Nateglinide

INTRODUCTION

Indications

To improve glycemic control in patients with type 2 diabetes (with diet and exercise); may also be used with metformin or a thiazolidinedione (pioglitazone, rosiglitazone).

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. Requires functioning pancreatic beta cells. Therapeutic Effects: Lowering of blood glucose.

Adverse Reactions/Side Effects

CNS: dizziness. Resp: bronchitis, coughing, upper respiratory infection. GI: diarrhea. Endo: HYPOGLYCEMIA. MS: arthropathy, back pain. Misc: flu symptoms.

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. Report episodes of severe hypoglycemia to the physician immediately.

• Monitor symptoms of upper respiratory tract infection and bronchitis, including cough, production of mucous, wheezing, chest discomfort, shortness of breath, fatigue, chills, and fever. Report severe or prolonged symptoms to the physician.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any back or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• 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).

• 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 ...