Antidiabetic Drugs

Question 1

What is diabetic mellitus?

Answer 1

DM is a chronic illness which is an absolute or deficiency of insulin & is often combined with a cellular resistance to insulin’s actions.

Question 2

How does an oral antidiabetic medication work?

Answer 2

The Rxs work in various ways to increase available insulin or modify CHO metabolism

Question 3

There are 4 types of insulin, can you name them?

Answer 3

1) Rapid-acting 2) Short-acting 3) Intermediate -acting 4) Long-acting

Question 4

Here is a phrase to learn to help you remember which insulins are the fastest.

Answer 4

Ready (rapid) Set (short) Inject (intermediate) Love (long

Question 5

What is an example of a rapid-acting insulin? What is the onset, peak & duration?

Answer 5

Lispro-, onset is 15-30 min, peaks in 0.5-3 h, duration is 3-5 hrs

Question 6

What is the example of s short-acting insulin? What is the onset, peak & duration?

Answer 6

Regular insulin, onset- 0.5-1 hr, peaks in 1–5 hrs, duration- 6–10 hrs

Question 7

What is an example of an intermediate -acting insulin? What is the onset, peak & duration?

Answer 7

NPH insulin, onset 1–2 hrs, peak 4–14 hrs, duration 14–24 hrs

Question 8

What is an example of a long-acting insulin? What is the onset, peak & duration?

Answer 8

Insulin glargine U-100, onset 1–4 hrs, *** peak NONE, duration 24 hrs

Question 9

There are other insulin medications for rapid acting (3) can you name them?

Answer 9

1) Insulin aspart, 2) Insulin glulisine 3*** Inhaled human insulin

Question 10

There is an ultra-long (longer duration insulin) : U-300 called glargine, insulin degludec ,so what is their duration?

Answer 10

• More than 24 hours

Question 11

Insulin detemir is a long-acting insulin which is dose dependent - describe what this means?

Answer 11

The greater units/kg the client receives, the longer the duration of the insulin; up to 24 hours with some doses.

Question 12

There are two kinds of pre-mixed insulin, can you name them?

Answer 12

1) 70% NPH and 30% Regular, 2) 75% insulin lispro protamine and 25% insulin lispro

Question 13

What is the pharmacological action of insulin? There are three actions.

Answer 13

1) Promotes cellular uptake of glucose (decreases glucose levels) 2) Converts glucose into glycogen & promotes energy storage 3) Moves potassium into cells (when the body becomes resistant to insulin then potassium may build up in the blood), so IV insulin leads to a decline in K levels)

Question 14

What is the therapeutic use for insulin?

Answer 14

Glycemic control of DM type 1, 2 & gestational diabetes- & to prevent complications, type 2 DM may require insulin when oral Rxs , diet, & exercise are unable to control glucose levels, when severe renal & liver disease are present, painful neuropathy is present, a person is undergoing surgery or diagnostic test, when there is extreme stress: infection or trauma, DKA & hyperosmolar and hyperglycemic nonketotic syndrome, and **hyperkalemia which required tx

Question 15

What are complications or adverse effects of insulin?

Answer 15

Hypoglycemia (BG is <70)

Question 16

Hypoglycemia can occur or result from what? 6 reasons

Answer 16

1) Toxic dose of insulin, 2) Too little food, 3) Vomiting & diarrhea 4) ETOH intake, 5) Strenuous exercise 6) Childbirth

Question 17

What are the sympathetic (SNS) symptoms or effects of an **ABRUPT **hypoglycemia, how will that client look?

Answer 17

For an abrupt hypoglycemic incident- tachycardia, palpitations, diaphoresis, shakiness

Question 18

If the hypoglycemia is a ***Gradual onset, how will the client appear? Think (PNS)

Answer 18

For a gradual onset, the client will experience, parasympathetic (PNS) manifestations: headache, tremors, weakness, lethargy, disorientation

Question 19

What is the treatment for a conscious person with hypoglycemia?

Answer 19

15 g CHO (4 oz of orange juice, or 2 oz. grape juice, or 8 oz of milk, glucose tablets to equal 15 g

Question 20

What is the treatment for an unconscious person with hypoglycemia?

Answer 20

If the client is not fully conscious do not risk aspiration, Administer glucose parenterally (IV glucose) or sub q /IM glucagon

Question 21

• What must you teach your person with diabetes to wear at all times & have on his or her person at all times ?

Answer 21

Wear a medical alert bracelet, Always have a snack with glucose handy.

Question 22

Clients who take large doses of insulin are at risk for what?

Answer 22

Hypoklemia

Question 23

What are signs or evidence of hypokalemia?

Answer 23

Muscle cramping, & cardiac dysrhythmias

Question 24

What are drug interactions with insulin?

Answer 24

Sulfonylureas, meglitinides, beta blockers & ETOH ( they have additive hypoglycemic effects.

Question 25

Beta Blockers can mask SNS response to hypoglycemia, making it difficult for clients to identify hypoglycemia (tachycardia & tremors? True or False

Answer 25

True

Question 26

One should rely on SNS manifestations and not on monitoring glucose levels - True or False

Answer 26

False monitoring glucose levels is important-