Pharmacologic: glucagon-like peptide-1 (GLP-1) receptor agonists
Adjunct treatment to diet and exercise in the management of adults with type 2 diabetes mellitus; not recommended as first line therapy, a substitute for insulin, use in patients with type 1 diabetes or ketoacidosis.
Acts as an acylated human Glucagon-Like Peptide-1 (GLP-1, an incretin) receptor agonist; ↑ intracellular cyclic AMP (cAMP) leading to insulin release when glucose is elevated, which then subsides as blood glucose ↓ toward euglycemia. Also ↓ glucagon secretion and delays gastric emptying. Therapeutic Effects: Improved glycemic control.
Adverse Reactions/Side Effects
CNS: headache. GI: diarrhea, nausea, vomiting, constipation, pancreatitis. Local: injection-site reactions.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of pancreatitis, including upper abdominal pain (especially after eating), indigestion, weight loss, and oily stools. Report these signs to the physician immediately.
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.
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.
Assess injection site for redness, swelling, or other reactions. Make sure patient understands the need to rotate injections sites to prevent local damage and lipodystrophy.
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).
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, including confusion, drowsiness, flushed, dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Drug dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.
Instruct patient to report other troublesome side effects such as severe or prolonged headache or GI problems (nausea, vomiting, diarrhea, constipation).
Absorption: 55% absorbed following subcutaneous injection.
Metabolism and Excretion: Endogenously metabolized.