Chapter 39 - Diabetes Mellitus

Question 1

Insulin (Regular)

-Novolin or Humulin

Answer 1

• Novolin or Humulin
• Short acting
• A clear liquid solution with the appearance of water
• The hypoglycemic drug of choice for patients with diabetes in acute or emergency situations, diabetic ketoacidosis (DKA), hyperosmolar nonketotic coma, severe infections or other illnesses, major surgery, and pregnancy
• Similar to physiologic insulin secretion after a meal, more effecting at decreasing postprandial hyperglycemia, and less likely to cause hypoglycemia before the next meal.
• May be mixed with NPH (intermediate acting) in the same syringe. Mixing order should be clear regular drawn up first, then the cloudy NPH (“clear before cloudy”)
• Onset: 0.5-1 hour (when it starts working)
• Peak: 2-4 hours (when the effect is the greatest)
• Duration: 4-8 hours (how long it lowers blood glucose)

Question 2

Insulin (Lantus)

Answer 2

• Long acting
• Provides basal amount of insulin through 24 hours, similar to normal, endogenous insulin secretion
• May not be diluted or mixed with any other insulin or solutions
• Onset: 4-6 hours (when it starts working)
• Peak: Same action throughout the day
• Duration: 24 hours (how long it lowers blood glucose)

Question 3

Sulfonylureas

• glyburide (DiaBeta)

Answer 3

 glyburide (DiaBeta)
 MOA: Increases secretion of insulin, which causes a reduction in the glucose level
 Use: Elevated serum glucose
 AE: Hypoglycemia
 Nursing process implications: Contraindicated w/ pregnancy, renal or hepatic impairment, critical illness, patients with sulfa allergy
 Usually given to patient within 30 minutes of a meal; patient cannot skip meals or snacks

Question 4

Biguanides

• metformin (Glucophage)

Answer 4

 metformin (Glucophage) –> Most common
 MOA: Increases use of glucose by muscle and fat cells, decreases hepatic glucose production, and decreases intestinal absorption of glucose
 Use: Insulin resistance, PCOS (polycystic ovarian syndrome)
 AE: Lactic acidosis, GI distress
 Nursing process implications: Does not cause hypoglycemia; monitor for potentially fatal lactic acidosis
 Good drug for Type 2 diabetes with obesity  helps with weight loss
 Need to be off drug for 48 hours before and after procedure (scanning with contrasts or IV dyes)

Question 5

Thiazolidinediones

• rosiglitazone maleate (Avandia)

Answer 5

 rosiglitazone maleate (Avandia)
 MOA: Stimulate insulin receptors on muscle, fat, and liver cells; “insulin sensitizer”
 Indications for use: Insulin resistance (makes circulating insulin more effective)
 AE: Hepatotoxicity (jaundice, increased LFT), congestive heart failure, weight gain
 Nursing process implications: Monitor liver function studies, and closely monitor patients for signs of heart failure
 Patient education: Takes about 12 hours for drug to take effect

Question 6

Dipeptidyl Peptidase-4 Inhibitors

• sitagliptin phosphate (Januvia)

Answer 6

 MOA: Balance the release of insulin and limit the release of additional glucose from the liver; it has also been linked to increased beta cell neogenesis, inhibition of beta cell apoptosis, inhibition of glucagon secretion, delayed gastric emptying, and induction of satiety
 Use: Elevated serum glucose
 Admin: Taken once a day, with or without food; use cautiously in patients with renal disease
 AE: May complicate renal disease
 Nursing process implications: Monitor for common side effects including upper respiratory tract infection, stuffy or runny nose, sore throat and/or headache

Question 7

Alpha-Glucose Inhibitors

• acarbose (Precose)

Answer 7

 acarbose (Precose)
 MOA: Delay digestion of complex carbohydrates
 Use: Decrease in postprandial glucose
 Admin: Take with first bite/at same time of meal
 AE: Hypoglycemia, gastric upset
 Contra: Hepatic disease, inflammatory and malabsorptive disorders
 Has shown best improvement in improving hemoglobin A1Cs; usually used with sulfonylureas as a combination drug (to increase secretion of insulin when taken together)

Question 8

Incretin mimetics

–> Usually second line, add on drug; usually never used alone

• exenatide (Byetta)

Answer 8

 exenatide (Byetta)
 MOA: Stimulating the pancreas to secrete the right amount of insulin based on the food that was just eaten
 Indications for use: Postprandial glucose elevations
 AE: GI distress and nausea, hypoglycemia
 Nursing process implications: Proper medication administration; monitor for a rare but serious side effect in the development of acute pancreatitis

Question 9

ACE inhibitors

• enalapril maleate (Vasotec)

Answer 9

 enalapril maleate (Vasotec)
 MOA: Blocks the conversion of angiotensin I to angiotensin II, thereby decreasing blood pressure
 Use: Ability to delay nephropathy; has productive effects on the kidneys in both Type 1 and Type 2 diabetes and in both normotensive and hypertensive people
 AE: Hypoglycemia
 Patient education: Additional measures to preserve renal function = effective treatment of hypertension, limited intake of dietary protein, prompt treatment of UTIs, and avoidance of nephrotoxic drugs
 Increase the effects of insulin