Diabetes Flashcards
metformin (Glucophage): Class
Biguanides - first line monotherapy
metformin (Glucophage): Use
Initial drug used to treat type II diabetes
metformin (Glucophage): EPA
Reduces the production of glucose by the liver, decreases absorption of glucose from the intestines & increases sensitivity of insulin receptors in tissues.
metformin (Glucophage): ADRs
Lactic acidosis, N/V/D, metallic taste, BLACK BOX WARNING
metformin (Glucophage): BLACK BOX WARNING
Risk for potentially fatal lactic acidosis for people with a history because increases production of lactate
metformin (Glucophage): contraindications
Not given during severe illness, surgery, or hospitalization
Pregnancy
Renal and hepatic impairment
Hx of lactic acidosis
ETOH
metformin (Glucophage): RN Interventions
take with meals, do not stop taking without consulting provider, avoid ETOH, CAN NOT be taken if client is having imaging done because it can cause kidney injury, hold 48 hrs before and after contrast imagery
glipizide (Glucotrol): Class
Sulfonylureas
glipizide (Glucotrol): Use
Used in combination with diet to lower blood sugar levels in patients with type II diabetes
glipizide (Glucotrol): EPA
Stimulates pancreatic beta cells to produce more insulin, therefore increasing secretion of insulin.
glipizide (Glucotrol): ADR
hypoglycemia
glipizide (Glucotrol): contraindications
Sulfa allergy-should not take
Pregnancy
Renal or hepatic dysfunction
glipizide (Glucotrol): RN Interventions
take 30 minutes before meals, Not given during severe illness, surgery, hospitalization or pregnancy (need to take insulin instead to control blood sugars)
repaglinide (Prandin): classification
Meglitinides
repaglinide (Prandin): EPA
similar to sulfonylureas, stimulate section of insulin
pioglitazone (Actos): Classification
Thiazolidinediones (TZDs)
pioglitazone (Actos): EPA
reduces insulin resistance of tissue
acarbose (Precose): Classification
Alpha-glucosidase inhibitors
acarbose (Precose): EPA
blocks/delays digestion/absorption of carbs
sitagliptin (Januvia): Classification
Gliptins
sitagliptin (Januvia): EPA
Inhibits inactivation of incretin hormones (and thus increases insulin secretion)
Regular insulin: classification
Short-Acting Insulin
Regular insulin: Use
To control blood sugar in patients with type I diabetes or in patients with type II diabetes that could not get control with diet, exercise and oral agents
Regular insulin: EPA and onset
Short-acting insulin with an onset of 30-60 minutes. Replaces endogenous insulin and has the same effect as the pancreatic hormone
What is specific about regular insulin administration?
It is the only insulin that can be given IV
regular insulin: ADR
hypoglycemia
regular insulin: contraindications
hypoglycemia, people with renal disease the dose will need to be lowered
lispro insulin (Humalog): classification
Rapid-Acting insulin (Meal-time insulin)
lispro insulin (Humalog): other medications
aspart (Novolog)
lispro insulin (Humalog): Use
Rapid-acting insulin that is given with meals or to correct a high blood glucose level. Can be used in patients with type I or type II diabetes
lispro insulin (Humalog): EPA and onset
onset is quick, about 15 minutes
lispro insulin (Humalog): ADR
hypoglycemia
lispro insulin (Humalog): contraindications
hypoglycemia, lower dose for people with renal disease
glargine insulin (Lantus): class
Insulin- Long Acting
glargine insulin (Lantus): Use
To control blood sugar in patients with type I diabetes or in patients with type II diabetes that could not get control with diet, exercise and oral agents
glargine insulin (Lantus): EPA and onset
Onset is about 2 hours and there is no peak…acts like basal insulin
glargine insulin (Lantus): ADR
hypoglycemia
glargine insulin (Lantus): contraindications
hypoglycemia, lower does for renal disease
Onset, Peak, and Duration of Rapid-acting “meal-time” insulin
onset=15 min, peak 30 min-2.5 hr, duration=3-6 hours
lispro (Humalog) & aspart (Novolog)
Onset, Peak, and Duration of Short acting insulin
onset=30-60 min, peak=1-5 hours, duration=6-10 hours
Regular insulin (can be mixed with longer acting insulin)
Onset, Peak, and Duration of Intermediate acting Insulin
onset=1-2 hours, peak=6-14 hours, duration=16-24 hours
NPH insulin
Onset, Peak, and Duration of Long-acting insulin
onset=2 hours, no peak, duration=18-24 hours
glargine (Lantus)
Nursing Considerations: Endocrine Insulin
administered in units, stores in refrigerator, can stay at room temp. for up to 1 month, do not expose to sunlight or high temperatures, mixed insulin do regular first (clear before cloudy), type I diabetes-insulin pumps use rapid-acting insulin
Insulin Administration
injection subcutaneous, sites should be rotated (abdomen has greatest absorption, posterior upper arm, anterior thigh, hips are least absorptive)
How to inject insulin
- Prime insulin pen with 2 units of insulin or draw up insulin in insulin syringe
- Dial up correct amount of insulin on pen, or verify amount on syringe
- Locate site of injection and clean skin with alcohol
- With non-dominant hand hold and pinch area. - With dominant hand inject the insulin pen/needle at a 90-degree angle.
- Hold in place for at least 5 seconds after administering insulin
glucagon (GlucaGen): Class
Hyperglycemics
glucagon (GlucaGen): other medications
50% glucose (D50-given IV)
glucagon (GlucaGen): Use
Hypoglycemia from an insulin overdose
glucagon (GlucaGen): EPA
Raises blood levels of glucose through glycogenesis.
glucagon (GlucaGen): ADR
nausea, vomiting
glucagon (GlucaGen): contraindications
hypersensitive
glucagon (GlucaGen): RN Interventions
- Turn client on side if unconscious
- Provide food after patient regains consciousness and able to swallow safely
- Educate on signs and symptoms of hypoglycemia and how to treat
