CH 66: Diabetes Medications Flashcards
If in doubt, what do you do?
Check blood glucose
- if pt isn’t feeling well
- went for exam, didn’t get breakfast
- sweating, confused
Why should you watch for hypoglycemia with beta blockers?
it masks s/s of hypoglycemia
Short-acting insulin - types, onset, peak, duration
regular insulin: Humulin R or Novolin R
onset: 0.5-1h (30 min before meal)
peak: 2-3 h
duration: 8h
Rapid Acting insulin - onset, peak, duration
Lispro (Humalog), Aspart (Novorapid), Glulisine (Apidra)
onset: 0-15 min before meal
peak: 0.5-1hr (best to be eating)
duration: 3-4h
which insulin is given in pregnancy & in IV form?
regular insulin
- for gestation diabetes
human regular insulin - Humulin R, Novolin R: AEs + SAEs
AEs:
- irritation at injection site
- lipodystrophy
- weight gain
SAEs:
- hypoglycemia
- rebound hyperglycemia
- hypokalemia - always watch K+ levels, goes up in DKA
Insulin Therapy: Considerations
- adminster only regular insulin via IV
- assess alc intake & BG – will make them go up and down
- medicine hx - herbs + dietary supplements, note meds that can alter effects of insulin
- ensure pt has consumed or is capable of consuming adequate food to prevent hypoglycemmia rxn
- assess K of insulin therapy, diet, and exercise, and how these affect serum glucose levels
Insulin Therapy - Injections, what to know
- don’t admin if BG < 4 mmol, or if exhibting signs of hypoglycemia
- rotate injection sites weekly to prevent lipodystrophy
- check periodic hemoglobin A1C levels
- assess s/s LT DM complications: eyes, heart, kidneys, feet
R
Role of Nurse in Insulin Therapy?
- be familiar w/ onset, peak, duration of action of prescribed insulin
- be aware of important aspects of each specific insulin
- not all insulin types compatible
- know s/s hypoglycemia + hyperglycemia
Compatibility of Insulins?
- some may not be mixed tgt in single syringe, e.g., Lantus
- clear insulin always drawn into syringe first
Considerations for all oral antidiabetic agents (T2D)
- monitor BG (hypo- & hyperglycemia)
- check s/s illness or infection
- watch liver function
- assess for adherence to therapy + ability for self-care
- sulfonylureas contraindicated in women who are pregnant/breast-feeding, or persons w/ renal/liver disease
- 2nd gen sulfonylureas have fewer drug-drug interactions
Sulfonylureas - what do they do?
- stimulates insulin release from pancreas
- incr sensitivity to insulin receptors
- decr chance of prolonged hypoglycemia
- 10% experience decr effectiveness after prolonged use
- most SEs = minor + GI related
examples of sulfonylureas
- glipizide (Glucotrol)
- glyburide (Diabeta, Micronase)
- glimepiride (Amaryl)
Sulfonylureas: Contraindications/Precautions
- sensitivity to sulfa drugs or thiazide diuretics
- renal or hepatic disease
- if used during pregnancy, discontinue at least 1 month b4 delivery
Sulfonylureas: Drug Interactions
- alcohol
- oral anticoagulants, MAOIs, probenecid, sulfonamides
- chloramphenicol, salicylates, clofibrate
- rifampin
- thiazides / sulfonamide-based drugs
- ginseng, garlic, black cohosh, juniper berries, fenugreek, coriander, dandelion root
How long do biguanades need to be taken to reach therapeutic effect?
T2D
6-12 weeks
What does Biguanades (metformin) do?
- decr glucose production by liver
- incr insulin sensitivity at tissues
- improve glucose transport into cells
- don’t promote weight gain
- usually first line of treatment
T2D
how long do biguanades (metformin) need to be held when contrast dye is needed?
T2D
48h before and 48h after to prevent lactic acid buildup
Biguanades/metformin: Contraindications / precautions
- impaired renal function
- HF, liver failure, hx of lactic acidosis
- concurrent serious infection, e.g., septicemia
- any condition that predisposes pt to hypoxemia
- anemia, diarrhea, vomiting, fever, dehydration, gastroparesis, GI obstruction
- hyperthyroidism, pituitary insufficiency, trauma
- pregnancy + lactation
