Diabetes Pharm Flashcards
Goal of diabetes pharm and targeted range for blood sugar
Prevent hyperglycemia and long-term complications by maintaining tight glycemic control of 80-140 and A1C below 6.5%
Lispro (Humalog)/Novolog aspart—when given, peak, onset, duration
Rapid acting insulin given with long-acting or intermediate insulin and during or after meals; Onset—15m, Peak—1h, Duration—2-4h
Side effects of insulin
Hypoglycemia, lipodystrophy, lipoatrophy, somogyi effect
Human regular insulin
Short acting insulin; usually given before meals, often tube feed; O30-60, P2-6h, D3-8h
Neutral protamin hagedron (NPH)
Intermediate acting insulin; protamine slows absorption so it lasts thru the day; often given with rapid or short; must agitate before giving; O2-4h, P4-10h, D10-20h
Glargine (lantus)
Long-acting insulin; don’t mix with other insulin; usually given at night and can correct with rapid insulinl; O70min, all day
ACHS
Before each meal and at bedtime
Insulin pump
Mostly used for type 1; computerized to give a basal infusion of regular insulin based on calories/carb intake; surgically implanted; might still require a finger stick
Sliding scale
Regular insulin given thru days with meals according to sugar levels
What can cause hypoglycemia
Childbirth, insulin overdose, Dec caloric intake, diarrhea, excess alcohol, unaccustomed exercise
Hypoglycemia tx
Oral CHO intake, parenteral glucagon, IV dextrose
Lipodystrophies/lipoatropy
Depression of skin at injection sites (feels hard, changes color)
Somogyi effect
Overdose of insulin causes hypoglycemia and counter-regulatory mechanism cause hyperglycemia and ketosis
Dawn phenomenon
Hyperglycemia in morning from natural hormone release (usually cortisol) that often resolves itself
Teaching points for diabetes
Vials given for 30 days at room temp, monitor sugar according to dr, rotate sites, carry carbs like popcorn, nuts, cheese, fruit in case
Glipizide and glyburide class and MOA
2nd generation diabetes; SULFONYLUREAS that bind and close K-ATP channels in pancreatic beta cells which stimulates secretion of insulin (makes beta cells work harder); decreases liver release of glucose and inc body response to insulin
Glipizide and glyburide SE and nursing considerations
Hypoglycemia (esp for kidney/liver dysfunction); Be cautious using alcohol, not for pregnant, not for preexisting liver/kidney probs, be careful or don’t take with NSAIDS, sulfa-based ATB potentiates, and Tagamet
Metformin class and MOA
Biguanides; Lowers glucose by decreasing production of glucose in liver; enhances glucose uptake and use by muscles; does NOT promote insulin release from pancreas
Metformin SE and NC
Does NOT cause hypoglycemia; GI bloat, diarrhea, N/V, risk for ACIDOSIS in pt w/ elevated creatinine; not good when creatinine levels are elevated, elevated ALT levels, kidney probs, liver prob, excessive drinking, or heart failure; HOLD 48 hours post contrast use; monitor serum glucose levels and give 30 min before bed
linagliptin, sazagliptin, sitagliptin class and MOA
DPP4 inhibitors; inhibits dipeptidyl peptidase 4, which is an enzyme that normally inactivates the incretin hormone, causing increased insulin release thru enhanced incretin activity, dec glucagon release, dec hepatic glucose production, dec digestion and appetite
linagliptin, sazagliptin, sitagliptin SE and NC
low incidence of hypoglycemia, GI, flu-like, skin rx, inc risk pancreatitis; Watch pancreas, don’t use with other meds that increase risk of pancreatitis
dulaglutide, exenatide, semaglutide class and MOA
GLP1 agonist; enhances GLPq which causes glucose-dependent release of insulin, inhibits postprandiol release of glucagon and suppresses appetite, slows gastric emptying
GLP1 SE and NC
Headache, weight loss, upper resp infection, N/V/D; Usually given with metformin or another med; don’t give if history of pancreatitis; black box—don’t give with severe renal disease or history of thyroid cell tumors
Dapagliflozin class and MOA
Sodium glucose cotransporter 2 (SGLT2) inhibitor; prevents kidneys from reabsorbing glucose back into the blood by blocking sodium glucose transport proteins which normally absorbs glucose, allowing kidneys to lower glucose and remove excess glucose in urine
Dapagliflozin SE and NC
UTI, gentian mycotic infection, hypotension, faint, dizzy, fatigue; increasingly used with other conditions like heart failure; Don’t give with ESRD (renal disease) or severe kidney disease; not FDA approved for type 1; often given with other meds
Glucagon class and MOA
Hypoglycemia antidote; Activates hepatic glucagon receptors, stimulates glycogen lysis and releases glucose
Glucagon nursing considerations
Short duration or action, multiple dose may be needed (half-life 25-35 minutes); check finger stick 15 minutes post-admin
Steroid effect on blood sugar
Increase blood sugar; may need to alter insulin schedule
What happens when the body is sick with diabetes?
Body is more stressed—check blood sugar more often, patient prone to DKA, HHNS; may not eat normal with stomach virus
Exercise and blood sugar
Exercise can help Dec blood glucose levels; need to check often for hypoglycemia
How long does it take metformin to work?
2-3 days to onset; 2-4 weeks for peak
