Drugs for DM Flashcards
Glucose essential for cellular function
Insulin secreted from beta cells of pancreas opens cell to allow glucose entry - under norm circumstances releasing insulin at both rates
Counter-regulatory hormones released with low blood glucose levels - working to elevated BG because dangerously low - affects lot func in body
Regulation of BG review
Normal BG in range 70-120 mg/dl maintained by insulin and counter-regulatory hormones - body maintaining BG and regulating with insulin and other counter-regulatory hormones
Glucose essential for cellular function
Basal rate (little bit insulin all time to keep BG in target range at all time) and bolus (with meals) - glucose when sharply elevated as start digest food and break down and get more glucose in bloodstream; imp in understanding types insulin regimens pats on - common giving basal and bolus with meals - doing to mimic what norm pancreas does
Insulin secreted from beta cells of pancreas opens cell to allow glucose entry - under norm circumstances releasing insulin at both rates
Fast release of glucose
Slow release of glucose
Counter-regulatory hormones released with low blood glucose levels - working to elevated BG because dangerously low - affects lot func in body
Glucagon from alpha cells of pancreas
Epinephrine from medulla of adrenal glands
Fast release of glucose
Cortisol from cortex of adrenal glands
Growth Hormone from anterior pituitary gland
Slow release of glucose
Fasting blood glucose > 126 mg/dL
HbA1c > 6.5% - avg BG over past 3 months; looking at sugar on RBC - tells how well controlling DM; tell avg BG is: 10-12 A1C - BG running elevated all time - problematic and higher risk for developing comorbidities
Diagnostic criteria for diabetes
Goals of interventions:
Type 1 DM –
Type 2 DM –
Pharmacology overview for diabetes
Control blood glucose level
Prevent complications
Goals of interventions:
Lifestyle modifications with pharmacological therapy
Prevent complications
patho: no insulin
Beta cells destroyed and no insulin secreted
Insulin - need exogenous admin; all on some kind of insulin
Typ Combination:
Long-acting
Rapid-acting
Type 1 DM
patho: some insulin
Some Insulin secretion initially and as pancreas working to some extent put on lot diff drugs; lot options available when pancreas still working to supplement; eventually pancreas burns out with this and eventually get to point where need exogenous insulin - require insulin for adequate BG control
Oral agents
Non-insulin injectable(s)
Insulin
Long-acting
Rapid-acting
Type 2 DM
Replacement of endogenous insulin - insulin giving to pats is synthetically made and made in lab - drawing med up in vial, contained pen, in cassette in pump
Actions of insulin: Promote cellular uptake of glucose - major actions: glucose get into cells since need it for energy, amino acids, potassium - moves it into cells (AE: hypokalemia); protein synthesis, glycogen formation/storage (helps store extra glucose in liver for later use), fatty acid storage
Body sys/organ not need insulin: brain; see neurologic symp in DM pat means BG really low
MoA: - Class: insulin
T1DM, T2DM, DKA (typ give regular insulin only via IV drip), hyperkalemia (not often - help facilitate movement K into cells)
Indication: - Class: insulin
Hypoglycemia - giving insulin exogenously trying mimic pancreas norm do but it is an educated guess in terms of what pat insulin needs but not foolproof - sometimes get too much or need not ask much so need know risk for this is here; lipohypertrophy (changes of fat cell at injection site - risk reduced if rotate injection sites often to avoid changes - feel hardening), lipodystrophy at injection site (changes at injection - changes of fat cell at injection - risk reduced if rotate injection sites often to avoid changes - feel hardening); diarrhea, hypokalemia - can happen
AE: - Class: insulin
several types of insulin - Act diff and affects how monitor pat
Prototypes - Class: insulin
Lispro
Aspart
Onset, peak duration - meaningful to how intervene with pat
Onset rapid acting about 15 minutes; peak: 60 min; duration: 4 hours
High alert med - diligent in monitoring pats
Route: via Subcutaneous injection - insulin has be given this way so not broken down by body before body uses it when taken orally; can self-admin
Dose: Up to 4 x’s daily (meals and HS) - ordering depends on what BG do
Highest Risk for pat become hypoglycemic at peak action time of drug; when most insulin exerting action - BG lowest
Insulin: rapid acting
Assessment - general assessment and assess comorbidities
Always check blood glucose prior to administration - never miss this when admin insulin; about give them potent amount of insulin and have no idea what BG is before give drug is a shot in dark
Admin med (rapid acting insulin) 0-15 min prior to start of meal - onset 15 min so if give insulin and not get meal tray for awhile getting insulin and working but glucose not present and not have glucose from meal so higher risk for hypoglycemia; make sure not have too much med before glucose enters bloodstream and have mismatch
Verify orders, follow facility protocol for admin - all have unique orders; carefully read orders; make sure know protocol for doing safest thing for pat
Hold parameters
Nursing: rapid acting insulin
Prior to eating - dosing based on fasting BG - dosing based on not having eaten in sev hrs; after eaten BG falsely elevated and results in too much insulin for pats
Always check blood glucose prior to administration - never miss this when admin insulin; about give them potent amount of insulin and have no idea what BG is before give drug is a shot in dark
Rotate injection sites
Admin med (rapid acting insulin) 0-15 min prior to start of meal - onset 15 min so if give insulin and not get meal tray for awhile getting insulin and working but glucose not present and not have glucose from meal so higher risk for hypoglycemia; make sure not have too much med before glucose enters bloodstream and have mismatch
Set dose (i.e. 5 units with meals) - orders are diff; regardless BG give units unless too low (for hold parameters) give set dose; safer for certain pop; can yield less errors - elevated not as bad compared to hypoglycemia
Sliding scale (units to admin based on BG level; add to routine dose) - most pats on this; sometimes on set dose with sliding scale/just sliding scale
Verify orders, follow facility protocol for admin - all have unique orders; carefully read orders; make sure know protocol for doing safest thing for pat
In orders
Do not give rapid insulin if BG less than…….# (check order) - afraid bottoming BG
Consider NPO status - order pat for hold parameters and hold parameters - if not eating and BG close to hold parameters nursing judgement says hold insulin; even tho BG high - pat not eat anything not get glucose so if give insulin and NPO BG only go down; risk for hypoglycemia greater; look lot diff things to keep pat safe with insulin admin
Hold parameters
Sig one for risk of hypoglycemia
Quickest onset, highest peak, shortest duration
Rapid activity -
Regular insulin
Onset: slower; 30-60 min
Peak: later; 2-3 hours
Duration: Longer acting; 6-10 hrs
Given either SQ/IV
Only one give IV: given as IV drip typ - on pump and check BG q1hr
Risk for low BG at peak action time - 2-3 hours after admin
Short -
Glargine
Onset: gradual
Peak: none
Duration: up to 24 hours
Trying to mimic basal insulin rate that pancreas normally do
Route: SQ
Lower risk low BG
1-2 times daily (12-24 hrs) - typ admin once a day but sometimes bid - high amounts because sig amount of volume and break it up because of volume
Basal insulin
Gradual onset; no peak because acting as basal insulin
Long
Rapid activity -
Short -
Long
Many pats on multiple insulin - on long-acting (once a day) act as basal and rapid-acting take with meals and sometimes HS - take when BG spike after meals to help facilitate movement BG into cells; sometimes on one insulin if new to insulin and just starting insulin therapy; T2DM: not always require high amounts insulin right away, give insulin in supplement in addition to other oral/non-insulin injectable agents; most on both
Trying to mimic norm action pancreas
Insulin therapy comparison
Insulin by syringe
Insulin by pen
Insulin pump
IV insulin drip
Insulin delivery devices
Special insulin syringe - looked at number units
Widely used; inexpensive
Multi-dose vial
Syringe one time use ONLY
Insulin by syringe
Keep unopened vials at house and keep those refrigerated (cool, dark, place) until expired; once open vials, keep at room temp for up to 30 days - imp edu piece for pats that storing insulin properly and not using longer 30 days once sitting at room temp; not have keep one using in fridge
Draw up from vial
Not give insulin cold; sit out - not prob; good idea take out fridge day before use it so room temp so not giving it cold
Multi-dose vial
Pre-filled syringe
Multi-dose syringe – disinfect with alcohol
New needle attached for each use
Prime pen first; then dial for dose
Insulin by pen
Med stored in pen and dial on end; screw on needle should be alcohol wipe to prevent infection; put on needle and dial up units and prime up pen to get rid air so drug there and ready for admin and dial up number units then push top pen down once in skin - take needle off and in sharps then have pen
Lot easier for pats
Less errors
Not utilized as much - expensive
Prime pen first; then dial for dose
Infusion set insertion device
Insulin reservoir
Frequent BG monitoring
Very expensive
Insulin pump
Inserted Cannula via needle into SQ tissue and tubing - change every week/so where rotate insertion site; pump has all insulin in it; programmable and very individualized; some pumps speak to glucose readers; can read BG and dose based on BG
Superior for BG control - computer monitoring BG and admin insulin and alerts when BG too low
Risk for infection at insertion site
Infusion set insertion device
Slow insulin release + bolus (rapid or short acting insulin) - controls BG with rapid acting so small amounts all time and bolus with meals
Insulin reservoir
Continuous glucose monitoring communicates with pump
Frequent BG monitoring
In-pat; pump and regular insulin in bag and program how many units on pump to be admin to pat so admin continuously; pat on insulin drip check BG hourly
Indications -
Peripheral or central line
IV insulin drip
critically ill; higher risk scenarios where tight glucose control needed
Diabetic ketoacidosis
Hyperosmolar state
Critical care (ICU)
Peri-operative period
NPO type I diabetes
Labor and delivery
Glucose exacerbated by high dose glucocorticoid therapy
TPN
Indications -IV insulin drip
