diabetes mellitus drugs and labs

Question 1

2nd generation sulfonylureas (examples)

Answer 1

• glipizide (Glucotrol)
• glyburide (Glynase)
• glimedpiride (Amaryl)

Question 2

2nd generation sulfonylureas (action)

Answer 2

• works to increase output of insulin by beta cells in pancreas
• stimulates insulin release from the pancreas

Question 3

2nd generation sulfonylureas (nursing implications)

Answer 3

• best taken 30 minutes prior to meal
• main potential side effects: hypoglycemia with delayed or skipped meals or alcohol
• use cautiously in elderly

Question 4

Biguanide (examples)

Answer 4

-Metformin (glucophage)

Question 5

Biguanide (action)

Answer 5

• decreases liver output of sugar
• increases peripheral insulin sensitivity
• reduces production of glucose through suppression of gluconeogenesis

Question 6

Biguanide (nursing implications)

Answer 6

• kidney surveillance testing required (monitor serum creatinine)
• contraindicated if patient has CHF, alcohol abuse, metabolic acidosis, liver or kidney disease, or if they are >80 years old
• potential side effects: GI distress/diarrhea; lactic acidosis
• take with food
• discontinue after OR, dye (contrast) studies for 48 hours or until kidney function is normal

Question 7

Insulin (very rapid acting) examples

Answer 7

• Lispro (Humalog)

- Aspart (Novalog)

Question 8

Insulin (very rapid acting) action

Answer 8

• onset 10 minutes
• peak 1 hour
• lasts 3-4 hours

Question 9

Insulin (short, rapid acting) examples

Answer 9

-Regular (R)

Question 10

Insulin (short, rapid acting) action

Answer 10

• onset 30 min
• peaks 3-5 hours
• lasts 6-10 hours

Question 11

Insulin (very rapid acting) nursing implications

Answer 11

• clear solution

- give 15 minutes prior to meal

Question 12

Insulin (nursing implications for all kinds)

Answer 12

• monitor blood sugar level

- when mixing, draw rapid acting first (CLEAR before CLOUDY)

Question 13

Insulin (short, rapid acting) nursing implications

Answer 13

• clear solution

- give 30 minutes prior to meal

Question 14

Insulin (intermediate acting) examples

Answer 14

• NPH

- Lente

Question 15

Insulin (intermediate acting) action

Answer 15

• onset 1 hour
• peaks 6-12 hours
• lasts 20-24 hours

Question 16

Insulin (intermediate acting) nursing implications

Answer 16

• cloudy solution

- rotate prior to use

Question 17

Insulin (long acting) examples

Answer 17

-Glargine (lantus)

Question 18

Insulin (long acting) action

lantus

Answer 18

• onset 1 hour
• no peak
• lasts 24 hours

Question 19

Insulin (long acting) nursing implications

lantus

Answer 19

• clear solution

- DO NOT MIX with others

Question 20

Insulin (long acting) second example

Answer 20

-Detemir (Levemir)

Question 21

Insulin (long acting) action

levemir

Answer 21

• onset 3-4 hours
• no peak
• lasts 24 hours

Question 22

Insulin (long acting) nursing implications

levemir

Answer 22

• clear solution

- DO NOT MIX with others

Question 23

anytime plasma glucose level

Answer 23

-screens for diabetes

normal is < 200 mg/dL

• interpretation- INCREASED in diabetes, acute stress reaction, severe liver or renal disease, pancreatitis; DECREASED in hypoglycemia, excess insulin, cancer, malnutrition, alcohol use, liver disease
• nursing implications- assess nutritional status; encourage proper body weight; monitor blood glucose

Question 24

fasting plasma glucose level

Answer 24

• screens for diabetes
• normal is 70-100 mg/dL
• indications- 100-126 mg/dL is prediabetes; >126 mg/dL is diabetes
• nursing implications- medicate as ordered; encourage diet evaluation and education; monitor for hypoglycemia

Question 25

Oral glucose tolerance test

Answer 25

• screens for diabetes
• normal is < 200 mg/dL
• indications- > 200 mg/dL is diabetes
• nursing implications- encourage activity/exercise

Question 26

glycosylated hemoglobin A1c (HbA1c)

Answer 26

• assess long-term (2-3 months) glucose control
• normal is <6.0%
• indications- increased in poorly controlled or uncontrolled diabetes
• nursing implications- educate that good glycemic control delays onset and slows progression or diabetic retinopathy, nephropathy, and neuropathy