January 27, 2023

Okay so we learned about type 1 diabetes and we learned out there’s only about 5% it’s the most severe type 2 diabetes is more common and it occurs either because the person is not making enough insulin or their body is less sensitive to the insulin that they are making therefore we don’t need to give them insulin we need to give them medication that is increases

Production and increases the sensitivity of the body to the insulin that’s there the first cause of action used to be diet and exercise and we still do talk to patients about diet and exercise and what they should need to do and then when that didn’t occur they would go to the drugs but now they’re starting to go to the medications as well as i eat and exercise

And the first one that they are going to either buy grenades ok metformin they’re usually the first line of defense metformin glucophage you will hear called is the first line of defense it’s that first one that we use here’s where when we talk the first few weeks of school we talked about that knowing the mechanism of action and that the mechanism of action is

Important here is an example of where that’s important because you may have a patient who is on 2 or 3 different type 2 medications to help bring their sugar down and they’re gonna ask you why am i taking three things to bring my sugar down or for type 2 diabetes and why are you adding something else and you as a nurse need to kind of explain well this medicine

Works this way this medicine works this way and together they’re going to help bring your sugar down so metformin is typically your migron eyes are typically the first line of defense because they do three things their mechanism of action there’s three things one is it inhibits glucose production in the liver so when you stop eating when you have those breaks we

Don’t eat constantly 24/7 your body goes into fasting hope and so the liver kind of looks and the liver goes oh there’s all this insulin out there all right cuz body’s producing insulin but you’re not recognizing you so there’s insulin floating around it’s going through the liver and the labor goes oh we’re in trouble there’s too much insulin in the bloodstream

And i don’t have enough sugar to take care of that so we’re gonna drop and i don’t want that to happen so the liver does an amazing thing it takes and breaks down and creates sugar okay so the first thing that metformin does is it tells the liver don’t do that i know you see all this insulin coming through here it’s coming through this gate and it’s doing and you

Want to but don’t you’ve worked hard enough you don’t need to make any that’s the first thing it does is it stops that liver the second thing it does is it sensitizes the insulin receptors in your body so you have been slim floating around what’s happening is your body’s not recognizing that insulin and not using it correctly so glucophage comes in metformin comes

In these my grenades come in and they kind of go to the people they go oh look i know you’re looking for a red shirt but the blue shirts will help you as well so grab a blue shirt so kind of sensitizes them so that more insulin is being taken up and then the third thing it does is in the gut when you eat and you break down and you get some glucose it kind of gets

Your you’ve got to reabsorb not a lot okay so you can’t one of those little side effects that may happen but he gets to reabsorb some of that glucose or reduce the glucose absorption so it doesn’t get it to reabsorb says no we don’t need to bring in any more sugar and it lets you get rid of it through excretion your therapeutic uses are that it’s used to low blue

Blood glucose and people diagnosed with type 2 diabetes the adverse effects are the ones that we need to watch out for because these are the ones that are going to make your patient non-compliant and the biggest one is gi upset it usually only lasts six weeks till your body honey gets used to it to you patient gets used to the medication but it is a big problem

It can cause your patient to have diarrhea and the problem that we have with the glucophage is there’s not a okay you eat and an hour later you have to go to the bathroom it’s you eight and your body may react to it just a little bit differently because it doesn’t like the amount of sugar it doesn’t like the amount of carbs that are in the body and so it’s going

To make you go to the bathroom and that first six weeks that adjustment period where the body’s going what am i doing i don’t know that type of thing your patient will need to be close to a bathroom is the easiest way to say that so you’re gonna have top of it okay but you’re gonna have to walk things here like if you can put up with this for the first month or so

Once we get it regulated what your buddy is used to having it that portion is gonna stop but also letting them know that if they then go and eat a huge meal that has lots of carbohydrates or they eat a big piece of cake or they eat lots of chocolate anything that has lots of carbohydrates the diarrhea may happen to them again because again the body the metformin

Tell them the stomach get rid of all this sugar and the only way that was sewing those to do that is to dump it all the good thing is that it doesn’t lower blood sugar any further than should so it’s just going to sensitize things to the insulin out there but it’s not going to make more insulin and make things happen so that the boy sugar just keeps going down it’s

Just going to say use what you have so your chances of hypoglycemia are very well it’s very low it does get excreted through the kidneys so we do need to still watch kidney function especially because they’re diabetic and you may have some nephropathy but we need to watch the kidney function and make sure everything’s going well and for some reason your metformin

Doesn’t work you’re by gonna eyes don’t work make sure that they may be put on in addition to this isn’t just stop that it’s not working go here will be your so find out yuri is your clip design you’re gonna see lots of patients on clip design ok and what glipizide does is metformin came in until delivered don’t break down don’t make any more glucose coke the gut

Don’t bring in any more glucose is there sugar just get rid of it and it told the people that were looking for insulin hey it’s here you just need to kind of see if you’re looking for egg you should be looking for right edler clemens ide comes in and he goes to the pancreas and it talks to the pancreas and it says you need to make more insulin you’re not making

Enough i know you’ve been working hard but the livers been working harder and you really need to start kicking in it so you’re gonna put that on top up telling them the liver not to make any more sugar telling you got nothing to get any more sugar and telling the body hey insulin is out here and then what you’re gonna do is say alright i told the body insulin

Was out there we need to put more in someone out of there so let’s go right um the problem with glipizide is you can go hypoglycemic because it just creates insulin and it just tells the pancreas to start making insulin so you can just flood the body with too much insulin that would cause it to go hypoglycemic the other problem is that don’t know why but in the

Trial phases and in the early stages of glipizide they had several patients that kind of had this certain cardiac death which they couldn’t attribute to anything else but they really couldn’t attribute it to the glipizide either so that’s still kind of on there so you may have a patient who has heart problems you may kind of be looking at it alright do i know

What’s going on with their heart if we’re starting them on this drug okay and again what i’m giving you is just kind of that quick this is what’s out there type thing there’s lots of type 2 diabetes diabetic drugs that kind of fall into these categories i’m giving you what you’re gonna see most of the other type that you’re going to see nowadays are you seeing

Lots and lots and lots of commercials for are your injectable type 2 medications so they’re not insulin and that’s the first thing you need to teach your patient is this is not insulin you are not taking insulin yes you are giving yourself a shot but it is not insulin okay the one that’s been around the longest is the exhibit id 2 by ada that’s been out for quite

A while now and works well it’s usually typically one shot a day it is dosed in units okay so you know they will tell you if i need to take six units of my ada so that’s why a lot of people think of insulin because it’s in units it’s a shot that’s acting but it is not it has nothing is not extra insulin it goes in and it does these things that the glipizide in

The metformin we’re doing it just does it through an injectable way victoza is another one you’ll hear and trulicity is the one that’s come out the most trulicity has begun where it’s just a one time shot a week so it’s a long-acting it’s just one shot a week and so you would talk to your patients about that but you would do the same thing that you did with type

1 insulin diabetics you’re going to teach them how to give a shot how to do those things and then lastly is you may with type 2 diabetics in hhns which is the hypo hyperosmolar hypo non-ketotic state so they have the hyper hyper glycaemia and the high sugars but it’s not it’s not but you’re gonna see that the sit the treatment for it is very similar to eat decay

And if this patient comes in in this you are going to give them insulin iv so you’re gonna use regular you’re gonna give them iv foods you can give them electrolytes to kind of help them on but tabligh is everything new or these new students and when you get in your next class which is the first minute search pot i just want you to see this because if you’re giving

Any of these medicines you may see a protocol or if this were to happen and this is what’s going on with your patient this is what you need to

Transcribed from video
Type two medication By Cynthia Booher