Diabetes Meds

Question 1

What was Diabetes Mellitus called in the 16th century

Answer 1

“Honey Urine”-smells and tasted like urine

Question 2

When was Insulin developed?

Answer 2

Insulin was developed in the 1920s from pork
Most people before insulin died early from diabetes
Insulin or Oral meds to control glucose levels

Question 3

What are other drugs besides Glucagon that can increase glucose?

Answer 3

Steroids, Hydrochlorothiazide, and Epinephrine

Question 4

What relationship does glucose and glucagon have?

Answer 4

Inverse-Glucose increases/ glucagon decreases

Hypoglycemics appear to be drunk

Question 5

Regular Insulin

Answer 5

Onset: 30-60min/ Peak: 2-4hr/ Duration: 6-12 hours
Short acting-only insulin given IV (ICU)
No problem with lactation
Somogyi effect=2-4am body senses blood glucose drop and stimulates glucagon release=increases glucose
Dawn effect=body prepares for waking and stimulates glucose release. Body doesn’t wake up in time, very high glucose. May get night sweats, headaches, irritability
Adverse reactions: Hypoglycemia; Allergic
Caution: renal or hepatic impairment

Question 6

Lispro (Humalog)

Answer 6

Rapid-acting; Onset: <15 min; Peak: 30-90 min; Duration: 2-5 hr

Question 7

NPH (Humulin N)

Answer 7

Intermediate acting; Onset: 1-1.5 hr; Peak: 4-12 hr; Duration: 24 hr

Question 8

Aspart (Novolog)

Answer 8

Rapid-acting; Onset: 10-20 min; Peak: 1-3 hr; Duration: 3-5 hr

Question 9

Glargine (Lantus)

Answer 9

Long-acting; Onset: 60-70 min; Peak: None; Duration: 24 hr

Question 10

Detemir (Levemir)

Answer 10

Long-acting; Onset: 1-2 hr; Peak 3-6 hr; Duration: 5.7-23.3 hr

Question 11

Glulisine (Apidra)

Answer 11

Rapid-acting; Onset: 2-5 min; Peak: 30-90 min; Duration: 2 hr

Question 12

Role of the Nurse in Insulin Therapy

Answer 12

S+S of Hypo/Hyperglycemia
Teach about stress, exercise, and change in food intake
Lantus and Levomere can’t be mixed with other insulins
Children tend to do better at monitoring their blood sugar then adults
Children typically have pens- hard to push

Question 13

Glyburide

Answer 13

Given if beta cells are functioning-no TYPE I
Developed in 1940s and improves insulin binding
Contraindications: Severe Trauma-need tight control of glucose/ Major Surgery: Antidiabetics shouldn’t be taken before surgery
Adverse: Nausea, Heartburn, Possible anorexia=watch for hypoglycemia
Drug-Drug: Alcohol-Increases half-life/ Ginseng/ Betablockers/ Anticoagulants
should be given with food to prevent hypoglycemia

Question 14

Metformin (Biguanides)

Answer 14

Only drug in this class
Doesn’t usually cause hypoglycemia
Decrease hepatic production of glucose and reduces insulin resistance
Adverse effects: Metallic Taste in mouth; Flatulence; Nausea, Vomiting, Tends to give diarrhea at beginning
Can give to children at least 10 years of age
Can Cause lactic acidosis and renal failure
Withhold 48 hrs before and after IV radiographic contrast dye
Drug-Drug: Captopril/ Furosemide increase risk of hypoglycemia
Digoxin/ Morphine/ Vancomycin may decrease elimination

Question 15

Exenatide

Answer 15

Increases insulin release and decreases glucagon release and slows gastric emptying and increases satiety
Given SQ within 60 mins of morning and evening meals NOT AFTER
Don’t give if: NPO/ Gastroparesis/ Pregnant/ Children/ Renal impairment
Typically lose 1-3 lbs
Used in conjunction with diet and exercise

Question 16

Sitagliptin

Answer 16

Slows breakdown of GLP-1=Increases Insulin secretion and decreases glucagon secretion, slows GI emptying
PO every day-no regard to meals
Adverse effects: pancreatitis, URI, Nausea, vomiting, diarrhea
Cautious use in pregnancy, lactation, and renal failure
Excreted in urine
May increase digoxin level

Question 17

Glucagon

Answer 17

Increases blood glucose levels by slowing insulin secretion and increasing breakdown of glycogen in the liver
Given if blood glucose is severely low 20-30s
Typically given IV
glucose tablets/ glucose frosting/ etc.