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Oral Medications. In: Michigan Diabetes Research and Training Center; Funnell, M.M., et al. Life with Diabetes: A Series of Teaching Outlines by the Michigan Diabetes Research and Training Center. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. p. 157-170

This teaching outline, part of a series of teaching outlines on living with diabetes, provides information about the purpose, action, use, and adverse effects of oral hypoglycemic agents. The outline includes a statement of purpose; prerequisites that participants should know before attending a particular session; objectives; materials needed for teaching a session; a recommended teaching method; a content outline that includes the general concepts to be covered, specific details, and instructor's notes or teaching tips; an evaluation and documentation plan; and suggested readings. Concepts covered in the outline include types of oral medications such as sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinide; the side effects of oral agents; and the administration and dosage of oral agents. Other topics include the occurrence of hypoglycemia when taking oral agents, the care and storage of oral medications, and the importance of diet and exercise. A visual is also provided.

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Saying a Mouthful About Oral Diabetes Drugs. Nursing2000. 30(11): 34-39. November 2000.

This article reviews the various oral medications available to treat type 2 diabetes and describes the unique features of each type. The physiologic characteristics of the patient, the drug's site of action, and the patient's response to therapy have a role in determining the appropriate regimen. Five classes of oral medications are used to manage type 2 diabetes: sulfonylureas, meglitinide, biguanide, alpha glucosidase inhibitors, and thiazolidinediones. Sulfonylureas are the oldest class of oral diabetes drugs. Their primary effect is to stimulate insulin release from the pancreas. An ideal candidate for sulfonylurea therapy early in the course of diabetes is an average weight adult who has no lipid abnormalities. Meglitinide increases insulin release but more rapidly than the sulfonylureas. The only meglitinide currently available is repaglinide. Metformin, which is the only biguanide currently available, works by reducing hepatic glucose production, enhancing tissue response to insulin, and improving glucose transport to cells. This drug does not promote weight gain and may help improve blood lipid levels. Alpha glucosidase inhibitors, acarbose and miglitol, limit the absorption of carbohydrates from the small intestine. The two currently available thiazolidinediones, rosiglitazone and pioglitazone, work by increasing insulin sensitivity at insulin receptor sites on the cells. Once a single oral agent becomes ineffective, combining therapies can be highly effective. A table presents the daily dosage range, dose per day, contraindications, potential adverse effects, and nursing considerations for each class. The article also presents guidelines for nurses to use when teaching a patient about oral medications. 1 table. 4 references.

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Step Lively!: The Wonders of Walking. Diabetes Forecast. 53(10): 60-64. October 2000.

This article discusses the benefits of walking for people who have type 1 or type 2 diabetes. Brisk walking has been shown to improve cardiovascular health, promote weight loss, and provide a person with a sense of well-being. Walking also has a beneficial metabolic effect on type 2 diabetes. Walking can have enough impact on insulin sensitivity and blood glucose so that people taking oral medications may be able to lower the amount they take. The benefits of walking on type 2 diabetes are particularly noticeable in younger people and people who have more easily controlled diabetes. In people who have type 1 diabetes, the benefits of walking are more evident in an improved overall quality of life. The article provides guidelines for beginning a walking regimen, including undergoing a physical examination, buying a decent pair of walking shoes, making an action plan, and building up to 30 minute walks at least three or four times per week. The article includes one sidebar that offers tips on selecting appropriate shoes and keeping feet injury free and another that lists target heart rates. 1 table.

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What Do I Need to Know About Diabetic Eye Disease?. In: Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 77-85.

This chapter provides information on diabetic eye disease. The major eye problems that cause people who have diabetes to lose their eyesight are diabetic retinopathy, cataracts, and glaucoma. These problems can be avoided or treated to lessen their impact if they are diagnosed early. Diabetic retinopathy is a disease of the retina. One type of retinopathy is background or nonproliferative retinopathy, and another is proliferative retinopathy. Both types of retinopathy can be treated with laser surgery. The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study both showed that careful blood glucose control reduces the chances of getting diabetic retinopathy. Cataracts cause the lens of the eye to cloud. This problem is particularly frequent in older people who have diabetes. Treatment involves surgery or the use of sunglasses to relieve visual symptoms. Glaucoma is more common in people who have type 2 diabetes. Vision loss from glaucoma is due to nerve damage from increased pressure in the eye. Treatment options include eyedrops or oral medications. The chapter provides guidelines on the frequency of eye examinations among people who have type 1 and type 2 diabetes, women with diabetes who are pregnant, and people who already have eye disease. The chapter includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 1 figure.

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