Medications Affecting Blood Glucose Flashcards
What drugs can cause hypoglycemia?
ACE inhibitors, alcohol, lithium, beta-adrenergic blockers ( blocking beta-1 masks symptoms and blocking beta-2 causes hypoglycemia)
What drugs can cause hyperglycemia?
epinephrine (alpha and beta adrenergic agonist) (through its beta-2 stimulation it causes hyperglycemia), thyroid hormones, growth hormone, corticosteroids (prednisone, solu-medrol, especially if a stressed diabetic with an infection), loop and thiazide diuretics, phenytoin
What is the onset, peak, and duration of Lispro (Humalog), and aspart (Novolog), rapid acting insulins?
onset: 15-30 minutes
peak: 0.5-2.5 hours
duration: 3-6 hours
USUALLY GIVEN BEFORE MEALS, MAKE SURE YOU SEE THE FOOD TRAY ON THE UNIT BEFORE ADMINISTERING
What is the onset, peak, and duration of regular insulin (Humulin R); and regular insulin (Novolin R), short-acting insulins?
onset: 0.5-1 hour
peak: 1-5 hours
duration: 6-10 hours
CAN BE GIVEN BEFORE BREAKFAST FOR GLUCOSE CONTROL
What is the onset, peak, and duration of NPH (Humulin N); and detemir (Levemir), intermediate-acting insulins?
onset: 1-2 hours
Peak: 6-14 hours
duration: 16-24 hours
USUALLY GIVEN IN MORNING FOR LUNCH, POSTPRANDIAL LUNCH AND INTO DINNER
What is the onset, peak, and duration of glargine (Lantus), long-acting insulin?
onset: 70 minutes
peak: NONE
duration: 24 hours
USUALLY GIVEN AT NIGHT for steady blood glucose control
What is Humulin 70/30 composed of?
70% NPH and 30% regular insulin
USUALLY GIVEN IN MORNING TO COVER BREAKFAST, LUNCH, AND DINNER
What is Humalog 75/25 composed of?
75% insulin lispro protamine (intermediate-acting) and 25% insulin lispro (rapid-acting)
USUALLY GIVEN IN MORNING TO COVER BREAKFAST, LUNCH, AND DINNER
Is the pre-mixed insulin injection a better way than assessing blood glucose and getting the exact dose needed?
NO NO NO
If the nurse needed to manually mix insulin, what is the proper procedure, do you draw up cloudy or clear first?
draw up clear first!
- roll insulin vials between hands
- pull air into syringe and inject air into NPH (cloudy) vial
- inject air into regular vial
- draw up regular
- draw up NPH (cloudy)
What is the therapeutic outcome of insulin?
promotes cellular uptake of glucose
moves potassium into cells with glucose (can be an emergent treatment of hyperkalemia) usually given with glucose to maintain bg
What can insulin be a treatment for other than hyperglycemia?
hyperkalemia (promotes influx of potassium into cells)
USUALLY GIVEN WITH GLUCOSE TO MAINTAIN BG LEVELS
What type of diabetes is insulin typically used to treat?
Type 1 glycemic control
Why would insulin be used in a patient with type 2 diabetes?
If diet/oral medications arent effective
NPO for surgery
Experiencing stress (can increase BG)
Tx for DKA and HHNS
What is the big adverse effect that can happen with insulin? What is a sign of this?
hypoglycemia - acute onset = (sympathetic response) - tachycardia, palpitations, diaphoresis, shakiness… gradual onset = (parasympathetic response) - weakness, HA, tremors, largely unknown why this gradual response occurs
If the patient has suspected hypoglycemia and is conscious what are the two things the nurse should do?
Check the blood glucose with a glucometer AND if hypoglycemic administer glucose - 15g carbohydrate (4oz juice, 8oz milk, or 1-2 glucose tablets)
If the patient is hypoglycemic and is unconscious, what is the best way to administer glucose?
IV glucose
IM or SQ glucagon
NOTHING ORAL!!!
Should diabetics wear a medical alert bracelet?
YES YES YES
What is an adverse effect from insulin injections themselves? What is a good way to prevent this?
lipohypertrophy - scar tissue and fat deposits form a lump under the skin of injection site
part injections at least an inch away from previous injections
Are there drugs that can make hypoglycemia worse or counteract the effects of insulin causing hyperglycemia?
YES YES YES
When are some times when insulin dosing may need to be adjusted?
ill
stressed
growth spurts
increased food intake
2nd and 3rd trimester of pregnancy
Do you shake the insulin vials?
NO NO NO, you gently rotate vials to avoid damaging the insulin.
If the short-acting insulin looks cloudy should it still be administered?
NO NO NO (should be clear, means its bad)
What insulins can Lantus be mixed with?
NONE
it is acidic and cannot be mixed
Should insulin be injected in the same area? Which area allows for fastest absorption and which area allows for slowest absorption?
YES YES YES
but sites in the area should be rotated
Abdomen - fastest
Thigh - slowest
What are some key points for storage of insulin?
Unopened vials can be stored in the fridge until the expiration date
opened vials can be stored at room temperature for one month
premixed vials may be stored for up to 3 months in the fridge
syringes that are premixed may be kept for 1-2 weeks in the fridge, keep in vertical position with needles pointing up, gently rotate syringe to mix medication.
What is the therapeutic action of sulfonylureas and meglitinides?
They both increase insulin secretion from the pancreas.
What are the two adverse effects of sulfonylureas and meglitinides?
hypoglycemia
disulfiram reaction with alcohol
When should sulfonylureas and meglitinides be administered?
30 minutes before meals for onset to occur during meal.
What is the therapeutic action of biguanides?
reduces production of glucose in the liver and increase muscle uptake of glucose
What are the 3 adverse effects of biguanides? and some nursing considerations/teaching points for them?
GI - anorexia, n/v, weight loss - monitor and may need to discontinue
Vitamin B12 and folic acid deficiency - provide supplements, encourage patient to take vitamins
Lactic acidosis - BIG ONE - hyperventilation, sluggishness, somnolence, myalgia (muscle pain) – avoid in patients in shock, severe infection, and hypoxic condition because these cause lactic acidosis as well
What should the patients avoid while taking biguanides ?
alcohol - it can increase the lactic acidosis
When should biguanides be taken?
With meals (helps with GI effects)
What is the therapeutic action of thiazolidinediones (Gliazones)?
increase cellular response to insulin by decreasing resistance
increase cellular uptake of glucose and decrease the production of glucose
What are the 3 adverse effects of gliazones? What are some patient teaching/nursing considerations for them?
fluid retention - monitor for edema, weight gain, signs of heart failure
elevation in LDL - monitor cholesterol
hepatotoxicity - baseline and periodic liver function tests, teach patient signs of liver dysfunction
What are the two types of patients who shouldnt receive gliazones?
Patients in severe heart failure and patients in liver failure
Can gliazones be taken with or without food?
YES YES YES
What is the therapeutic action of alpha glucosidase inhibitors?
slows carbohydrate absorption and digestion
What are the 3 adverse effects of Alpha glucosidase inhibitors? What are some nursing considerations/patient teaching points for them?
GI effects - abdominal distention, cramping, hyperactive bowel sounds, diarrhea, gas - monitor and report, may discontinue, TAKE WITH MEALS
anemia - due to decreased iron absorption - monitor H&H, may discontinue
hepatotoxicity with long-term use - check baseline and periodic liver function
What types of patients would we want to avoid giving alpha glucosidase inhibitors to?
inflammatory GI disorders, ulcerations, obstructions
What is the therapeutic action of amylin mimetics?
mimics the action of peptide hormone to reduce postprandial glucose levels
MAY BE USED IN CONJUNCTION WITH OTHER ORAL ANTIDIABETIC AGENTS
When and how would you administer amylin mimetics? What should the nurse watch out for?
administer SQ prior to meals using the thigh or abdomen, this slows the absorption allowing for its postprandial effect
monitor injection site for reactions
What is the therapeutic action of incretin mimetics?
mimics the effects of naturally occurring glucagon promoting the increase of insulin
MAY BE USED IN CONJUNCTION WITH OTHER ORAL ANTIDIABETICS
When and how would you administer incretin mimetics?
administer 60 minutes before meal SQ (so effect occurs during meals)
Do we mix amylin or incretin mimetics with insulin?
NO NO NO
some incretin mimetics come pre-mixed, but we never mix ourselves
What is an adverse effect of incretin mimetics?
pancreatitis - severe abdominal pain - MONITOR AND REPORT SIGNS
What is the therapeutic action of glucagon (GlucaGen)?
increases the breakdown of glycogen to glucose to increase blood sugar levels
What is glucagon used for?
emergent treatment of hypoglycemic state, usually when patient is unconscious.
How would glucagon be administered when unconscious?
SQ, IM, or IV
As soon as the patient is conscious what would you immediately give them?
FOOD!!
What is the big thing to teach patients about management of hypoglycemia?
always have a source of glucose with you!!
What does glucagon do to help radiological procedures?
decreases gastric motility for better imaging.
