Antidiabetic Drugs

Question 1

Type I Diabetes

Answer 1

Develops during childhood or adolescence; beta cells do not produce insulin

MUST have insulin as little or none is being produced

Question 2

Type II Diabetes

Answer 2

Decreased sensitivity to insulin; slow, progressive glucose intolerance

Comorbid conditions include obesity, coronary heart disease, dyslipidemia, hypertension, microalbuminemia, increased risk of blood clots

Do not use finger stick to diagnose diabetes

Question 3

Acute Complications of Diabetes

Answer 3

Hypoglycemia, diabetic ketoacidosis (Type I), hyperglycemic hyperosmolar nonketoic syndrome (Type II)

Question 4

Gestational Diabetes

Answer 4

Hyperglycemia that develops during pregnancy

Insulin must be given to prevent birth defects

Question 5

Screening for Diabetes

Answer 5

Prediabetes: HbA1C 5.7-6.4%; fasting blood glucose levels between 100 and 126; impaired glucose tolerance test

Question 6

Rapid Acting Insulin

Answer 6

Most rapid onset of action (5-15 minutes)

Patient must eat a meal after injection

Lispro (Humalog) and Aspart (Novolog)

DO NOT give intravenously

Question 7

Short Acting Insulin

Answer 7

Regular insulin (Humulin R) should be CLEAR

The only insulin that can be given IV

Question 8

Intermediate Acting Insulin

Answer 8

Insulin Isophane Suspension (NPH)

Only insulin suitable for mixing with short-acting insulin

Should be cloudy

Subcutaneous

Question 9

Long Acting Insulin

Answer 9

Glargine (Lantus); referred to as basal insulin

Can only be given subcutaneously

Cannot be mixed with any other insulin in the same syringe

Question 10

Sliding-Scale Insulin Dosing

Answer 10

Subcutaneous short-acting or regular insulin in doses adjusted according to blood glucose test results

Typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings

Question 11

Insulin Concentration

Answer 11

100 units/mL (U-100)

Question 12

Storage of Insulin

Answer 12

Unopened vials should be stored under refrigeration until needed

Keep out of sunlight and direct heat

Question 13

Oral Antidiabetic Drugs

Answer 13

Used for Type II DM ONLY

Need to carefully monitor blood glucose levels, use multi-drug therapy, and treat comorbid conditions as well

Question 14

Oral Hypoglycemics

Answer 14

Metformin (Glucophage) is a biguanide

Glipizide (Glucotrol) is a second generation sulfonylurea

Repalinide (Prandin) and Nateglinide (Starlix) are meglitinides

Acarbose (Precose) is an alpha-glucosidase inhibitor and must be taken with the first bite of food

Question 15

Adverse Effects of Metformin (Glucophage)

Answer 15

Diarrhea, reduced vitamin B12 levels

Does not cause hypoglycemia

Question 16

Hypoglycemia

Answer 16

Abnormally low blood glucose level (below 60mg/dL)

Causes include too much insulin or oral hypoglycemic agents, too little food, and excessive physical activity

Manifested by sweating, tremors, inability to concentrate, confusion, memory lapses, disorientation

Question 17

Management of Hypoglycemia

Answer 17

Treatment must be immediate

If patient is able to swallow, give 15 g of fast-acting, concentrated carbohydrate

Question 18

Glucose-Elevating Drugs

Answer 18

Glucagon (IM or IV push) increases blood sugar

These are given when patients have very low blood glucose and are unable to swallow

Question 19

Diabetic Ketoacidosis

Answer 19

Caused by an absence of or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat

Characterized by “fruity” breath, ketone bodies in blood and urine, and hyperventilation with Kussmaul respirations

As a result of dehydration, not blood sugar

Question 20

Treatment of DKA

Answer 20

Rehydrate with IV fluid and regular insulin

Rehydration leads to increased plasma volume and decreased potassium, insulin enhances the movement of potassium from ECF into the cells

Monitor blood glucose and renal function, EKG and electrolyte levels for potassium, and vitals, lung assessment, and signs of fluid overload

Question 21

Hyperosmolar Hyperglycemic State

Answer 21

Due to lack of effective insulin

Ketosis is minimal or absent

Blood glucose can be as high as 1000 mg/dL or higher

Much more common in Type II Diabetes

Question 22

Nursing Implications

Answer 22

Give oral antidiabetic drugs 30 minutes before meals

Metformin will need to be discontinued if the patient is to undergo studies with contrast dye because of possible renal effects (check with prescriber)