Abstract
The focus of this chapter is the pathophysiology of the two predominant types of diabetes and their pharmacological management. The overall aim of treating diabetes is blood glucose management. This includes attempting to avoid high and low blood glucose levels occurring, thereby reducing the risk of complications. The management of diabetes is frequently demanding and multifactorial; understanding the pharmacological therapies available for the contemporary treatment of diabetes is a central aspect of a nurse’s knowledge and skill.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Barnea M, Haviv L, Gutman R, Chapnik N, Madar Z, Froy O (2012) Metformin affects the circadian clock and metabolic rhythms in a tissue-specific manner. Biochimi Biophys Acta 1822(11):1796–1806
Boxberger KH, Hagenbuch B, Lampe JN (2014) Common drugs inhibit human organic cation transporter 1 (OCT1)-mediated neurotransmitter uptake. Drug Metab Dispos 42(6):990–995
Burcelin R (2010) The gut-brain axis: a major glucoregulatory player. Diabetes Metab 36(Suppl 3):S54–S58
Cernea S, Raz I (2011) Therapy in the early stage: incretins. Diabetes Care 34(Suppl 2):S264–S271
de la Peña A, Yeo KP, Linnebjerg H, Catton E, Reddy S, Brown-Augsburger P, Morrow L, Ignaut DA (2015) Subcutaneous injection depth does not affect the pharmacokinetics or glucodynamics of insulin lispro in normal weight or healthy obese subjects. J Diabetes Sci Technol 9(4):824–830
Diabetes UK (2017) Diabetes risk factors. https://www.diabetes.org.uk/Preventing-Type-2-diabetes/Diabetes-risk-factors/ Accessed 6 June 2017
Diamant M, Blaak EE, De Vos WM (2011) Do nutrient–gut–microbiota interactions play a role in human obesity, insulin resistance and type 2 diabetes? Obes Rev 12(4):272–281
Duerden M (2009) What are hazard ratios? http://www.bandolier.org.uk/painres/download/whatis/What_are_haz_ratios.pdf. Accessed 5 May 2019
Elashoff M, Matveyenko AV, Gier B, Elashoff R, Butler PC (2011) Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1–based therapies. Gastroenterology 141(1):150–156
Filippi CM, von Herrath MG (2008) Viral trigger for type 1 diabetes: pros and cons. Diabetes 57(11):2863–2871
Fonseca VA (2009) Defining and characterizing the progression of type 2 diabetes. Diabetes Care 32(Suppl 2):S151–S156
Forsmark CE (2016) Incretins, diabetes, pancreatitis and pancreatic cancer: what the GI specialist needs to know. Pancreatology 16(1):10–13
Frayling TM, Evans JC, Bulman MP, Pearson E, Allen L, Owen K, Bingham C, Hannemann M, Shepherd M, Ellard S, Hattersley AT (2001) Beta-cell genes and diabetes: molecular and clinical characterization of mutations in transcription factors. Diabetes 50(Suppl 1):S94
Gault VA (2018) RD Lawrence lecture incretins: the intelligent hormones in diabetes. Diabet Med 35(1):33–40
Gong L, Goswami S, Giacomini KM, Altman RB, Klein TE (2012) Metformin pathways: pharmacokinetics and pharmacodynamics. Pharmacogenet Genomics 22(11):820
Gupta V (2013) Glucagon-like peptide-1 analogues: an overview. Indian J Endocrinol Metab 17(3):413–421
Hirsch LJ, Gibney MA, Albanese J, Qu S, Kassler-Taub K, Klaff LJ, Bailey TS (2010) Comparative glycemic control, safety and patient ratings for a new 4 mm× 32G insulin pen needle in adults with diabetes. Curr Med Res Opin 26(6):1531–1541
Hofman PL, Derraik JGB, Pinto TE, Tregurtha S, Faherty A, Peart JM, Drury PL, Robinson E, Tehranchi R, Donsmark M, Cutfield WS (2010) Defining the ideal injection techniques when using 5-mm needles in children and adults. Diabetes Care 33(9):1940–1944
International Diabetes Federation (2017) IDF diabetes atlas, 8th edn. https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html. Accessed 12 Mar 2019
International Hypoglycaemia Study group (2015) Minimizing hypoglycemia in diabetes. Diabetes Care 38(8):1583–1591
Iqbal A, Heller S (2016) Managing hypoglycaemia. Best Pract Res Clin Endocrinol Metab 30(3):413–430
Ji J, Lou Q (2014) Insulin pen injection technique survey in patients with type 2 diabetes in mainland China in 2010. Curr Med Res Opin 30(6):1087–1093
Kahn SE, Andrikopoulos S, Verchere CB (1999) Islet amyloid: a long-recognized but underappreciated pathological feature of type 2 diabetes. Diabetes 48(2):241–253
Kahn SE, Cooper ME, Del Prato S (2014) Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet 383(9922):1068–1083
Kaneto H, Obata A, Shimoda M, Kimura T, Hirukawa H, Okauchi S, Matsuoka TA, Kaku K (2016) Promising diabetes therapy based on the molecular mechanism for glucose toxicity: usefulness of SGLT2 inhibitors as well as incretin-related drugs. Curr Med Chem 23(27):3044–3051
Karp I, Sivaswamy A, Booth C (2019) Does the use of incretin-based medications increase the risk of cancer in patients with type-2 diabetes mellitus? Pharmacoepidemiol Drug Saf 28(4):489–499. https://doi.org/10.1002/pds.4746
Kreugel G, Beijer HJM, Kerstens MN, Ter Maaten JC, Sluiter WJ, Boot BS (2007) Influence of needle size for subcutaneous insulin administration on metabolic control and patient acceptance. Eur Diabetes Nurs 4(2):51–55
Lee EY, Hwang S, Lee YH, Lee SH, Lee YM, Kang HP, Han E, Lee W, Lee BW, Kang ES, Cha BS (2017) Association between metformin use and risk of lactic acidosis or elevated lactate concentration in type 2 diabetes. Yonsei Med J 58(2):312–318
Liang C, Bertoia ML, Ding Y, Clifford CR, Qiao Q, Gagne JJ, Dore DD (2018) Exenatide use and incidence of pancreatic and thyroid cancer: a retrospective cohort study. Diabetes Obes Metab 21(4):1037–1042
Lim GE, Brubaker PL (2006) Glucagon-like peptide 1 secretion by the L-cell. Diabetes 55(Suppl 2):S70–S77
Madsbad S (2016) Review of head-to-head comparisons of glucagon-like peptide-1 receptor agonists. Diabetes Obes Metab 18(4):317–332
Medicines and Healthcare Products Regulatory Agency (2016). https://www.gov.uk/drug-safety-update/sglt2-inhibitors-updated-advice-on-the-risk-of-diabetic-ketoacidosis. Accessed 21 May 19
Miller RE (1981) Pancreatic neuroendocrinology: peripheral neural mechanisms in the regulation of the islets of Langerhans. Endocr Rev 2(4):471–494
Miwa T, Itoh R, Kobayashi T, Tanabe T, Shikuma J, Takahashi T, Odawara M (2012) Comparison of the effects of a new 32-gauge× 4-mm pen needle and a 32-gauge× 6-mm pen needle on glycemic control, safety, and patient ratings in Japanese adults with diabetes. Diabetes Technol Ther 14(12):1084–1090
Mueckler M, Thorens B (2013) The SLC2 (GLUT) family of membrane transporters. Mol Asp Med 34(2–3):121–138
Nadkarni P, Chepurny OG, Holz GG (2014) Regulation of glucose homeostasis by GLP-1. In: Progress in molecular biology and translational science, vol 121, pp 23–65
National Institute for Health and Care Excellence (2019) British national formulary. https://bnf.nice.org.uk/. Accessed 12 Mar 2019
NHS Digital (2018) National diabetes audit 2017–2018: short report, characteristics of people with diabetes. https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/report-1-care-processes-and-treatment-targets-2017-18-short-report. Accessed 27 Feb 2019
Pani LN, Nathan DM, Grant RW (2008) Clinical predictors of disease progression and medication initiation in untreated patients with type 2 diabetes and A1C less than 7%. Diabetes Care 31(3):386–390
Robinson S, Kessling A (1992) Diabetes secondary to genetic disorders. Baillieres Clin Endocrinol Metab 6(4):867–898
Scheen AJ (2007) Drug-drug and food-drug pharmacokinetic interactions with new insulinotropic agents repaglinide and nateglinide. Clin Pharmacokinet 46(2):93–108
Scheen AJ (2015) Pharmacodynamics, efficacy and safety of sodium–glucose co-transporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus. Drugs 75(1):33–59
Tahrani AA, Barnett AH, Bailey CJ (2016) Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus. Nat Rev Endocrinol 12(10):566–592
Thawabi M, Studyvin S (2015) Euglycemic diabetic ketoacidosis, a misleading presentation of diabetic ketoacidosis. North American journal of medical sciences, 7(6), 291
Tushuizen ME, Bunck MC, Pouwels PJ, Bontemps S, Van Waesberghe JHT, Schindhelm RK, Mari A, Heine RJ, Diamant M (2007) Pancreatic fat content and beta-cell function in type 2 diabetic and non-diabetic males. Diabetes 30(11):2916–2921
Van Dalem J, Brouwers MC, Stehouwer CD, Krings A, Leufkens HG, Driessen JH, de Vries F, Burden AM (2016) Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal function and sulphonylurea metabolite group: population based cohort study. Br Med J 13(354):i3625
Vrieze A, Van Nood E, Holleman F, Salojärvi J, Kootte RS, Bartelsman JF, Dallinga-Thie GM, Ackermans MT, Serlie MJ, Oozeer R, Derrien M (2012) Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology 143(4):913–916
Weyer C, Tataranni PA, Bogardus C, Pratley RE (2001) Insulin resistance and insulin secretory dysfunction are independent predictors of worsening of glucose tolerance during each stage of type 2 diabetes development. Diabetes Care 24(1):89–94
World Health Organization (1999) Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1, Diagnosis and classification of diabetes mellitus. WHO, Geneva. https://apps.who.int/iris/bitstream/handle/10665/66040/WHO_NCD_NCS_99.2.pdf?sequence=1&isAllowed=y. Accessed 12 Mar 2019
Xu W, Mu Y, Zhao J, Zhu D, Ji Q, Zhou Z, Yao B, Mao A, Engel SS, Zhao B, Bi Y, Zeng L, Ran X, Lu J, Ji L, Yang W, Jia W, Weng J (2017) Efficacy and safety of metformin and sitagliptin based triple antihyperglycemic therapy (STRATEGY): a multicenter, randomized, controlled, non-inferiority clinical trial. Sci China Life Sci 60(3):225–238
Yin J, Deng H, Qin S, Tang W, Zeng L, Zhou B (2014) Comparison of repaglinide and metformin versus metformin alone for type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 105(3):e10–e15
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Appendices
Multiple Choice Questions
-
1.
The onset of action of fast-acting insulin is normally:
-
(a)
Up to 10 min
-
(b)
Up to 15 min
-
(c)
Up to 20 min
-
(d)
Up to 30 min
-
(a)
-
2.
Most insulin is clear and translucent except for some:
-
(a)
Fast-acting preparations
-
(b)
Short-acting preparations
-
(c)
Intermediate-acting preparations
-
(d)
Long-acting preparations
-
(a)
-
3.
Metformin’s main mechanism of action involves:
-
(a)
Stimulation of insulin secretion
-
(b)
Insulin receptor up-regulation
-
(c)
Enhancing secretion of glucagon-like peptide-1 (GLP1) secretion
-
(d)
Inhibiting secretion of glucagon-like peptide-1 (GLP1) secretion
-
(a)
-
4.
Use of metformin is cautioned in which condition:
-
(a)
Liver dysfunction
-
(b)
Kidney dysfunction
-
(c)
GI tract dysfunction
-
(d)
Cardiac dysfunction
-
(a)
-
5.
Sulphonylurea medications’ main mechanism of action involves:
-
(a)
Stimulation of insulin secretion
-
(b)
Insulin receptor up-regulation
-
(c)
Enhancing secretion of glucagon-like peptide-1 (GLP1) secretion
-
(d)
Inhibiting secretion of glucagon-like peptide-1 (GLP1) secretion
-
(a)
-
6.
A common adverse effect of sulphonylurea medications such as glibenclamide is:
-
(a)
Tachycardia
-
(b)
Hypoglycaemia
-
(c)
Polyuria
-
(d)
Myalgia
-
(a)
-
7.
Glinides such as repaglinide are safe to use in combination with which other medication:
-
(a)
Most forms of insulin
-
(b)
Tolbutamide
-
(c)
Metformin
-
(d)
Glibenclamide
-
(a)
-
8.
Together with metformin, which oral antiglycaemic drug may not cause hypoglycaemia?
-
(a)
Sulphonylureas
-
(b)
Glinides
-
(c)
SGLT inhibitors
-
(d)
Insulin
-
(a)
-
9.
Together with metformin, which antiglycaemic drug is commonly associated with gastro-intestinal disturbances as an adverse effect?
-
(a)
Sulphonylureas
-
(b)
SGLT inhibitors
-
(c)
Incretins
-
(d)
Insulin
-
(a)
-
10.
Glucose secretion from pancreatic beta cells is caused by:
-
(a)
Beta cell depolarisation following ATP formation
-
(b)
Beta cell repolarisation following ATP formation
-
(c)
Beta cell depolarisation following ATP depletion
-
(d)
Beta cell repolarisation following ATP depletion
-
(a)
Answers
1. c
2. c
3. c
4. b
5. a
6. b
7. c
8. c
9. c
10. a
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ghazaleh, H.A., Khan, E. (2020). Medications Used for Diabetes Mellitus. In: Hood, P., Khan, E. (eds) Understanding Pharmacology in Nursing Practice . Springer, Cham. https://doi.org/10.1007/978-3-030-32004-1_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-32004-1_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-32003-4
Online ISBN: 978-3-030-32004-1
eBook Packages: MedicineMedicine (R0)