Repaglinide

INTRODUCTION

Indications

Type 2 diabetes mellitus, with diet and exercise; may be used with metformin, rosiglitazone, or pioglitazone.

Action

Stimulates the release of insulin from pancreatic beta cells by closing potassium channels, which results in the opening of calcium channels in beta cells. This is followed by release of insulin. Therapeutic Effects: Lowering of blood glucose levels.

Adverse Reactions/Side Effects

CV: angina, chest pain. Endo: HYPOGLYCEMIA, hyperglycemia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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. Be alert for signs of hypoglycemia, especially during and after exercise. Report episodes of severe hypoglycemia to the physician immediately.

• Monitor symptoms of angina pectoris or chest pain at rest and during exercise. Report these symptoms to the physician.

• 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).

• Because of the risk of angina pectoris, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Provide a source of oral glucose (fruit juice, glucose gels/tablets, etc.) to treat mild hypoglycemia. Call for emergency assistance if symptoms persist or in cases of severe hypoglycemia. Emergency treatment typically consists of IV glucose, glucagon, or epinephrine.

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 of appetite; unusual thirst). Drug dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

Pharmacokinetics

Absorption: Well absorbed (56%) following oral administration.

Distribution: Unknown.

Protein Binding: >98%.

Metabolism and ...