Chapter 50: Antidiabetic Drugs & Glycemic Control

The text distinguishes between the pathophysiology of Type 1 diabetes, which necessitates exogenous insulin due to the autoimmune destruction of pancreatic beta cells, and Type 2 diabetes, which is driven by insulin resistance and is often managed with oral agents, diet, and exercise. A significant portion of the summary focuses on insulin therapy, classifying formulations into rapid-acting, short-acting, intermediate-acting, and long-acting types, while emphasizing the critical importance of understanding onset, peak, and duration times to prevent adverse events like hypoglycemia and the Somogyi effect. The chapter outlines essential administration techniques, including the rotation of subcutaneous injection sites to prevent lipodystrophy, and the use of various delivery systems such as insulin pens and pumps. Furthermore, the description details the mechanism of action for major classes of oral antidiabetic drugs, including sulfonylureas which stimulate insulin release, biguanides like metformin that reduce hepatic glucose production, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinides. Advanced pharmacological classes are also reviewed, such as DPP-4 inhibitors, SGLT2 inhibitors that facilitate glucose excretion via urine, and injectable non-insulin agents like incretin mimetics and amylin analogs. Finally, the chapter covers emergency management for severe hypoglycemia using glucagon or diazoxide and applies the nursing process to patient education regarding hemoglobin A1c monitoring, recognizing signs of ketoacidosis, and managing drug interactions.