Blood Glucose Agents Flashcards
1
Q
How does Insulin regulate blood glucose?
A
- It is a hormone produced by the BETA cells in the pancreas
- Released into circulation when blood glucose levels rise
- Stimulates glycogen synthesis, conversion of lipids into fat stored as adipose tissue, and synthesis of proteins from amino acids
- Released after meals causing blood glucose levels to fall
2
Q
How does glucagon regulate blood glucose?
A
- Released from the ALPHA cells of the Pancreas
- Released when blood glucose levels fall
- Causes immediate mobilization of glycogen stored in the liver
- Raises blood glucose levels
3
Q
Other processes that regulate blood glucose
A
- Adipocytes secrete adiponectin, increases insulin sensitivity, decreases release of glucose from the liver, protects blood vessels from inflammation
- Endocannabinoid receptors keep the body in a state of energy gain to prepare for stressful situations
- Sympathetic nervous system decreases insulin release, increases release of stored glucose, and increases fat breakdown
- Corticosteroids decrease insulin sensitivity, increase glucose release, and decrease protein building
- Growth hormone decreases insulin sensitivity, increases FFAs, increases protein building
4
Q
Clinical Signs of Diabetes Mellitus
A
- Hyperglycemia: Fasting blood glucose > 126mg/dL
- Glycosuria: sugar in the urine (may appear frothy)
5
Q
Disorders associated with Diabetes Mellitus
A
- Atherosclerosis: MIs and CVAs related to the build up of plaques in the vessel lining
- Retinopathy: loss of vision as tiny vessels in the eye are narrowed and closed
- Neuropathies: Oxygen is cut off to feet and legs, progressive changes to nerves, motor and sensory changes
- Nephropathy: Renal dysfunction related to changes in the basement membrane of the glomerulus
- Infections: Increase in frequency and severity r/t decreased blood flow and altered neutrophil function
- Foot ulcers: Decreased wound healing r/t vascular insufficiency, unnoticed wounds r/t neuropathy and decreased perception of pain
6
Q
Metabolic changes when insufficient insulin is released
A
- Hyperglycemia: inc. blood sugar
- Glycosuria: sugar in the urine
- Polyuria: increased urine
- Polyphagia: increased hunger
- Polydipsia: increased thirst
- Lipolysis: Fat breakdown
- Ketosis: ketones cannot be removed efficiently and build up
- Acidosis: Liver cannot remove all waste products
- Protein in urine
- Elevated BUN
7
Q
What is Type 1 DM?
A
- Rapid onset
- Usually diagnosed in younger years
- Caused by autoimmune destruction of BETA cells in the pancreas
- Pts need INSULIN replacement
8
Q
What is Type 2 DM?
A
- Usually occurs in mature adults
- Has a slow and progressive onset
- Decreased insulin sensitivity in peripheral cells (insulin resistance)
9
Q
Hypoglycemia
Signs and Symptoms
A
Blood glucose < 70mg/dL
* Shakiness
* Dizziness
* Sweating
* Hunger
* Tachycardia
* Inability to concentrate
* Confusion
* Irritability or moodiness
10
Q
Signs of DANGEROUS complications of
Hyperglycemia
A
- Fruity breath (ketones are being excreted through the lungs)
- Dehydration
- Fast, deep breaths (Kussmaul’s respirations)
- Loss of orientation, coma
11
Q
Lifespan Considerations for Antidiabetic Agents
In Children
A
- Monitor closely for hyper- and hypoglycemia
- Insulin often needs to be diluted due to small dosages
- Two nurse check for insulin
- Challenging to treat in teams d/t noncompliance and changing hormones
- Team approach - family, patient, teachers, coaches, etc.
- Metformin is the only oral DM drug approved
12
Q
Lifespan Considerations for Antidiabetic Agents
In Adults
A
- Two nurse check for insulin
- Emphasize diet and exercise
- Caution about OTC, herbal, and alternative therapies
- Insulin is best choice in pregnancy and lactation
13
Q
Lifespan Considerations for Antidiabetic Agents
In Older Adults
A
- Two nurse checks for insulin
- 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
- Emphasize diet, exercise, skin, and foot care
- More likely to experience end organ damage (i.e. kidneys)
14
Q
Insulin
Mechanism of Action
A
- Hormone that promotes the storage of the body’s fuels
- Facilitates the transport of various metabolites across cell membranes
- Stimulates the synthesis of glycogen from glucose
- Reacts with specific receptor sites on the cell membranes
15
Q
Insulin
Indications
A
- Type 1 DM
- Type 2 DM in patients whose diabetes cannot be controlled by diet or other agents
16
Q
Insulin
Contraindications
A
Absolute:
* Hypoglycemia
Caution:
* Pregnancy and lactation (monitor closely)
17
Q
Insulin
Adverse Effects
A
- Hypoglycemia and ketoacidosis
- Local injection site reactions
- Decreased blood potassium levels
18
Q
Insulin
Drug Interactions
A
Will need increased insulin doses
* Beta Blockers
* Thiazide Diuretics
* Glucocorticosteroids
* Glucose altering medications (salicylates, alcohol, oral antidiabetic agents, beta blockers)
19
Q
Regular Insulin
Onset, peak time, duration
A
Onset: 30-60 min
Peak: 2-4 hours
Duration: 6-12 hours
20
Q
NPH Insulin
Onset, peak time, duration
A
Onset: 1-1.5 hours
Peak: 4-12 hours
Duration: 24 hours
21
Q
Inhaled Insulin
Onset, peak time, duration
A
Onset: 12-15 minutes
Peak: 60 minutes
Duration: 2.5-3 hours
22
Q
Lispro Insulin
Onset, peak time, duration
A
Onset: < 15 min
Peak: 30-90 min
Duration: 2-5 hours
23
Q
Aspart Insulin
Onset, peak time, duration
A
Onset: 10-20 min
Peak: 1-3 hours
Duration: 3-5 hours
24
Q
Glargine Insulin
Onset, peak time, duration
A
Onset: 60-70 min
Peak: NONE
Duration: 24 hours
25
**Glulisine Insulin**
Onset, peak time, duration
**Onset:** 2-5 min
**Peak:** 30-90 min
**Duration:** 2 hours
26
**Detemir Insulin**
Onset, peak time, duration
**Onset:** 1-2 hours
**Peak:** 3-6 hours
**Duration:** 5.7-23.3 hours
27
**Insulin**
Assessment
**History:**
* Check for hypoglycemia, pregnancy, lactation
* Assess nutritional intake and activity level
* Assess history of blood sugar regulation
**Physical:**
* Skin lesions
* Orientation and reflexes
* Pulse and BP
* Respiratory status
**Labs:**
* Blood glucose within the hour
* Monitor High A1C
* Urinalysis
* BMP
28
**Insulin**
Nursing Diagnoses/ Conclusions
* Glucose and electrolyte imbalance risk *(r/t use of insulin and underlying disease)*
* Malnutrition risk *(r/t changes in glucose transport)*
* Altered sensory perception *(r/t glucose levels)*
* Infection risk *(r/t injections and disease processes)*
* Injury risk *(r/t potential hypoglycemia, hyperglycemia, and injection technique)*
* Coping impairment *(r/t diagnosis and need for injection therapy)*
* Knowledge deficit
29
**Insulin**
Implementation/ Patient Teaching
* Educate on foot care, drug-drug interactions, nerve sensitivities
* Ensure patient is following dietary and exercise regimen and using good hygiene practices
* Gently rotate the vial, never shake
* Select a site free of bruising and scarring; rotate site each time
* Give maintenance doses by subq injection or inhaled routes only
* Monitor pt for signs and symptoms of hypoglycemia, especially during peak times
* Always verify name of insulin being given
* During stress - insulin may need to be increased
* Do not mix insulins in the same injection
* Store in a cool place away from sunlight
* Make sure patient eats when taking insulin
* Protect pt from infection
* Instruct pts receiving betablockers to monitor glucose levels closely
30
**Sulfonylureas**
Drug Names
**Tolbutamide**: first generation - *inc. risk of CV disease*
**Glipizide** - 2nd generation
**Glyburide** 2nd generation
*2nd generation has fewer drug interactions and longer duration*
31
**Sulfonylureas**
Mechanism of Action
* Stimulate insulin release from the beta cells in the pancreas
* Improve binding to insulin receptors
32
**Sulfonylureas**
Indications
* Adjunct to diet and exercise for Type 2 DM
33
**Sulfonylureas**
Contraindications
**Absolute:**
* Allergy
* Diabetic complications
* Type 1 DM
* Pregnancy and lactation
34
**Sulfonylureas**
Adverse Effects
* Hypoglycemia
* GI distress
* Allergic skin reactions
35
**Sulfonylureas**
Drug Interactions
* Beta Blockers
* Alcohol
* Herbal remedies
36
**Biguanides**
Drug Name
**Metformin**
37
**Biguanides: Metformin**
Mechanism of 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
38
**Biguanides: Metformin**
Indication
* 1st line treatment for Type 2 DM
*Can be used off label for PCOS*
39
**Biguanides: Metformin**
Contraindications
**All will increase risk of lactic acidosis**
**Absolute:**
* Hypersensitivity
* Metabolic acidosis
* Severe renal impairment
**Cautions:**
* Hepatic impairment
* Excessive alcohol intake
* NPO status
* Radiologic contrast
* Age 65 and older
* Hypoxic state *(HF, resp. distress)*
40
**Biguanides: Metformin**
Adverse Effects
* **Black Box warning:** Lactic acidosis *(rare)*
* GI effects
* Dizziness, headache
* Upper Respiratory Infections
* Taste disturbances
41
**Biguanides: Metformin**
Drug Interactions
* Alcohol
* Carbonic anhydrase
* Iodine containing contrast media *(can lead to kidney failure)*
42
**DPP-4 Inhibitor**
Drug Name
**Sita"-gliptin"**
43
**DPP-4 Inhibitor: Sitagliptin**
Mechanism of Action
* Slow inaction of incretin hormones: increase insulin release and decrease glucagon release
44
**DPP-4 Inhibitor: Sitagliptin**
Indication
* Adjunct to diet and exercise for Type 2 DM
45
**DPP-4 Inhibitor: Sitagliptin**
Contraindications
**Absolute:**
* Allergy
* Type 1 DM or DKA
**Caution:**
* Renal impairment
46
**DPP-4 Inhibitor: Sitagliptin**
Adverse Effects
**Rarely reported**
46
**Meglitinides**
Indication
* Adjunct to diet and exercise in Type 2 diabetes
46
**DPP-4 Inhibitor: Sitagliptin**
Drug Interactions
* Other medications that lower blood glucose
47
**Meglitinides**
Mechanism of Action
* Stimulates insulin release from the beta cells in the pancreas
48
**Meglitinides**
Drug Names
**"-glinide"**
Repa**glinide**
Nate**glinide**
49
**Meglitinides**
Contraindications
**Absolute:**
* Hypersensitivity
* Type 1 DM or DKA
50
**Meglitinides**
Adverse Effects
* Upper Respiratory Infections
* Headache
* Arthralgias
* Nausea, diarrhea
* Hypoglycemia
51
**Meglitinides**
Drug Interactions
**Numerous**
52
**SGLT-2 Inhibitors**
Drug Name
**"-gliflozin"**
**Canagliflozin**
53
**SGLT-2 Inhibitors: Canagliflozin**
Mechanism of Action
* Blocks co-transporter system so glucose is not reabsorbed but is lost in the urine
54
**SGLT-2 Inhibitors: Canagliflozin**
Indication
* Adjunct to diet and exercise in Type 2 DM
*(Research being done for Type 1 DM - not FDA approved)*
55
**SGLT-2 Inhibitors: Canagliflozin**
Contraindications
**Absolute:**
* Type 1 DM or DKA
* Severe renal impairment
* Pregnancy *(2nd and 3rd trimester: can affect fetal kidney development)*
56
**SGLT-2 Inhibitors: Canagliflozin**
Adverse Effects
* Dehydration and Hypotension
* UTIs
* Genital fungal infections
* DKA
* Lower Limb amputations *(esp in patients with vascular disorder)*
57
**SGLT-2 Inhibitors: Canagliflozin**
Drug Interactions
* Numerous: Rifampin
58
**Thiazolidinediones**
Drug Name
**"-glitazone"**
**Pioglitazone**
59
**Thiazolidinediones: Pioglitazone**
Mechanism of Action
* Decrease insulin resistance in peripheral cells and liver
* Increase responsiveness to insulin
60
**Thiazolidinediones: Pioglitazone**
Indication
* Adjunct to diet and exercise in Type 2 DM
61
**Thiazolidinediones: Pioglitazone**
Contraindications
**Absolute:**
* Mild to moderate HF
**Cautions:**
* Liver impairment
62
**Thiazolidinediones: Pioglitazone**
Adverse Effects
* Upper Respiratory Infections
* Headaches, muscle pain
* Increased Total Cholesterol
* Rapid weight gain and edema
63
**Thiazolidinediones: Pioglitazone**
Drug Interactions
**Numerous**
Other Antidiabetic medications
64
**GLP-1 Agonists**
Drug Names
**"-glutide" and "-natide"**
**Semaglutide**
**Exanatide**
65
**GLP-1 Agonists**
Mechanism of Action
* Increase insulin release
* Decrease glucagon release
* Slow down GI emptying
66
**GLP-1 Agonists**
Indication
* Adjunct to diet and exercise in Type 2 DM
* Reduce risk of major CV events in Type 2 DM
67
**GLP-1 Agonists**
Contraindications
* Type 1 DM or DKA
* Pregnancy or lactation
68
**GLP-1 Agonists**
Adverse Effects
* GI effects
* Pancreatitis
69
**GLP-1 Agonists**
Drug Interactions
* Other antidiabetic medications
* Oral medications: effects may be slowed
70
**Noninsulin Antidiabetic Agents**
Assessment
**History:**
* Assess for contraindications and cautions
* Assess activity level and nutrition intake
**Physical:**
* Baseline complete physical assessment
* Look for any skin lesions
**Labs:**
* Blood glucose levels
* Urinalysis
* Renal and hepatic function tests
71
**Noninsulin Antidiabetic Agents**
Nursing Diagnoses/ Conclusions
* Hyperglycemia risk *(r/t diabetes mellitus disease process)*
* Hypoglycemia risk *(r/t dosing of antidiabetic agents)*
* Coping impairment *(r/t diagnosis and therapy)*
* Knowledge deficit
72
**Noninsulin Antidiabetic Agents**
Implementation/ Patient Teaching
* Administer the drug as prescribed in relationship to meals *(short acting insulin immediately before meals)*
* Ensure patient is following diet and exercise modifications
* Monitor nutritional status
* Monitor response carefully: Blood glucose
* Monitor patients during times of trauma, pregnancy, or severe stress
73
**Glucose Elevating Agents**
Drug Name
**Glucagon**
74
**Glucose Elevating Agent: Glucagon**
Mechanism of Action
* Increases the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose
75
**Glucose Elevating Agent: Glucagon**
Indications
* Hypoglycemia
76
**Glucose Elevating Agent: Glucagon**
Contraindications
**Absolute:**
* Allergy
* Pregnancy
**Caution:**
* Lactation
* Hepatic dysfunction
* Renal dysfunction
* Cardiac disease
77
**Glucose Elevating Agent: Glucagon**
Adverse Effects
* GI Effects
* Alteration of Blood Pressure
78
**Glucose Elevating Agent: Glucagon**
Drug Interactions
* Anticoagulants
79
**Glucose Elevating Agent: Glucagon**
Assessment
**History:**
* Contraindications and cautions
**Physical:**
* Orientation and reflexes
* Baseline pulse and BP
* Lung sounds
* Bowel sounds
**Labs:**
* Glucose levels
80
**Glucose Elevating Agent: Glucagon**
Nursing Diagnoses/ Conclusions
* Risk for unstable blood glucose *(r/t ineffective dosing of the drug)*
* Malnutrition risk: more than body requirements *(r/t metabolic effects)*
* Malnutrition risk: less than body requirements *(r/t GI effects)*
* Altered sensory perception *(r/t glucose levels)*
* Knowledge Deficit
81
**Glucose Elevating Agent: Glucagon**
Implementation
* Monitor blood glucose levels closely
* Have insulin on standby for emergency use
* Monitor nutritional status
