . Cinnamon .A Japanese study evaluated the effect of aloe Vera gel on blood sugar. In the first study.3%) compared with the placebo group (3. recent animal studies suggest that aloe Vera gel may help people with diabetes.

bitter melon has also long been used as a herbal remedy for a range of ailments. - These substances either work individually or together to help reduce blood sugar levels.In addition to being a food ingredient. also known as bitter gourd or karela (in India). including charantin.and is rich in vital vitamins and minerals.Bitter melon. Asia. which has been confirmed to have blood glucoselowering effect.  4.It is the edible part of the plant Momordica Charantia. . including type 2 diabetes.The bitter melon itself grows off the vine as a green. is a unique vegetable-fruit that can be used as food or medicine.which is considered the most bitter among all fruits and vegetables. • Decreased swelling and faster healing of wound injuries.  .  ( Leg wounds and ulcers are common complications of diabetes. and they typically take longer time to heal than in healthy non-diabetic individuals. texture and bitterness vary between the different regions in which it grows . parts of Africa and the Caribbean   .The plant thrives in tropical and subtropical regions. oblong-shaped fruit with a distinct warty exterior . vicine and an insulin-like compound known as polypeptide-p. Bitter Melon .)  • These positive effects are thought to be due to the presence of compounds such as lectins.It is also known that bitter melon contains a lectin that reduces blood glucose concentrations by . mannans and anthraquinones.  .The fruit contains at least three active substances with anti-diabetic properties.though its size.   .   How does it affect diabetes?  . including  South America.

although the hypoglycemic effect was less than a 1.This lectin is thought to be a major factor behind the hypoglycemic effect that develops after eating bitter melon. [68]  .  Scientific evidence  . which showed that a 2.  . the results of a four-week clinical trial were published in the Journal of Ethno pharmacology.000 mg/day dose of metformin.acting on peripheral tissues and suppressing appetite similar to the effects of insulin in the brain.000 mg daily dose of bitter melon significantly reduced blood glucose levels among patients with type 2 diabetes.Other older studies have also suggested an association between bitter melon intake and improved glycemic control. while a report published in the March 2008 issue of Chemistry and Biology found that bitter melon increased cellular uptake of glucose and improved glucose tolerance.In January 2011. [69]  .

5. and microgreens) commonly known as methi. or as an herb (dried leaves). incorporating 15 grams of powdered fenugreek seed into a meal eaten by people with type 2 diabetes reduced the rise in post-meal blood glucose. This suggests they may be effective in treating people with diabetes.  -The plant.  . while the seeds are used both whole and in powdered form as a spice. which is widely grown in South Asia. North Africa and parts of the Mediterranean.and medicinal. improved glucose tolerance and also lowered total cholesterol. while a separate . both culinary – (fenugreek is a key ingredient of curries and other Indian recipes) . researchers in India found that adding 100 grams of defatted fenugreek seed powder to the daily diet of patients with insulin-dependent (type 1) diabetes significantly reduced their fasting blood glucose levels.Fenugreek is an aromatic plant that has many uses.  . has small round leaves and also produces long pods that contain distinctive bitter-tasting seeds. LDL or ‘bad’ cholesterol and triglycerides.   Scientific evidence  In one study.   How does it affect diabetes?  .  In another controlled trial. fenugreek has a number of health benefits and is used in both Ayurvedic and traditional Chinese medicine.  -The leaves are either sold as a vegetable (fresh leaves.Multiple studies have been carried out to investigate the potential anti-diabetic benefits of fenugreek. several clinical trials showed that fenugreek seeds can improve most metabolic symptoms associated with both type 1 and type 2 diabetes in humans by lowering blood glucose levels and improving glucose tolerance.Fenugreek seeds (trigonella foenum graecum) are high in soluble fibre. Fenugreek  . which helps lower blood sugar by slowing down digestion and absorption of carbohydrates.  -As well as being a popular cooking ingredient. sprouts.Of these.

but not severe.  .study found that taking 2.5 grams of fenugreek twice a day for three months lowered blood sugar levels in people with mild. type 2 diabetes.

and for fragrance in soaps and cosmetics.the major active component of ginger rhizome .Ginger is the thick knotted underground stem (rhizome) of the plant “Zingiber officinale” that has been used for centuries in Asian cuisine and medicine. Australia. found that extracts from Buderim Ginger (Australian grown ginger) rich in gingerols . as an alternative ‘herbal’ treatment for various ailments such as nausea and indigestion.6. China.Native to Africa.Ginger rhizome can be used fresh. interact with serotonin receptors to reveres their effect on insulin secretion. Treatment with the extracts led to a 35 per cent drop in blood glucose levels and a 10 per cent increase in plasma insulin levels.can increase uptake of glucose into muscle cells without using insulin. dried and powdered. It has a pungent and sharp aroma and adds a strong spicy flavor to food and drink. spissum and an oily extract. .  Insulin secretion  In the December 2009 issue of the European Journal of Pharmacology.    How does it affect diabetes?  Glycemic control  A study published in the August 2012 edition of the natural product journal Planta Medica suggested that ginger may improve long-term blood sugar control for people with type 2 diabetes.  7. Ginger  . Australia and Jamaica. it is commonly used as a spice or flavouring agent in cooking.  .  .  Researchers from the University of Sydney. and may therefore assist in the management of high blood sugar levels. India. or as a juice or oil. researchers reported that two different ginger extracts. Okra -  Okra is fast gaining a reputation as a so-called 'superfood' for people with or at risk of diabetes or cancer.

and have no adverse side effects.   How does it affect diabetes? -  Evidence of okra having anti-diabetic properties has increased in recent years. many people with diabetes have reported decreasing blood sugar levels after soaking cut-up okra pieces in water overnight and then drinking the juice in the morning. and contain no saturated fats or cholesterol.  8.  Outside of scientific research. India.Commonly referred to as ladyfingers. with multiple Vitro (laboratory) and Vivo (animal) studies confirming okra as a potent blood glucose-lowering (or anti-diabetic) food. okra is known to have a positive effect on blood sugar control.  . completely non-toxic. or by its biological names Abelmoschus esculentus and Hibiscus esculentus. among many other health benefits. while others showed a gradual decrease in blood glucose following regular feeding of okra extract for about ten days.These tender pods are very low in calories. while in Turkey roasted okra seeds have been used as a traditional diabetes medicine for generations.  . researchers in India found that diabetic mice fed dried and ground okra peels and seeds experienced a reduction in their blood glucose levels. providing just 30 calories per 100 g. They are also rich in nutrients. the Americas and the Caribbean.  In one study. published 2011 in the Journal of Pharmacy & BioAllied Sciences. Okra  . Okra is a tall-growing vegetable that traces its origin from ancient Ethiopia (Abyssinia) through to Eastern Mediterranean.

Dry Banaba leaves and fruits for about two weeks. 5. Strain the leaves and fruits. India and others. . 4.  Evidence Based-Practice  Cannabis compound legally sold in pill form for first time could provide health benefits for people with diabetes. Take the Banaba herbal tea for 4 to 6 times daily. The capsules. Banaba is also used as Ayurvedic medicine for the treatment of diabetes. Banaba is also rich in dietary fibers. The Banaba leaves and flowers contain Corrosolic Acid. Let it steep for 30 minutes. could offer health benefits to people with diabetes. One cup of dried banaba leaves and fruits to one cup water. While in India.      How to use Banaba Herb for Diabetes:  The following details the preparation and application of Banaba herbal medicine for diabetes. a substance being studied for its insulin like effect of lowering the glucose in the body. Banaba is widely used in the Philippines and as herbal medicine for diabetes. 3. 2.- Banaba is a flowering plant that grows in warm climate like the Philippines. Cut Banaba leaves into pieces Boil the dried Banaba leaves and fruits in water. (September 2015)  "Cannabis pills" have been legally sold in Europe for the first time. 1. which are available to buy online. 6. Banaba is also rich in vitamins and minerals including zinc and magnesium. Banaba is also being studied as a weight-loss supplement for its ability to delay or reduce the absorption of carbohydrates. 7.

 For people with diabetes.uk http://altmedicine. do not provide the "high" of smoking cannabis. a compound found in cannabis. epilepsy rheumatoid arthritis. They can be purchased in Europe on the company's website. PTSD. cancer. A 100mg box costs €579. A 10mg box can be purchased for €89.  Sources:   http://www. There is substantial evidence to suggest that Cannabidiol (CBD). which is caused by tetrahydrocannabinol (THC).co. and heart disease.00 (or £65.  The pills.22).diabetes. including glaucoma.com  .com Medscape. research suggests that CBD reduces the pain of neuropathy and lowers blood glucose levels. It can also benefit some diabetic complications.  The capsules are manufactured in Switzerland and registered in Germany. sleep disorders. They contain only CBD. including chronic pain.66). which are sold by MMJ PhyoTech of Australia. anxiety. has beneficial effects on a number of health conditions.about.00 (or £427. which is the specific compound linked to health benefits. diabetes.