Diabetes - Medications

Question 1

rapid acting

Answer 1

lispro (Humalog); aspart (NovoLog); glulisine (Apidra)

• onset = 10-30min
• peak = 10min-3hr
• duration = 3-5hr

Question 2

short acting

Answer 2

regular (Humulin R, Novolin R)

• onset = 30min-1hr
• peak = 2-5hr
• duration = 5-8hr

Question 3

intermediate acting

Answer 3

NPH (humulin N, Novolin N)

• onset = 1.5-4hr
• peak = 4-12hr
• duration = 12-18hr

Question 4

long acting

Answer 4

glargine (lantus); detemir (Levemir); degludec (Tresiba)

• onset = 0.8-4hr
• peak = less defined, no pronounced peak
• duration = 16-24hr

Question 5

inhaled

Answer 5

Afrezza

• onset = 12-15min
• peak = 60min
• duration = 2.5-3hr

Question 6

nursing considerations

Answer 6

• avoid extreme temperatures when storing
• administer through injection or pump
• when mixing: inject cloudy > inject clear > draw up clear > draw up cloudy

Question 7

problems with insulin therapy

Answer 7

• allergic rxn > extremely rare
• Somogyi effect: increased blood glucose in morning due to excessive insulin dosage at night; SOMOgyi = SO MOch insulin
• Dawn Phenomenon: increased blood glucose level in the morning due to naturally occuring release of hormones in early morning - results in high morning glucose levels; Dawn = Down insulin

Question 8

children with type 1 DM

Answer 8

goals
*facilitating appropriate growth
*maintaining ahe-appropriate lifestyle
*achieving age-related near-normal A1C with minimal episodes of hypoglycemia
*preventing acute complications - hypoglycemia, hyperglycemia, DKA
goals of insulin therapy
*replace insulin child no longer making in acceptable physiologic pattern
*insulin requirement - based on age, weight, pubertal status

Question 9

nursing considerations with insulin therapy

Answer 9

• administration
• storage
• side effects
• support
• follow up

Question 10

oral glucose control agents

Answer 10

• increase production of insulin
• lower insulin resistance
• slow absorption of carbohydrates
• help lower blood glucose

Question 11

biguanides - Metformin (Glucophage)

Answer 11

• Decrease rate of glucose production by liver
• Enhances insulin sensitivity in skeletal muscle
• Improves glucose transport
• May cause weight loss
• Used in prevention of type 2 DM
• Teaching points: Hold if having surgery or radiologic procedure with contrast medium – day or 2 before and at least 48hr after
• Monitor serum creatinine
• Take with food to minimize GI side effects
• Contraindications: Renal, liver, cardiac disease; Excessive alcohol intake

Question 12

Sulfonylurea

Answer 12

glipizide (Glucotrol); glyburide (DiaBeta)

• Increase insulin production from pancreas by stimulating beta cells
• Major side effect: HYPOGLYCEMIA

Question 13

Thiazolidinediones

Answer 13

pioglitazone (Actos); rosiglitazone (Avandia)

• Most effective in those with insulin resistance
• Increase insulin sensitivity
• Decrease glucose production in liver
• Side effects – weight gain, edema
• Rarely used because of adverse effects
• Rosiglitazone is associated with adverse cardiovascular events
• Pioglitazone can worsen heart failure and is associated with an increased risk of bladder cancer

Question 14

Metglitinides

Answer 14

repaglinide (Prandin); nateglinide (Starlix)

• Increase insulin production from pancreas by stimulating beta cells
• Rapid onset: ↓ hypoglycemia
• Taken 30 minutes to just before each meal
• Should not be taken if meal skipped

Question 15

α-Glucosidase Inhibitors

Answer 15

acarbose (Precose); miglitol (Glyset)

• “Starch blockers”
• Slow the breakdown and absorption of sugars and starches
• Take with first bite of each meal
• May cause diarrhea & flatulence

Question 16

Dipeptidyl Peptidase–4 (DDP-4) Inhibitor

Answer 16

Linagliptin (Tradjenta)
*Blocks inactivation of incretin hormones
*↑ Insulin release
*↓ Glucagon secretion
*↓ Hepatic glucose production
*Side effects: pancreatitis, 
allergic reactions

Question 17

Glucagon-like Peptide-1 Receptor Agonists

Answer 17

exenatide (Byetta); dulaglutide (Trulicity)

• Lower glucose levels by slowing glucose absorption from intestine, increasing insulin secretion when blood glucose levels are high, and lower high glucagon levels sometimes found in diabetics after meals
• Injected twice a day, an hour before breakfast and an hour before dinner