Diabetic Medications

Question 1

Not a form of insulin. Requires some pancreatic function. Combo meds available.

Answer 1

Oral meds. May be changed periodically. Patients need to know the name of each med along with the dosage.

Question 2

These drugs stimulate insulin release. Some reduction of hepatic glucose output. SE?

Answer 2

Sulfonylureas

Side effects include hypoglycemia, rash, GI disturbance.

Question 3

First generation sulfonylureas?

Answer 3

orinase, diabinese, tolinase

Question 4

Second generation sulfonylureas?

Answer 4

glipizide
glimepiride
glyburide

Question 5

Stimulates insulin production in the pancreas. repaglinide, nateglinide

Answer 5

Meglitinides: non-sulfonylurea insulin secretagogues

Hypoglycemia SE

Question 6

Decreases hepatic glucose production, decreases intestinal glucose absorption. Increases sensitivity to insulin.

Answer 6

Biguanides
glucophage, metformin with glyburide
Diarrhea, abdominal distress, weight loss, hypoglycemia

Question 7

What’s important to know about metformin?

Answer 7

It cannot be given before a procedure (usually 48 hrs) and usually for 48 hrs after ny procedure that uses contrast dye. It may contribute to renal failure if not used in these ways. Monitor BUN and creatinine.

Question 8

Decrease cellular resistance to insulin. Causes an increase in glucose uptake and decreased glucose production.

Answer 8

Thiazolidinediones
pioglitazone, rosiglitazone
Hypoglycemia, liver dysfunction, decreased effectiveness of oral contraceptives

Question 9

Inhibitors of intestinal enzymes that break complex carbs into smaller molecules. Slows carb metabolism in the small intestine.

Answer 9

Alpha-glucosidase inhibitors
acarbose, miglitol
Hypoglycemia, abdominal bloating, diarrhea, flatulence: causes increased gas formation

Question 10

Increases insulin resistance and decreases glucagon levels. sitagliptin, vidagliptin

Answer 10

Didpeptidyl peptidase-4 inhibitors (DPP-4)

Hypoglycemia, upper respiratory infections (stuffy nose/sore throat), headache, abdominal pain

Question 11

Reduces post prandial levels of glucose by delaying gastric emptying and suppressing glycogen secretions

Answer 11

Amylin mimetics
promlintide
Hypoglycemia, injection site reactions because it’s given SQ

Question 12

Slows gastric emptying. Stimulates glucose dependent release of insulin. Inhibits post prandial release of glycogen.

Answer 12

Incretin mimetics
exenatide
Hypoglycemia. Given SQ

Question 13

What should be known about meds?

Answer 13

Why is the patient taking this medication? What nursing implications are there? How will the nurse know if the med is working? What would the nurse look for if the pt was having an adverse reaction?

Question 14

What should happen if medications are missed?

Answer 14

If pills are taken twice a day, may take meds within 3 hrs of the scheduled administration time.
If greater than 3 hrs, wait for the next scheduled dose.
Don’t take a double dose or without eating

Question 15

What should be done if a pt is on a long-acting sulfonylurea taken once a day, but the dose is missed?

Answer 15

Take med if within 12 hours of missed dose. Otherwise wait until the next scheduled dose.

Question 16

Refers to the number of units of insulin/mL

Answer 16

Strength

U-100 is the most common. U-500 can be obtained with a prescription.

Question 17

What do insulins differ in?

Answer 17

Onset, peak, and duration

Question 18

Rapid-acting insulin that’s used in combination with intermediate-acting insulin

Answer 18

Insulin aspart (Novolog) and insulin lispro (humalog)
Onset: 15
Peak: 30-90 mins
Duration: 3-5 hrs
Clear in color. Can provoke hypoglycemia very rapidly.

Question 19

Short-acting insulin that can be combined with an intermediate-acting insulin

Answer 19

Regular insulin (Humulin R, Novolin R)
Onset: 30-60 mins
Peak: 2-4 hrs
Duration: 5-8 hrs
Clear. Monitor for hypoglycemia. Only one that can be given in an IV.

Question 20

Intermediate-acting insulin that is formulated to dissolve more slowly when administered SQ.

Answer 20

Isophane insulin (NPH), Humulin N, Novolin N
Onset: 1-3 hrs
Peak: 8 hrs
Duration: 12-16 hrs
Cloudy.

Question 21

Long-acting insulin that cannot be given in combination with other insulins. Must use a separate syringe.

Answer 21

Insulin glargine (Lantus) (Levemir)
Onset: 1 hr
Peak: None
Duration: 20-26 hrs

Question 22

Explain mixing insulins?

Answer 22

Can mix rapid and short acting with longer acting. Be consistent on how you mix it. Draw up air and inject into longer acting, then draw air and inject into short acting. Draw up into syringe the short acting or rapid, and then draw up the longer acting amount

Question 23

What should be remembered when coordinating food and insulin?

Answer 23

Carb intake must be coordinated with insulin action. Regular insulin requires a supplemental snack of 15g of carbs to match the peak action of the insulin.

Question 24

What are the general principles of sliding scale therapy that’s frequently used in acute care settings?

Answer 24

The amount of carbs eaten at each meal is pre-set. The basal insulin doesn’t change. The bolus insulin is based on the blood sugar level before the meal or at bedtime. Pre-mixed doses are based on the blood sugar level before the meal.

Question 25

Insulin storage?

Answer 25

Insulin is stable at room temp for 30 days. Pre-filled syringes should be refrigerated. Expiration date should be checked. Have an extra vial of each type of insulin, also refrigerated.

Question 26

Provides continuous subcutaneous insulin infusion. Provides the most normal delivery of insulin.

Answer 26

Insulin pumps. Mimics the action of the pancreas found in a non-diabetic person. Programmed to deliver varying amounts of insulin hourly.

Question 27

What are the advantages of insulin pumps?

Answer 27

Most physiologically normal delivery system. Elicits better control. Allows for more independence.

Question 28

What are the disadvantages of insulin pumps?

Answer 28

Initial cost of about $5,000. SQ needle placed in the abdomen all the time. Risk for rapid-onset DKA if there is interruption of insulin delivery.