When are oral antidiabetic drugs given?
usually given 30 minutes before meals
What is hypoglycemia?
low blood glucose level <50mg/dL
What is the most rapid acting insulin?
1. Insulin lispro (Humalog, similar to endogenous insulin)
2. Insulin aspart (NovoLog)
3. Insulin glulisine (Apidra, newest) *if cloudy, do not use. Must be clear. Onset: 5-15 minutes Duration: 3-5 hours may be given SC or by SC cont. infusion *No IV *Pt must eat meal after injection
Since biguanides do not increase insulin secretion from the pancreas, what does that mean?
does not cause hypoglycemia and weight gain *results in decreased insulin resistance
How to treat gestational diabetes?
Insulin must be given to prevent birth defects; usually subsides after delivery
What is a Biguanide and and example?
Oral antidiabetic drug
What is there potential for with sulfonylureas?
Potential for cross allergy in pts allergic to sulfonamide antibiotics*
What is FPG? What does >126 mg/dL but <110 mg/dL mean? How do you find those numbers?
Fasting plasma glucose levels; may indicate "prediabetes"
Glucose tolerance test (oral glucose challenge)
*screening recommended every 3 years when 45 years or older
What are mild hypoglycemic cases treated with?
more protein, less carbs prevents rebound postprandial hypoglycemia
What is the treatment for DM?
Type 1: insulin therapy
Type 2: lifestyle changes, oral drug therapy, insulin when the previous no longer provides glycemic control
Example of Glinides (2)
1. repaglinide (Prandin)
2. nateglinide (Starlix)
What hormone(s) does the pancreas secrete?
Insulin and glucagon both assist in glucose regulation
Important when monitoring for therapeutic response:
Measure hemoglocin A1c to monitor long-term compliance with diet and drug therapy
Example of alpha-glucosidase inhibitors (2)
1. acarbose (Precose)
2. miglitol (Glyset)
What are other treatments for type 2 diabetes?
Lifestyle modifications: diet, exercise, smoking cessation, weight loss
How long should a pt rotate sites for insulin administration?
Rotate sites for about 1 week before rotating to a new location
0.5-1 inch away from previous site
How common is Diabetes Mellitus Type 1 vs Type 2?
Type 1: <10% of all diabetes
Type 2: 90% of all cases (most common)
Are insulin orders/prepared dosages second-checked with another nurse?
YES. Yellow. Know this. Do not ever forget that this needs to be second checked. Unforgivable.
In regards to fat metabolism, what does insulin do?
stimulates lipogenesis (production and accumulation of fat)
inhibits lipolysis (breakdown/destruction of fat)
What 2 things does inadequate insulin elevate?
Inadequate insulin elevates:
1. blood glucose levels (hyperglycemia)
2. triglyceride levels
What 2 things must be assessed before giving glucose-level-altering drugs?
1. pt's ability to consume food
hypoglycemia may occur if antidiabetics are given and pt does not eat
Which drug primarily affects GI tract: abdominal bloating, nausea, cramping, diarrhea, and feeling of fullness?
What is macrovascular/microvascular?
Both are major long-term complications of DM (1 and 2)
Macrovascular is atherosclerotic plaque in coronary, cerebral, and peripheral arteries; think MACRO as BIG
Microvascular is capillary damage: retinopathy, neuropathy, nephropathy; think MICRO ias small. capillary.
What is diabetes mellitus primarily, and how many types are there?
Disorder of carbohydrate metabolism that leads to hyperglycemia
What 4 things are important to obtain/document prior to giving glucose-level-altering drugs?
1. thorough history
2. vital signs
3. blood glucose level, A1C level
4. potential complications/drug interactions
People's Blood Takes Vacation
What complications occur from Type 1 Diabetes Mellitus?
Diabetic ketoacidosis (DKA)
Hyperosmolar nonketotic syndrome
Which 2 sulfonylureas need to be taken when?
1. glyBuride taken with breakfast THINK: glyB needs breakfast
2. glipizide taken 30 minutes prior to breakfast THINK: "ZIP" it down before breakfast
Glinides, slide 29 Thiazolidinediones (glitazones), slide 30 Alpha-glucosidase inhibitors (must be taken with meals), slide 32 Sulfonylureas, slide 36 (put in the yellow stuff and left out the white) Insulin, slide 42
How many types of antidiabetic drugs are there, and what are they?
2. oral hypoglycemic drugs
both aim to produce normal blood glucose states
Which drugs cause and do not cause weight gain?
Do not cause:
2. alpha-glucosidase inhibitors