Anti-Diabetic Drugs

Question 1

Describe Insulin (Indications, Action, Adverse Reactions/Side Effects)

Answer 1

Indications:
- Insulin replacement therapy for DM I
- Is often used post-operatively for DM II patients
- Advanced type II DM

MOA:
- Reduces blood glucose by stimulating cells to take in, use, and store glucose
- Stimulates glucose uptake in skeletal muscles and fat tissues
- Inhibits hepatic glucose production
- Inhibits lipolysis and proteolysis
- Enhances protein synthesis

Adverse effects:
- Hypoglycemia – occurs when too much insulin is given to patient, or if given at wrong time, or if a meal is skipped. Symptoms: tachycardia, confusion, sweating, drowsiness -> convulsions, coma, death if not treated. Treat with glucagon or glucose source
- Hypokalemia

Question 2

What should you describe in Insulin nursing implication?

Answer 2

Nursing implications:
- Assess for symptoms of hypoglycemia: Anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; excessive hunger; headache; irritability
- Assess for symptoms of hyperglycemia: Confusion; drowsiness; flushed; fruit-like breath odor; rapid deep breathing; loss of appetite; nausea
- Overdose is manifested by symptoms of hypoglycemia:
Mild hypoglycemia: treat by ingestion of oral glucose
Severe hypoglycemia: treat with IV glucose; glucagon; or epinephrine
- Overdose is manifested by symptoms of hypoglycemia.
- Mild hypoglycemia: treat by ingestion of oral glucose
- Severe hypoglycemia: treat with IV glucose; glucagon; or epinephrine

Question 3

Describe Rapid-acting (Clear) (Type of Insulin, Purpose, When to Give, Onset, Peak, and Duration)

Answer 3

Insulin Lispro (Humalog) U-100 U-200

Purpose:
- Work over a narrow and more predictable range of time
- Acts the most like insulin that is produced by the human pancreas -> Quickly drops the blood glucose levels and works for a short time

When are they given:
- Because they work quickly, they are used most often at the start of a meal
- Because the peak effect is less than 2 hours, you need to ensure that the patient will eat within 15 minutes -> to prevent insulin-related hypoglycemic reaction
- Advantage: If given at the start of dinner -> May prevent severe drops in blood glucose levels in the middle of the night -> preventing nocturnal hypoglycemia
- Given with one or more meals per day
- To be given 0-15 minutes before or after meals
- Should be used with an intermediate- or long-acting insulin

Onset: Within 15 minutes

Peak: 1-2 hours

Duration 3-4 hours

Question 4

Describe Short-acting (Clear) (Type of Insulin, Purpose, When to Give, Onset, Peak, and Duration)

Answer 4

Insulin Regular (Humulin R)

Purpose:
- Take effect and wear off more quickly than long-acting, but slower than rapid acting

When to Give:
- Given with one or more meals per day
- Often given 30-45 minutes before a meal so that it has time to work
- Prescribed on a sliding scale for more precise and consistent blood glucose control

Onset: 30-60 mins

Peak: 2-4 hours

Duration: 5-7 hours

Question 5

Describe Intermediate-acting (Cloudy) (Type of Insulin, When to Give, Onset, Peak, and Duration)

Answer 5

Insulin neutral protamine Hagedorn - NPH (Humulin N, Novolin NPH)

When to Give:
- Often started once daily at bedtime
- May be given once or twice daily
- Not given at any time specific to meals
- Commonly prescribed as a fixed dosage -> it is not used on a sliding scale

Onset: 2-4 hours

Peak: 4-10 hours

Duration: 10-16 hours

Question 6

Describe Long-acting (Cloudy) (Type of Insulin, When to Give, Onset, Peak, and Duration)

Answer 6

Insulin glargine

When to give:
- Often started once daily at bedtime
- May be given once or twice daily
- Not given at any time specific to meals
- Commonly prescribed as a fixed dosage -> it is not used on a sliding scale

Onset: 3-4 hours

Peak: Not applicable

Duration 24 hours