Diabetic Medications Flashcards
Not a form of insulin. Requires some pancreatic function. Combo meds available.
Oral meds. May be changed periodically. Patients need to know the name of each med along with the dosage.
These drugs stimulate insulin release. Some reduction of hepatic glucose output. SE?
Sulfonylureas
Side effects include hypoglycemia, rash, GI disturbance.
First generation sulfonylureas?
orinase, diabinese, tolinase
Second generation sulfonylureas?
glipizide
glimepiride
glyburide
Stimulates insulin production in the pancreas. repaglinide, nateglinide
Meglitinides: non-sulfonylurea insulin secretagogues
Hypoglycemia SE
Decreases hepatic glucose production, decreases intestinal glucose absorption. Increases sensitivity to insulin.
Biguanides
glucophage, metformin with glyburide
Diarrhea, abdominal distress, weight loss, hypoglycemia
What’s important to know about metformin?
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.
Decrease cellular resistance to insulin. Causes an increase in glucose uptake and decreased glucose production.
Thiazolidinediones
pioglitazone, rosiglitazone
Hypoglycemia, liver dysfunction, decreased effectiveness of oral contraceptives
Inhibitors of intestinal enzymes that break complex carbs into smaller molecules. Slows carb metabolism in the small intestine.
Alpha-glucosidase inhibitors
acarbose, miglitol
Hypoglycemia, abdominal bloating, diarrhea, flatulence: causes increased gas formation
Increases insulin resistance and decreases glucagon levels. sitagliptin, vidagliptin
Didpeptidyl peptidase-4 inhibitors (DPP-4)
Hypoglycemia, upper respiratory infections (stuffy nose/sore throat), headache, abdominal pain
Reduces post prandial levels of glucose by delaying gastric emptying and suppressing glycogen secretions
Amylin mimetics
promlintide
Hypoglycemia, injection site reactions because it’s given SQ
Slows gastric emptying. Stimulates glucose dependent release of insulin. Inhibits post prandial release of glycogen.
Incretin mimetics
exenatide
Hypoglycemia. Given SQ
What should be known about meds?
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?
What should happen if medications are missed?
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
What should be done if a pt is on a long-acting sulfonylurea taken once a day, but the dose is missed?
Take med if within 12 hours of missed dose. Otherwise wait until the next scheduled dose.
Refers to the number of units of insulin/mL
Strength
U-100 is the most common. U-500 can be obtained with a prescription.
What do insulins differ in?
Onset, peak, and duration
Rapid-acting insulin that’s used in combination with intermediate-acting insulin
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.
Short-acting insulin that can be combined with an intermediate-acting insulin
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.
Intermediate-acting insulin that is formulated to dissolve more slowly when administered SQ.
Isophane insulin (NPH), Humulin N, Novolin N Onset: 1-3 hrs Peak: 8 hrs Duration: 12-16 hrs Cloudy.
Long-acting insulin that cannot be given in combination with other insulins. Must use a separate syringe.
Insulin glargine (Lantus) (Levemir)
Onset: 1 hr
Peak: None
Duration: 20-26 hrs
Explain mixing insulins?
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
What should be remembered when coordinating food and insulin?
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.
What are the general principles of sliding scale therapy that’s frequently used in acute care settings?
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.
Insulin storage?
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.
Provides continuous subcutaneous insulin infusion. Provides the most normal delivery of insulin.
Insulin pumps. Mimics the action of the pancreas found in a non-diabetic person. Programmed to deliver varying amounts of insulin hourly.
What are the advantages of insulin pumps?
Most physiologically normal delivery system. Elicits better control. Allows for more independence.
What are the disadvantages of insulin pumps?
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.
