Antidiabetics

Question 1

What are some signs and symptoms of diabetes?

Answer 1

Some signs and symptoms of diabetes include:
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Elevated fasting blood glucose (higher than 7 mmol/L) or a hemoglobin A1c (HbA1c) level greater than or equal to 6.5%
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Polyuria
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Polydipsia
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Polyphagia
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Glycosuria
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Weight loss
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Fatigue
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Blurred vision

Question 2

What is the primary characteristic of Type 1 diabetes? What is the treatment?

Answer 2

Type 1 diabetes is characterized by a lack of insulin production, or production of defective insulin. Affected patients need exogenous insulin.

Question 3

What percentage of all diabetes cases are Type 1? What are some complications?

Answer 3

Fewer than 10% of all diabetes cases are Type 1. Complications include diabetic ketoacidosis and hyperosmolar hyperglycemic state.

Question 4

What is the most common type of diabetes and what percentage of cases does it represent? What are the primary causes?

Answer 4

Type 2 diabetes is the most common type, accounting for 90% of all cases. It is caused by insulin deficiency and insulin resistance. Many tissues are resistant to insulin due to a reduced number of insulin receptors or insulin receptors being less responsive.

Question 5

What are some common comorbid conditions associated with Type 2 diabetes?

Answer 5

Several comorbid conditions associated with Type 2 diabetes include:
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Obesity
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Coronary heart disease
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Dyslipidemia
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Hypertension
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Microalbuminemia (protein in the urine)
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Increased risk for thrombotic (blood clotting) events

Question 6

What are the major long-term macrovascular complications of both types of diabetes?

Answer 6

Major long-term macrovascular (atherosclerotic plaque) complications include damage to the coronary arteries, cerebral arteries, and peripheral vessels.

Question 7

What are the major long-term microvascular complications of both types of diabetes?

Answer 7

Major long-term microvascular (capillary damage) complications include retinopathy, neuropathy, and nephropathy.

Question 8

What HbA1c range indicates prediabetes?

Answer 8

An HbA1c of 6.0 to 6.4% indicates prediabetes, which is a category of increased risk.

Question 9

What fasting plasma glucose levels indicate prediabetes

Answer 9

Fasting plasma glucose levels higher than or equal to 6.1 mmol/L but less than 6.9 mmol/L indicate prediabetes.

Question 10

How often is diabetes screening recommended for patients 40 years of age and older?

Answer 10

Screening for diabetes is recommended every 3 years for all patients 40 years of age and older.

Question 11

What are the nonpharmacological treatments for Type 2 diabetes?

Answer 11

Nonpharmacological treatments for Type 2 diabetes include:
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Weight loss
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Improved dietary habits
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Smoking cessation
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Reduced alcohol consumption
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Regular physical exercise

Question 12

What is the general glycemic goal for HbA1c in the treatment of diabetes?

Answer 12

The general glycemic goal of treatment is an HbA1c of less than 7%.

Question 13

What is the fasting blood glucose goal for diabetic patients

Answer 13

The fasting blood glucose goal for diabetic patients is 4 to 7 mmol/L.

Question 14

What is the 2-hour postprandial target blood glucose range?

Answer 14

The 2-hour postprandial target blood glucose range is 5 to 10 mmol/L.

Question 15

What is the primary treatment for Type 1 diabetes?

Answer 15

insulin therapy

Question 16

What are the initial treatment strategies for Type 2 diabetes? When is insulin considered?

Answer 16

Initial treatment strategies for Type 2 diabetes include lifestyle changes and oral drug therapy. Insulin is considered when the above no longer provide glycemic control.

Question 17

What are the main types of antidiabetic drugs?

Answer 17

The main types of antidiabetic drugs are insulins and oral hypoglycemic drugs. A combination of oral antihyperglycemic drugs and insulin can also control glucose levels. Some new injectable hypoglycemic drugs may be used in addition to insulin or oral antidiabetic drugs.

Question 18

For which type of diabetes are oral antidiabetic drugs used?

Answer 18

Oral antidiabetic drugs are used for type 2 diabetes.

Question 19

What are the key elements of effective treatment for type 2 diabetes?

Answer 19

Effective treatment for type 2 diabetes involves several elements:
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Lifestyle changes
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Careful monitoring of blood glucose levels
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Therapy with one or more drugs
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Treatment of associated comorbid conditions such as high cholesterol and high blood pressure

Question 20

What is the primary biguanide drug? For which type of diabetes is it the first-line and most commonly used oral medication? Is it used for Type 1 diabetes?

Answer 20

The primary biguanide drug is metformin (Glucophage). It is the first-line drug and the most commonly used oral medication for the treatment of type 2 diabetes. It is not used for type 1 diabetes.

Question 21

What are some common adverse effects of metformin? What is a rare complication?

Answer 21

Common adverse effects of metformin include abdominal bloating, nausea, cramping, a feeling of fullness, and diarrhea, as well as metallic taste, hypoglycemia, and a reduction in vitamin B12 levels after long-term use. Lactic acidosis is an extremely rare complication.

Question 22

What are some examples of second-generation sulphonylureas? What are some adverse effects?

Answer 22

Examples of second-generation sulphonylureas include glimepiride (Amaryl), gliclazide (Diamicron), and glyburide (DiaBeta). Adverse effects include hypoglycemia, weight gain, skin rash, nausea, epigastric fullness, and heartburn.

Question 23

What are some examples of glinides? For which type of diabetes are they indicated?

Answer 23

Examples of glinides include repaglinide (GlucoNorm®) and nateglinide (Starlix®). They are indicated for type 2 diabetes.

Question 24

What are some examples of thiazolidinediones (glitazones)? What is their mechanism of action? For which type of diabetes are they indicated?

Answer 24

Examples of thiazolidinediones (glitazones) include pioglitazone (Actos®) and rosiglitazone (Avandia®). They are insulin-sensitizing drugs and are indicated for type 2 diabetes.

Question 25

What is an example of an α-Glucosidase inhibitor? For which type of diabetes is it indicated?

Answer 25

An example of an α-Glucosidase inhibitor is acarbose (Glucobay). It is indicated for type 2 diabetes.

Question 26

What are some examples of dipeptidyl peptidase 4 (DPP-4) inhibitors?

Answer 26

Examples of dipeptidyl peptidase 4 (DPP-4) inhibitors include sitagliptin (Januvia®), saxagliptin (Onglyza®), linagliptin (Tradjenta®), and alogliptin (Nesina®).

Question 27

What defines hypoglycemia? How are mild cases treated?

Answer 27

Hypoglycemia is defined as an abnormally low blood glucose level (below 4 mmol/L). Mild cases can be treated with diet—higher intake of protein and lower intake of carbohydrates—to prevent rebound postprandial hypoglycemia

Question 28

What are some adrenergic symptoms of hypoglycemia?

Answer 28

Adrenergic symptoms of hypoglycemia include anxiety, tremors, sensation of hunger, palpitations, and sweating

Question 29

What are some central nervous system symptoms of hypoglycemia? What are some later signs?

Answer 29

Central nervous system symptoms of hypoglycemia include difficulty concentrating, confusion, weakness, drowsiness, vision changes, difficulty speaking, dizziness, and headache. Later signs include hypothermia and seizures. If not treated, coma and death will occur.

Question 30

What are some oral forms of glucose used to treat hypoglycemia? What are other treatments for hypoglycemia?

Answer 30

Oral forms of concentrated glucose include gel, liquid, or tablet form. Other treatments for hypoglycemia include 50% dextrose in water (D50W), glucagon, and if the patient is conscious, glucose tablets, liquid, or gel; corn syrup; honey; fruit juice or nondiet soft drink; or a small snack, such as crackers or a half sandwich. D50W or IV glucagon should be given if the patient is unconscious.

Question 31

What is an important nursing consideration when a patient taking antidiabetic drugs is NPO for a test or procedure?

Answer 31

If a patient taking antidiabetic drugs is to take nothing by mouth (NPO) for a test or procedure, the nurse should consult the primary care provider to clarify orders for antidiabetic drug therapy.

Question 32

What are some conditions that increase overall concerns for any patient with diabetes?

Answer 32

Overall concerns for any patient with diabetes increase when the patient: ◦ Is under stress ◦ Is pregnant or lactating ◦ Has an infection ◦ Has an illness or trauma

Question 33

What is a key nursing action to take before administering oral antidiabetic drugs? When are they usually given? How should α-Glucosidase inhibitors and metformin be administered in relation to meals?

Answer 33

Always check blood glucose levels before administering oral antidiabetic drugs. They are usually given 30 minutes before meals. α-Glucosidase inhibitors are given with the first bite of each main meal. Metformin is taken with meals to reduce gastrointestinal effects.

Question 34

What is an important consideration regarding metformin and studies with contrast dye?

Answer 34

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