Pioglitazone

INTRODUCTION

Indications

Management of type 2 diabetes mellitus; may also be used with a sulfonylurea, metformin, or insulin when the combination of diet, exercise, and metformin does not achieve glycemic control.

Action

Improves sensitivity to insulin by acting as an agonist at receptor sites involved in insulin responsiveness and subsequent glucose production and utilization. Requires insulin for activity. Therapeutic Effects: ↓ insulin resistance, resulting in glycemic control without hypoglycemia.

Adverse Reactions/Side Effects

CV: edema. GI: hepatitis, ↑ liver enzymes. Hemat: anemia. Misc: fractures (arm, hand, foot) in female patients.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention. Also report signs of pulmonary edema such as dyspnea and abnormal breath sounds (rales/crackles; See Appendix K).

• Assess any pain that might indicate fractures, especially in the arms, hand, and feet in women. Protect and support any suspected fracture sites, and report the problem to the physician for further evaluation.

• Monitor signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain. Report these signs to the physician.

• Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Assess blood pressure periodically (See Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management and should be reported to the physician.

Interventions

• Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).

Patient/Client-Related Instruction

• Encourage patient to monitor blood glucose before and after exercise and to adjust food intake to maintain normal glycemic levels.

• Emphasize the importance of adhering to nutritional guidelines and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) throughout the management of diabetes mellitus.

• Advise patient about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss ...