Oral antidiabetic medications - Sulfonylureas and meglitinides: Nursing pharmacology

Sulfonylureas and meglitinides are medications used to treat type 2 diabetes mellitus. Type 2 diabetes is characterized by insulin resistance, which is when tissue cells have trouble responding to insulin in order to use glucose from the blood. As a result, tissue cells starve for energy despite having high blood glucose levels, which is called hyperglycemia.

Now, sulfonylureas can be classified into first and second generation and are easy to recognize because they all have the suffix “–ide” and include glimepiride, glipizide and glyburide. On the other hand, meglitinides have the suffix “-glinide” and include repaglinide and nateglinide.

Okay, now both sulfonylureas and meglitinides are given orally and once administered, they both act on the pancreas by inhibiting ATP-sensitive potassium channels on the membrane of pancreatic beta cells. As a result, these medications initiate a cascade of events that stimulate the pancreatic beta cells to secrete more insulin, ultimately leading to a decrease in blood glucose levels.

The most common side effects of both classes of medications are hypoglycemia and weight gain. Other notable side effects of sulfonylureas include hepatotoxicity, leukopenia, and thrombocytopenia; while meglitinides commonly cause nausea, diarrhea, and indigestion.

As far as contraindications go, both sulfonylureas and meglitinides should not be used in clients with type 1 diabetes mellitus, or those experiencing diabetic ketoacidosis or DKA, since these medications will be ineffective in patients with no pancreatic beta-cell function. In addition, some of these medications should be used with caution during pregnancy and breastfeeding, as well as in children or elderly clients. Final precautions for these medications include hepatic or renal disease.

Alright, if a client with type 2 diabetes is prescribed an oral antidiabetic medication, such as a sulfonylurea or meglitinide, be sure to review their most recent laboratory test results, including blood glucose, hemoglobin A1c, CBC, electrolytes, as well as their renal and hepatic function. Next, explain how the medication works in their pancreas to lower their blood glucose level. Be sure to remind your client that the medication is most effective when combined with an antidiabetic regimen, which includes following a low-carbohydrate and high-fiber diet, regular physical activity, and frequent blood glucose monitoring.

Next, review with your client the symptoms of hyperglycemia, such as fatigue, blurred vision, increased thirst, appetite, and urination; if the client develops any of these symptoms, advise them to check their blood glucose level and contact their healthcare provider immediately. Then, review the symptoms of hypoglycemia, such as hunger, headache, fatigue, tremors, dizziness, and confusion; if the client develops any of these, instruct them to check blood glucose level, followed by consuming a source of glucose, such as half a cup of juice, three glucose tablets, or approximately 15 grams of sugar; and then check blood glucose again after 15 minutes.

Okay, if your client is prescribed the sulfonylurea “glipizide,” teach them to take their medication once daily, 30 minutes before the first meal of the day. Then, let them know that they should avoid consuming alcohol, since it can increase the hypoglycemic effects of glipizide, and may cause a disulfiram-like reaction, characterized by flushing, palpitations, and nausea.

If these occur, stress the importance of contacting their healthcare provider right away.