Blood Glucose Agents Flashcards
Use of Antidiabetic Agents Across the Lifespan:
CHILDREN
- monitoring and treating diabetes and children is challenging because of their growth, activity levels and their diets.
○Monitor closely for hyper- and hypoglycemia r/t fluctuations
○Insulin often needs to be diluted due to small dosages (needs to be checked by a 2nd nurse)
○Two nurse check for insulin
○Challenging to treat in teens
○Team approach- family, teachers, coaches, etc.
○Metformin is the only oral DM drug approved for children
Use of Antidiabetic Agents Across the Lifespan:
ADULTS
*PROVIDE A LOT OF EDUCATION
○Emphasized diet and exercise
○Caution about OTC, herbal, and alternative therapies (should be avoided)
○Insulin is best choice in pregnancy and lactation
Use of Antidiabetic Agents Across the Lifespan:
OLDER ADULTS
○Underlying problems complicate diabetic therapy (i.e. poor vision)
○Dietary deficiencies lead to fluctuations in glucose levels
○Renal or hepatic impairment may make oral agents not feasible (risk of organ damage/toxicity)
○Emphasize diet, exercise, skin and foot care (r/t ulcer prevention)
○More likely to experience end organ damage (i.e. kidneys)
Drug class: Insulin
What are the actions and indications?
●Actions
○Hormone that promotes the storage of the body’s fuels
○Facilitates the transport of various metabolites and ions across cell membranes
○Simulates the synthesis of glycogen from glucose
○Reacts with specific receptor sites on the cells
●Indications
○Treatment of type 1 diabetes mellitus
○Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents
Drug class: Insulin
What are the cautions and contraindications?
●Contraindications
○There are no contraindications except episodes of hypoglycemia
●Caution
○Pregnancy and lactation
Drug class: Insulin
What are the adverse effects and drug-drug interactions?
●Adverse Effects
○Hypoglycemia
○Ketoacidosis (mainly type 1 diabetes)
○Local site reactions (should be rotated- not given in same spot every time)
○Decreased blood potassium levels
●Drug-Drug Interactions
○Beta blockers (can mask the signs of hypoglycemia)
○Thiazide diuretics
○Glucocorticoids
○Glucose altering medications
(salicylates, alcohol, oral antidiabetic agents, beta blockers)
Nursing Considerations for Insulin
●Assessment:
- you should have a blood glucose reading from the last hour if not right before you give it
○Assess for contraindications or cautions * before giving insulin make sure to assess for allergies, pregnancy or current hypoglycemia
○Assess for skin lesions; orientation and reflexes; baseline pulse and blood pressure; respiratory status (inhaled)
○Assess body systems for changes suggesting possible complications associated with poor blood glucose control
○Investigate nutritional intake
○Assess activity level, including amount and degree of exercise
○Obtain blood glucose levels as ordered; monitor Hgb A1C, urinalysis, and BMP
Nursing Considerations for Insulin:
●Nursing Diagnoses:
○ Glucose and electrolyte imbalance risk related to the use of insulin and underlying disease processes
○Malnutrition risk related to changes in glucose transport
○Altered sensory perception (kinesthetic, visual, auditory, and tactile) related to glucose levels
○Infection risk related to injections and disease processes
○Injury risk related to potential hyperglycemia or hypoglycemia and injection technique
○Coping impairment related to diagnosis and the need for injection therapy
○Knowledge deficit risk regarding drug therapy
Nursing Considerations for Insulin:
●Implementation
○Ensure that the patient is following a dietary and exercise regimen and is using good hygiene practices
○Gently rotate the vial containing the agent and avoid vigorous shaking
○Select a site that is free of bruising and scarring
○Give maintenance doses by the subcutaneous or inhaled routes only; rotate injection sites regularly (helps prevent scarring, bruising, and lipodystrophy)
○Monitor response carefully
○Monitor the patient for signs and symptoms of hypoglycemia, especially during peak insulin times
○Always verify the name of the insulin being given
○Use caution when mixing types of insulin
○Store insulin in a cool place away from direct sunlight
○Monitor the patient during times of trauma or severe stress
○Monitor the patient’s food intake; ensure that the patient eats when using insulin
○Monitor the patient’s exercise and activities
○Protect the patient from infection, including good skin care and foot care
○Monitor the patient sensory losses
○Help the patient to deal with necessary lifestyle changes
○Instruct patients who are also receiving beta blockers about ways to monitor glucose levels and signs and symptoms of glucose abnormalities
○Provide thorough patient teaching
Nursing Considerations for Insulin:
●Evaluation
○ Monitor patient response to the drug (stabilization of blood glucose levels)
○Monitor for adverse effects (hypoglycemia, ketoacidosis, lung function decline with inhaled insulin, and injection site irritation)
○Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and proper administration technique).
○Monitor compliance with the regimen
Drug class: Sulfonylureas
What are the drug names in this class?
First Generation
○Tolbutamide
Second generation
○Glipizide
○Glyburide
*THINK - “Good game, Toby”
Drug class: Sulfonylureas
What are the differences between first and second gen medications?
●First Generation (aren’t used as much- there are safer ones now)
○Associated with increased risk of cardiovascular disease
●Second Generation
○Advantage over 1st generation drugs
-They do not interact with as many protein-bound drugs
-They have a longer duration of action, making it possible to take them only once or twice a day
Drug class: Sulfonylureas
What are the actions and indications?
●Actions
○Stimulate insulin release from the beta cells in the pancreas
○They improve binding to insulin receptors
●Indications
○Adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes who are making lifestyle changes
Drug class: Sulfonylureas
What are the contraindications and adverse effects?
●Contraindications
○Allergy
○Diabetic complications
○Type 1 diabetes mellitus (ineffective bc pts don’t have functioning beta cells)
○Pregnancy and lactation
●Adverse Effects
○Hypoglycemia
○GI distress
○Allergic skin reactions
Drug class: Sulfonylureas
What are the drug-drug interactions?
●Drug-Drug Interactions
○Beta blockers (mask the signs of hypoglycemia)
○Alcohol
○Herbal remedies
Drug class: Metformin (Biguanides)
What are the actions and indications?
●Action
○Decreases production and increases uptake of glucose
○Lowers both basal and postprandial glucose levels
○Decreases hepatic glucose production
○Improves insulin sensitivity of peripheral cells
●Indication
○1st line treatment for type II diabetes
-can also be used off-label for PCOS
Drug class: Metformin (Biguanides)
What are the cautions and contraindications?
●Contraindications
○Hypersensitivity
○Metabolic acidosis
○Severe renal impairment
●Cautions
○Hepatic impairment (metformin is eliminated in the liver)
○Excessive alcohol intake (alcohol can enhance the effects of metformin on lactate accumulation, increasing the risk of lactic acidosis)
○NPO status (fasting or not eating can lead to dehydration or kidney issues which increases the risk of lactic acidosis)
○Radiologic contrast
○Age 65 and older
○Hypoxic state
*all of these essentially increase the risk of lactic acidosis
Drug class: Metformin (Biguanides)
What are the adverse effects and drug-drug interactions?
●Adverse Effects
○Black box warning: lactic acidosis
○GI effects (take med with food)
○Dizziness, headache
○Upper respiratory infections (side effect of long term use)
○Taste disturbance metallic taste
●Drug-Drug Interactions
○Alcohol
○Carbonic anhydrase (“zolamides” - can increase the risk of lactic acidosis)
○Iodine containing contrast media (can lead to kidney failure)
Drug class: DPP-4 inhibitors (-gliptin)
What is the drug name in this class?
Sitagliptin
