Antidiabetic Drugs Flashcards
Type I Diabetes
Develops during childhood or adolescence; beta cells do not produce insulin
MUST have insulin as little or none is being produced
Type II Diabetes
Decreased sensitivity to insulin; slow, progressive glucose intolerance
Comorbid conditions include obesity, coronary heart disease, dyslipidemia, hypertension, microalbuminemia, increased risk of blood clots
Do not use finger stick to diagnose diabetes
Acute Complications of Diabetes
Hypoglycemia, diabetic ketoacidosis (Type I), hyperglycemic hyperosmolar nonketoic syndrome (Type II)
Gestational Diabetes
Hyperglycemia that develops during pregnancy
Insulin must be given to prevent birth defects
Screening for Diabetes
Prediabetes: HbA1C 5.7-6.4%; fasting blood glucose levels between 100 and 126; impaired glucose tolerance test
Rapid Acting Insulin
Most rapid onset of action (5-15 minutes)
Patient must eat a meal after injection
Lispro (Humalog) and Aspart (Novolog)
DO NOT give intravenously
Short Acting Insulin
Regular insulin (Humulin R) should be CLEAR
The only insulin that can be given IV
Intermediate Acting Insulin
Insulin Isophane Suspension (NPH)
Only insulin suitable for mixing with short-acting insulin
Should be cloudy
Subcutaneous
Long Acting Insulin
Glargine (Lantus); referred to as basal insulin
Can only be given subcutaneously
Cannot be mixed with any other insulin in the same syringe
Sliding-Scale Insulin Dosing
Subcutaneous short-acting or regular insulin in doses adjusted according to blood glucose test results
Typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings
Insulin Concentration
100 units/mL (U-100)
Storage of Insulin
Unopened vials should be stored under refrigeration until needed
Keep out of sunlight and direct heat
Oral Antidiabetic Drugs
Used for Type II DM ONLY
Need to carefully monitor blood glucose levels, use multi-drug therapy, and treat comorbid conditions as well
Oral Hypoglycemics
Metformin (Glucophage) is a biguanide
Glipizide (Glucotrol) is a second generation sulfonylurea
Repalinide (Prandin) and Nateglinide (Starlix) are meglitinides
Acarbose (Precose) is an alpha-glucosidase inhibitor and must be taken with the first bite of food
Adverse Effects of Metformin (Glucophage)
Diarrhea, reduced vitamin B12 levels
Does not cause hypoglycemia
Hypoglycemia
Abnormally low blood glucose level (below 60mg/dL)
Causes include too much insulin or oral hypoglycemic agents, too little food, and excessive physical activity
Manifested by sweating, tremors, inability to concentrate, confusion, memory lapses, disorientation
Management of Hypoglycemia
Treatment must be immediate
If patient is able to swallow, give 15 g of fast-acting, concentrated carbohydrate
Glucose-Elevating Drugs
Glucagon (IM or IV push) increases blood sugar
These are given when patients have very low blood glucose and are unable to swallow
Diabetic Ketoacidosis
Caused by an absence of or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat
Characterized by “fruity” breath, ketone bodies in blood and urine, and hyperventilation with Kussmaul respirations
As a result of dehydration, not blood sugar
Treatment of DKA
Rehydrate with IV fluid and regular insulin
Rehydration leads to increased plasma volume and decreased potassium, insulin enhances the movement of potassium from ECF into the cells
Monitor blood glucose and renal function, EKG and electrolyte levels for potassium, and vitals, lung assessment, and signs of fluid overload
Hyperosmolar Hyperglycemic State
Due to lack of effective insulin
Ketosis is minimal or absent
Blood glucose can be as high as 1000 mg/dL or higher
Much more common in Type II Diabetes
Nursing Implications
Give oral antidiabetic drugs 30 minutes before meals
Metformin will need to be discontinued if the patient is to undergo studies with contrast dye because of possible renal effects (check with prescriber)
