Week 8: Antidiabetic Drugs

Question 1

Two types

Answer 1

Type 1—insulin-dependent (IDDM) Affected patients need exogenous insulin

Type 2—non-insulin dependent (NIDDM)

Question 2

without insulin, the kidneys are unable to absorb the excess glucose in the glomerular filtrate and

Answer 2

lose large amounts of glucose, ketones and other solutes in urine.

Question 3

normal serum levels are

Answer 3

4- 6 mmol

Question 4

when blood glucose levels are high but no insulin is present to allow glucose to be used for energy production,

Answer 4

the body may break down fatty acids for fuel, producing ketones as a metabolic byproduct

Question 5

dka can lead to

Answer 5

coma and death

Question 6

the two major classes used to treat DM are

Answer 6

insulins and oral hypoglycemic drugs.

Question 7

the primary treatment for typ1 DM and gestational DM

Answer 7

is insulin therapy for type 2 DM is us. last resort

Question 8

clear insulins

Answer 8

rapid or short acting

Question 9

cloudy

Answer 9

intermediate acting insulins.

Question 10

to maintain constant blood glucose levels both after and between meals …

Answer 10

insulin must be present

Question 11

type 2 diabetes

Answer 11

is characterzed by insulin resistance and an ongoing reduction in beta cell function. thus glucose levels will worsen over time and necesitate ever-changing treatment.

 Most common type, associated with obesity
 Caused by insulin deficiency and insulin resistance
 Many tissues are resistant to insulin
>Reduced number insulin receptors
>Insulin receptors less responsive
 Receptors don’t recognize

Question 12

the use of submaximal doses of the drugs results

Answer 12

in a more rapid and better glycemic control and fewer adverse effects than with monotherapy at maximal dosages

Question 13

hypoglycemia

Answer 13

is an abnormally low blood glucose level (generally below 2.8 mmol)

signs of CNS manifestataions of confusion, irritability, tremor, sweating.

Question 14

insulin should be admind at a 90 degree angle

Answer 14

unless emanciated

Question 15

mixing insulins

Answer 15

clear withdrawn first. then cloudy.

Question 16

HBA

Answer 16

monitoring for ppl taking oral antidiabetic drugs.

Question 17

type 1 DM

Answer 17

 Autoimmune Disorder
 Lack of insulin producction
 Affected patients need exogenous insulin
 Complications: Retinopathy, nephropathy, neuropathy
 Diabetic ketoacidosis (DKA): Type 1 ONLY, Doesn’t happen in type 2
 Oral antidiabetic agents not effective

Question 18

normal ranges

Answer 18

A1C Glyco Hemoglobin: less than 6%
fasting glucose before meals: 4-6 mmmol
glucose level 2 hrs after eating.

Question 19

Insulins

Answer 19

 substitute for the endogenous hormone—↓ blood glucose levels by stimulating peripheral glucose uptake by skeletal muscle
 Facilitates passage of glucose, K+ and Mg+ across cell membranes
»Someone who is kyperkalemic and need to change immediately, insulin is the quickest way to do it (Mix insulin IV with dextrose. Dangerous so not all the time.)
 Restores the diabetic patient’s ability to:
» metabolize carbs, fats, and protein (Instead of metabolizing protein specifically)
» store glucose in liver
» Convert glycogen to fat stores

Question 20

Insulins USES

Answer 20

 treatment of type 1 diabetics
 Treatment of type 2 diabetics
 treatment of anyone with diabetes during acute situations
» Usually cortisol raises blood glucose levels so you wanna check for infection. Maybe that’s making the body release cortisol. Assess lungs, UTI, maybe wound
 To control Gestational diabetes
 treatment of hyperglycemia in nondiabetic clients induced by IV hyperalimentation solutions
 emergency treatment of ketoacidosis
 treatment of hyperkalemia (look above)


Question 21

Insulins Contraindications:

Answer 21

hypoglycemia (level of less than 4)

Question 22

INSULIN Interactions:

Answer 22

Alcohol may increase the effects of insulin causing hypoglycemia

Question 23

Insulins admin

Answer 23

Administration
 give SC only, in adequate adipose, rotate sites
 ONLY REGULAR or RAPID given IV
 Check blood sugar, dose is individualized
 use at room temp.—stable for 1 mos.—LABEL VIAL
 store additional insulin in the refrigerator
 when insulin is mixed, draw up regular insulin 1st and administer immediately
 Intermediate acting insulins are modified by adding a protein or zinc or both—this prolongs drug action
 glargine is acidic and CANNOT be mixed in the same syringe with other insulins
 Only some can be mixed. Check to make sure

Question 24

insulin adverse effects

Answer 24

Adverse Effects
 LOCAL—redness, swelling, itching, lipodystrophy
 HYPOGLYCEMIA – Cool, wet skin, tremors, headache, anxiety, hunger, tachycardia, diplopia, dizziness – monitor at peak action time of insulin
 HYPERGLYCEMIA – polydipsia, polyphagia, polyuria, dehydration, nausea, vomiting, deep rapid breathing, drowsiness
Very similar so ALWAYS CHECK WITH GLUCOMETER CHECK TO BE SAFE. Sometimes no symptoms.

Question 25

Oral Antidiabetic Drugs

Answer 25

Used to control hyperglycemia in type 2 diabetes

Treatment for type 2 diabetes includes lifestyle modifications

Oral antidiabetic drugs alone may not be effective unless the patient also makes behavioral or lifestyle changes—exercise is very beneficial

Usually check hemoglobin A1C and if not controlled glucose, will give the drug

Question 26

Gestational diabetes

Answer 26

can only be treated with insulin

Question 27

Oral Antidiabetic Drugs:Indications

Answer 27

Used alone or in combination with other drugs and/or diet and lifestyle changes to lower the blood glucose levels in patients with type 2 diabetes

Question 28

Oral Antidiabetic Drugs:Contraindications

Answer 28

Known drug allergy
Hypoglycemia
Severe liver or kidney disease

Pregnancy – goes through the placenta

Question 29

Keep in mind that overall concerns for any diabetic patient increase when the patient:

Answer 29

Is under stress – release of cortisol will cause blood sugars to go up

Has an infection

Has an illness or trauma

Is pregnant

Question 30

Nursing Action for Hypoglycemia

Answer 30

 Check blood sugar levels
 if conscious, give 15 g CHO (i.e. 175 ml of juice/pop, 2 tsp. sugar, 3 glucose tablets/gel, 6 lifesavers – any fast acting sugar
 check blood glucose level in 15 min.
(Make sure above 4)
 if unconscious, administer IV dextrose (D50W) or glucagon 1mg IM
 give client snack or meal to replace glycogen stores

Question 31

nursing implications for Oral antidiabetic drugs

Answer 31

 Always check blood glucose levels before giving
 Sulfonylureas given 30 min. ac meals
 Alpha-glucosidase inhibitors given TID with the first bite of each main meal
 metformin is taken BID with meals to ↓ GI effects