Chapter 32: Diabetes Drugs

Type 1 diabetes results from autoimmune destruction of insulin-producing beta cells in the pancreas, creating absolute insulin deficiency, while type 2 diabetes develops through a combination of cellular insulin resistance, diminished pancreatic insulin secretion, and excessive glucose production in the liver. Without appropriate treatment, both forms can trigger serious complications including diabetic ketoacidosis, hyperosmolar hyperglycemic state, peripheral and autonomic neuropathy, kidney disease, and vision loss. The chapter provides detailed coverage of insulin replacement therapy across multiple formulations organized by onset and duration of action: rapid-acting insulins for immediate glucose reduction following meals, short-acting regular insulin for flexible dosing, intermediate-acting NPH insulin for sustained coverage, and long-acting basal insulins that maintain steady glucose levels over 24 hours or longer. Clinically relevant delivery strategies such as basal-bolus regimens, variable-dose insulin protocols, and insulin pump technology are explained alongside injection technique, site rotation practices, and potential adverse effects including severe hypoglycemia, fat redistribution at injection sites, and metabolic weight gain. The chapter systematically reviews oral medications targeting different pathophysiologic defects in type 2 diabetes: sulfonylureas and glinides that trigger pancreatic insulin release, biguanides that reduce liver glucose output and enhance tissue insulin responsiveness, thiazolidinediones that improve cellular insulin sensitivity, alpha-glucosidase inhibitors that slow intestinal carbohydrate absorption, dipeptidyl peptidase-4 inhibitors that augment incretin hormone activity, and sodium-glucose cotransporter-2 inhibitors that increase renal glucose elimination. Injectable agents including glucagon-like peptide-1 receptor agonists and amylin analogs serve as adjunctive therapies for intensified glycemic management. Critical nursing responsibilities encompass comprehensive baseline assessment of metabolic parameters, patient education regarding dietary modifications, physical activity, self-monitoring techniques, recognition of hypoglycemic and hyperglycemic episodes, medication administration procedures, clinically significant drug interactions, and perioperative insulin adjustment strategies.