Agents to control Blood glucose levels Flashcards by Shaniya Capre

What does the endocrine gland do ?

-Insulin produced by beta cells in response to high blood glucose levels
-Glucagon in alpha cells in response to low blood glucose levels
-Insulin and glucagon maintain glucose levels

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**Diabetes mellitus
What happens when you eat a meal ?

-Insulin is secreted from beta cells
-Moves glucose from blood to muscle, liver, fat cells

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**Diabetes mellitus
What does insulin do in the body ?

-Transport/metabolizes glucose for energy
-Stimulates storage in liver/muscle (Glycogen)
-Enhances storage of dietary fat
-Signals liver to halt release of glucose
-Inhibits breakdown of stored glucose
-Speeds up transport of amino acids (from dietary protein) into cells

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Diabetes-System fails due to:

-Destruction of beta cells lead to lack of insulin productions ( Type l)
-Insulin resistance/ impaired insulin secretion (Type ll)

Results in complex disturbances in usual metabolism of:
-Carbohydrates
-Protein
-Fats

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**Diabetes Mellitus
What can failure of insulin system do to the body?

-Retinopathy-closing of tiny vessels in the eye
-Cardiac- Atherosclerosis
-Renal dysfunction- Related to changes in basement membrane of glomerulus
-Neuropathies-motor and sensory changes as nerves are deprived of oxygen

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What does insulin medication do?

-Insulin corrects blood sugars quickly
-Oral agents take a long time to reach optimal effect
-Oral agents do not clear as quickly from the system
-Oral agents have more side effect

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What are four major classes of insulin?

-Rapid acting- Insulin lispro (Humalog)
-Short acting- *Regular
-Intermediate acting- *NPH( Humulin N)
-Long acting- *Glargine(Lantus)

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What is fixed combination insulin?

-Usually intermediate acting rapid of short
-Numerical designation indicates percentage of each of two component
-Example: Humulin 70/30 and Novolin 70/30

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What is the onset peak and duration of Lispro insulin?

Onset: 15-30 min
Peak 30-90 mins
Duration <5 hours

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What is the onset peak and duration of Regular insulin?

Onset: 30-60 mins
Peak: 2-3 hours
Durations: 4-6 hours

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What is the onset peak and duration of NPH insulin?

Onset: 1-1.5 hrs of insulin
Peak: 4-12 hours
Duration: Up to 24. hours

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What is the onset peak and duration of Glargine insulin?

Onset: 3-6 hours
Peak: Non
Duration: 24 hours

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What Basal insulin(Background insulin)

-Slow continuous delivery of insulin: keeps blood glucose level stable between meals and during sleep
-intermediate or long acting insulin –> NPH, glargine, premixed 70/30

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What is Nutritional insulin?

-Dose of insulin that is taken before meals or snacks to cover the expected rise in blood glucose from the food
-Rapid acting (lispro) given when tray is serve or immediately after

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What is sliding scale insulin( Supplemental insulin/correctional insulin)

-Given in combination with nutritional insulin
-Dose of insulin given to correct elevated blood glucose level (based on blood sugar reading)
-Lispro(rapid acting)
-Regular insulin- TPN, TF
-rapid or short acting insulin

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Describe insulin?

-Only treats hyperglycemia
-Does not meet basal requirements
-Large swings in glucose control

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Describe insulin pump?

-Deliver rapid or short acting insulin over 24 hours
-Insulin doses can be basal, nutritional, or correctional

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Describe insulin pen

-Pre-filled with insulin, deliver insulin SQ
-Use different pen for each insulin, discard after use
-Single patient use! Do not share!

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What are adverse effects of insulin?

Hypoglycemia

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What are contraindications for insulin?

-No contraindications except hypoglycemia

What cautions to have when taking insulin?

-Pregnancy and lactation

What are drug interactions of insulin?

-Steroids, diuretics, niacin, thyroid hormones
—> antagonize insulin =elevated blood sugar
-ETOH, salicylates blocker, oral Anti-diabetic agents—>Potentiate insulin and lead to lower blood sugar levels
-Becareful with beta blockers because it suppresses the sns which blocks the signs and symptoms of hypoglycemia

**Special populations
Describe insulin given to different groups

Children
* Insulin ─ small doses used in infants
* Adolescents ─ constant changing insulin needs
* Metformin ─ only oral agent approved now
Pregnancy
* Gestational diabetes (9.2%), diet or med controlled
* Insulin drug of choice when pregnant
Older adults
* Co-morbidities, meds, physical limitations

What are insulin nursing considerations?

Assess baseline status, VS, labs, self care ability, schedule of meds taken
at home
Monitor for acute events that would change med requirements
Appropriate site, syringe, needle
Date vials
Pre-drawn syringes good for 1 week
Give mixed insulin within 15 minutes
Glargine (Lantus) can NOT be mixed
Assess response
Teach, teach, teach
Nutritional consult
VNA referral
Follow-up, when to call PCP/NP

How do oral diabetic medications work?

-Stimulate pancreas to release insulin -Decrease insulin resistance -Alter glucose absorption in GI tract -Control release of glucose from liver

Describe sulfonylureas

(Oral medication ) -Stimulate insulin release -Excreted in urine and bile, safer for renal compromise -Longer duration of action -Less likely to react with other meds

What is Glyburide (Diabeta, Micronase)

A sulfonylureas, a type of insulin (Oral medication )

What do sulfonylureas do?

-Stimulate functioning beta cells in the pancreatic islet to release insulin -Excreted in urine and bile, safer for renal compromise -Longer duration of action -Less likely to react with other med

Describe Glyburide (Diabeta, Micronase)

*Sulfonylureas Used for type ll diabetes -Adjunct to diet and excerise, can be used with insulin

What are adverse affects of Glyburide (Diabeta, Micronase)

*Sulfonylureas -Hypoglycemia -Gi effects which lead to N/V, heartburn, anorexia, sometimes when patients may not eat after taking

What are contras/ cautions with Glyburide (Diabeta, Micronase)?

*Sulfonylureas -Allergies, need for tight control of glucose, -Type l diabetes,they don't have any beta cells and it will not benefit them -Not used for pregnancy

What are drug to drug interactions when taking Glyburide (Diabeta, Micronase)?

*Sulfonylureas -Caution with beta blockers because they can mask hypoglycemic effect -Meds that acidifies urine- because that decreases excretion -Cross allergy with sulfa drugs

What is Biguanides also called?

Metformin(Gucophage)

What is the therapeutic action of metformin(Glucophage)?

Biguanides -Primarily decreases glucose production in liver, increases uptake of glucose -Decreases intestinal absorption of glucose -Improves insulin sensitivity of peripheral cells -Does not stimulate insulin secretion may allow for less or unchanged insulin secretion

What group of people use Metformin(Glucophage)?

Biguanides -Initial drug for type ll -Used in children> 10 years with type ll diabetes -Good for obesity related diabetes -Monotherepy or in combination

What are adverse affects of Metformine (Glucophage)?

Biguanides -Gi complications usually happens earlier (D/N/V, distention, constipation, abd. discomfort) -Asses for lactic acidosis (Malaise, myalgia's, respiratory hyperventilation, somnolence, severe abd pain

What are contradictions with Metformin (Glucophage)?

Biguanides -Renal disease, acute cardiac events,sepsis due to increased side effects including lactic acidosis -DKA -Caution with people with hepatic impairment

What are drug to drug interactions with Metformin (Glucophage)?

Biguanides -containing dyes, can lead to acute kidney failure stop metformin day of exam and 48 hrs after

What medication would be considered Glucagonlike Polypeptide Receptor Agonists (GLP-1 Agonists)?

**semaglutide (Ozempic, Rybelsus)

What is therapeutic actions of semaglutide (Ozempic, Rybelsus)?

**Glucagonlike Polypeptide Receptor Agonists (GLP-1 Agonists) -Increase insulin release -Decrease glucagon release -Slow GI emptying to allow more absorptions of nutrients

What are indications of semaglutide (Ozempic, Rybelsus)?

**Glucagonlike Polypeptide Receptor Agonists (GLP-1 Agonists) -Adjunct to diet and exercise in type 2 – Some agents used to reduce risk of major CV events in patients with type 2 and CV disease

**Glucagonlike Polypeptide Receptor Agonists (GLP-1 Agonists) What are pharmacokinetics semaglutide (Ozempic, Rybelsus)?

-Mostly given subcutaneous injection

What are adverse effects of semaglutide (Ozempic, Rybelsus)?

**Glucagonlike Polypeptide Receptor Agonists (GLP-1 Agonists) -Pancreatitis ( watch if pt says they feel epigastric pain) -GI N/V, decreased appetite, C/D

What are in contras of semaglutide (Ozempic, Rybelsus)?

**Glucagonlike Polypeptide Receptor Agonists (GLP-1 Agonists) -Boxed warning with risk of thyroid cancer -Not for type l diabetes or dka -Pregnancy/ lactation

What are drug to drug interactions of semaglutide (Ozempic, Rybelsus)?

**Glucagonlike Polypeptide Receptor Agonists (GLP-1 Agonists) -Oral medications effects may be delayed due to slowed emptying of gastric emptying -Other anti-diabetic medication

What would you give in a hypoglycemic event for conscious vs unconscious patients?

Conscious pt: Glucose tablet or gel which will be absorbed quickly Unconscious pt: D50% given IVP, and glucagon subcutaneous, may induce vomiting so turn pt to the side

Who is at risk for hypoglycemia ?

* Hepatic Disease * Renal Failure * Endocrine Deficiency * Beta Cell tumors(insulinoma) * Gastric disorders which interfere with absorption * Critically ill with: cardiac, sepsis or severe trauma * History of severe hypoglycemia * Type 1 diabetes * Severe malnutrition

What are signs and symptoms of hypoglycemia ?

* Sweating * Nervousness * Hunger * Mental confusion * Argumentative * Tremors * Diaphoresis * Loss of consciousness leading to seizures, coma and death * “COLD AND CLAMMY... NEED SOME CANDY

What are signs and symptoms of hyperglycemia?

* Unusual thirst (polydipsia) * Frequent urination (polyuria) * Excessive hunger (polyphagia) * Fatigue and weakness * Blurred vision * Abdominal pains * Nausea and vomiting * Rapid weight loss * Skin infections * Changed mental status * Warm, dry, flushed skin * “HOT AND DRY...SUGAR HIGH”

Agents to control Blood glucose levels Flashcards

Chapter 38