blood glucose drugs/diabetes

what is the shared symptom that type 1 and type 2 DM have?

sustained hyperglycemia

relationship between reflexes with blood glucose level?

inverse; hypoactive reflexes with hyperglycemia and hyperactive reflexes with hypoglycemia

how are insulins classed/divided?

by rate of action; rapid acting, short acting, intermediate acting, long acting

what are some rapid acting insulins and when are they given?

lispro, aspart → given if BS is high and given right before eating in order to bring BS down; dosed by sliding scale

what is a short acting insulin and when is it given?

regular insulin → commonly used as a carb count (1 unit of insulin/15g carbs eaten) but can also be given as a sliding scale before meals

what is important to know about regular insulin?

only insulin able to be given as a continuous IV infusions → seen in critical care settings, (also able to be given IM)

what is an immediate acting insulin and when is it given?

NPH insulin → dosed once daily or twice daily (once in morning and in afternoon); also want to monitor 12-24 hr trends of BG to ensure there aren’t any periods of hypoglycemia before giving med

what is a long acting insulin and when is it given?

glargine/lantus → qday in evening or twice daily at a lower dose; also want to monitor 12-24 hr trends of BG to ensure there aren’t any periods of hypoglycemia before giving med

what are the indications to administer insulin?

type 1 DM, type 2 DM (when other agents aren’t effective or for short-term management of BG during stress like hospitalization), DKA, hyperkalemia (pump-k-in), insulin resistance

what are some adverse effects of insulin?

hypoglycemia (most common and most dangerous), local reactions at side, hypokalemia, hypersensitivity reactions

what is important to educate patients on for insulin administration?

always check BG prior to administering insulin, rotate sites of injection, recognize signs and symptoms of hypoglycemia

should all insulin appear clear when drawing it up?

all should be clear except NPH → p means extra protein and can appear cloudy in the vial

can you combine multiple insulins in one syringe in order to reduce the amount of pokes for the pt?

yes EXCEPT glargine/lantus; can combine lispro with regular, NPH with aspart, etc but cannot combine long acting insulin with other insulins → draw up clear first and the NPH/cloudy second

what do nurses need to know about the patient prior to administering any insulin?

BG level, potassium level, meal timing, signs and symptoms of hypo/hyperglycemia

is insulin considered a high alert medication?

yes → have to have a second nurse check/sign off

what are some sulfonyureas?

glyburide, glimepiride, glipizide → original first oral anti-glucose drugs, work by stimulating insulin release from beta cells in pancreas “squeezing insulin out”

what are the uses for sulfonylureas?

type 2 DM (used in addition to diet, exercise, metformin, or insulin) → usually taken qday and can only be given to type 2 DM as these stimulate beta cells to release insulin and type 1 DM don’t have functional beta cells so it would do nothing

what are the adverse effects of sulfonylureas?

hypoglycemia, NVD

what are some alpha glucosidase inhibitors?

acarbose, miglitol

what are the uses for alpha glucosidase inhibitors?

type 2 DM (in addition to diet, exercise and other management meds) → needs to be taken with meals TID and works by slowing absorption of glucose in the GI tract (normally works to break down glucose in the GI tract but inhibitors slow this down)

what are some adverse effects of alpha glucosidase inhibitors?

GI distress like cramping, bloating, NVD → needs to be taken with food

what is a biguanide?

metformin

what are some uses for biguanides/metformin?

first line choice for t2DM with diet and exercise, also PCOS with metabolic insulin resistance → absorbed in GI tract

what are some education points about biguanides?

should not drink alcohol when taking, contraindicated with iodine contrast dye (not given in hospital due to this)

what are some adverse effects of biguanides?

lactic acidosis (dangerous for kidneys), hypoglycemia, NVD

what is a dipeptidyl peptidase 4 inhibitor (DPP-4)?

sitagliptin → DPP-4 enzymes usually break down incretin hormones like GLP-1s but inhibitors allow them to not break down and increase GLP-1 levels in bloodstream which then incr amount of insulin in bloodstream

what are the uses of DPP-4 meds?

used in addition to type 2 DM management → needs to be taken daily with or without food

what are some adverse effects of DPP-4 meds?

hypoglycemia (esp when combined with other meds); rare: pancreatitis, heart failure

what is a thiazolidinedione?

pioglitazone → works by decr insulin resistance by making cell receptors more receptive to the insulin that’s already available

what are thiazolidinediones used for?

type 2 DM and PCOS → taken once daily

what are the adverse effects of thiazolidinediones?

heart failure, bladder cancer, headache, incr total cholesterol, hepatic injury

what are some glucagon like peptide receptor agonists (GLP-1s)?

liraglutide, semaglutide

what are the uses of GLP-1s?

first line choice for type 2 DM with diet and exercise, PCOS metabolic insulin resistance → need to make sure to track input and output

what are some adverse effects of GLP-1s?

thyroid tumors, pancreatitis, NVCD, anorexia

what is a glucose elevating agent?

glucagon → given for hypoglycemia < 70 mg/dl)

what are the 3 things nurses need to do prior to administering glucose elevating agents?

recognize (s&s of hypoglycemia or see BG < 70), act according to hospital policy (give oral glucose like juice/crackers, give D50, or glucagon SUBQ, IM, IV push), reassess (check BG every 15 min until in nl range, assess pt for adverse effects)

what are some adverse effects of glucose elevating agents?

NVD, hypokalemia, hypotension