Antidiabetic drugs Differentiate between Type I & II diabetes Type I Insulin only (no oral) Hereditary Producing no insulin, not enough or ineffective Diagnosed as a child Skinny No insulin so glucose cannot get into cell= hyperglycemia Pump or SC injections Type II Most common Caused by lifestyle Reversible Insulin resistance or deficiency Need to decrease the insulin secretions DKA- only regular insulin via IV Identify normal blood glucose levels Normal fasting <100 mg/dL Identify values associated with hyperglycemia Fasting plasma >126 mg/dL Symptoms Hot and dry Identify values associated with hypoglycemia Blood glucose <70 mg/dL Symptoms Cool and clammy, need some candy Looks like they're drunk Know what the Hgb A1C indicates, what is it? What does it indicate? Ranges for diabetic/non-diabetic Average daily blood glucose over past 3 months Normal 4-5.9% Diabetic diagnosis >6.5% Well controlled Type II >7% Discuss the function of insulin Allows the cells in the muscles, fat and liver to absorb glucose that is in the blood. Differentiate between the insulins regarding onset, peak, and duration of therapeutic action, and names of the insulins Rapid acting Must be administered within 5 minutes before a meal Prototype Lispro (humalog) Aspart (novolog) Onset 15-30 minutes Peak (most risk for hypoglycemia) 0.5-2.5 hours Therapeutic duration 3-6 hours Short acting (clear) Given 30 minutes before a meal Only given IV bolus, infusion, IM Prototype Regular insulin (humulin R) Onset 30-60 minutes Peak (most risk for hypoglycemia) 1-5 hours Therapeutic duration 6-10 hours Intermediate acting (cloudy) Prototype NPH (humulin N) Onset 1-2 hours Peak (most risk for hypoglycemia) 6-14 hours Therapeutic duration 16-24 hours Long acting Administer once daily Cannot be mixed** Prototype Glargine (lantus) Onset 1 hour Peak (most risk for hypoglycemia) None Therapeutic duration 24 hours Identify why knowing when the insulins onset of action is important Know when patient needs to eat Identify why knowing when the insulins peak is important Most risk for hypoglycemia Discuss the causes, symptoms and treatment of hypoglycemia Cool and clammy, need some candy Looks like they're drunk Describe the sliding scale insulin dosing, understand how to read it and utilize it Regular insulin doses adjusted according to blood glucose Discuss nursing implications of administering insulin – drawing up, rotating injection sites, storage of, etc. Check glucose before giving insulin Roll vial instead of shaking to avoid bubbles Ensure correct storage Insulin only goes in insulin syringes Ensure correct timing with insulin does with meals Complete all rights Double verification Clear then cloudy Provide education Self administration Timing of dose Monitor blood glucoses Injection site rotation Know what the nurse needs to teach the patient about self- administration of insulin Rotate sites Differentiate between the different classifications of the oral antidiabetic agents Sulfonylureas (Pancreas) Stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels First generation Prototype Chlorpropamide (Diabinese) Tolazamide (Tolinase) Side effects Hypoglycemia, hematologic effects, nausea, epigastric fullness, heartburn, many others Second generation Prototype Glipizide (Glucotrol) Biguanides (Liver) Decreased production of glucose by the liver by inhibiting (gluconeogenesis) Increases muscles glucose uptake and use Prototype Metformin (Glucophage) Lactic Acidosis Fatal. Look at ABGs (pH). Risk increases with Impaired liver or renal function Alcoholism S&S Malaise, increasing somnolence Myalgias Hypotension Bradyarrhythmias Side effects Abdominal bloating, metallic taste, nausea, cramping, diarrhea, reduced vit B12 Meglitinides (Glinides) Prototype Repaglinide (Prandin) Promote insulin release by pancreas Prototype Sitagliptin (Januvia) Incretins “gliptins” DPP4 inhibitor Lowers fasting and post meal blood glucose levels Augments incretin hormones with promote release if insulin and decrease secretion of glucagon Prototype Exenatide (Byetta) Incretin mimetics GLP-1 May be used with metformin or a sulfonylurea Glitazones Alpha-glucosidase inhibitors (GI) Slows carbohydrate absorption and digestion Prototype Acarbose (Precise) Adverse Effects Abdominal bloating, gas, diarrhea Incretins Thiazolidinediones Enhances insulin action at the cell receptor site Increase glucose uptake and use in skeletal muscle Administered 1-2 times a day with food Hypoglycemia does not occur Adverse effects Liver damage Liver function test every 2-3 months Promotes fluid retention. Contraindicated for heart failure or pulmonary edema Prototype Pioglitazone (Actos) Side effects Moderate weight gain Edema Mild anemia Hepatic toxicity Identify the mechanism of action of each of the above classes Know which of the above work by causing insulin release from the pancreas Why is this important? Each drug class has a side effect specific to that class – be able to identify them Nursing implications regarding administration of the oral agents Always check blood glucose levels Usually given 30 minutes before meals Alpha-glucosidase inhibitors are given with the first bite of each main meal Metformin is taken with meals to reduce GI effects Before giving any drugs that alter glucose levels Assess the patient's ability to consume food Assess for nausea and vomiting Hypoglycemia may be a problem if antidiabetic agents are given and the patients does not eat overall concerns for any diabetic patient increase when the patient Is under stress Has an infection Has an illness or trauma Is pregnant Monitor for A therapeutic response Measure A1C to monitor long-term compliance to diet and drug therapy Watch for hypoglycemia and hyperglycemia Always determine LOC and ability to swallow If hypoglycemia occurs Give glucagon PRN Have the patient eat glucose tablets or gel,m corn syrup, honey Eat a small snack such as crackers or half a sandwich Monitor blood glucose levels Patient education Disease process Diet and exercise recommendations Self administration of insulin or oral agents
