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ANTIDIABETICS
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Diabetes Mellitus
Chronic disease of deficient glucose metabolism Insufficient insulin secretion from beta cells Impaired insulin utilization Major symptoms: polyuria, polydipsia, polyphagia Types
Type
Insulin Resistance
Insulin resistance
Body tissues do not respond to the action of insulin Insulin receptors are unresponsive Insulin receptors are deficient in numbers
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Insulin
Insulin
Released
from beta cells of islets of Langerhans in pancreas Responds to increase in blood glucose Function Promotes uptake of glucose, amino acids, and
fatty acids Converts to glycogen for future glucose needed in liver and muscle
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Insulin Types
Types of Insulin
Rapid-acting Short-acting Intermediate-acting Long-acting Combinations
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Rapid-acting insulin
Humalog (Lispro), aspart, exubera Onset of action (5-15 minutes) Peak (30 minutes-1 hour) Duration (2-4 hours) Humulin R
Onset of action (30-60 minutes) Peak (2-3 hours) Duration (3-4 hours)
Short-acting insulin
Regular
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Intermediate-acting
Humulin
N (NPH), Lente
Onset of action (2-4 hours) Peak (4-12 hours) Duration (18-24 hours)
Combinations
Composed
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Long-acting
Humulin
Onset of action (4-8 hours) Peak (14-20 hours) Duration (24-36 hours) Lantus (Insulin Glargine) Evenly dispersed action Duration (24 hours)
U (Ultralente)
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Type of Insulin Rapid Acting Novolog (Aspart) Humalog (Lispro) Short Acting Humulin R (Human) Novolin R (Human) Intermediate Acting NPH (Humulin N, Novolin N) Lente (Humulin L, Novolin L)
Onset
Peak
Duration
30 mins-1 hr 30 mins-1 hr
24 hours 24 hours
6 hours -
18-24 hours -
36 hours 24 hours
2-12 hours
18-24 hours
50%NPH / 50% Regular (Humulin (50/50) 1/2 hour 75% Lispro protamine / 25% Lispro 10-15 mins
24 hours 24 hours
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Insulins
Action
Promotes use of glucose by body cells, stores glucose as glycogen in muscles Reduce blood glucose Increased hypoglycemia with aspirin, oral anticoagulants, alcohol, oral hypoglycemics, BBs,TCAs, MAOIs, tetracyclines Decreased hypoglycemia with thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking
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Use
Interactions
Hypoglycemia
Headache, dizziness, confusion, slurred speech Nervousness, anxiety, agitation Tremors, uncoordination, sweating, tachycardia, seizures Extreme thirst, dry mucous membranes Poor skin turgor, polyuria, fruity breath Fatigue, tachycardia, Kussmaul respirations
Hyperglycemia
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Insulin Administration
Nursing interventions
Monitor vital signs and glucose levels Instruct client to report hypoglycemia and hyperglycemia Encourage compliance with diet, insulin, exercise Advise client to wear medic-alert tag Teach client how to check blood glucose Teach client how to administer insulin
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Insulins Administration
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Sliding-Scale Insulin
Adjusted doses dependent upon individual blood glucose Usually done before eating and at bedtime Usually utilizes rapid or short-acting insulin
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Insulin Storage
Storage of insulin
Usually kept in refrigerator Remove from refrigerator 30 minutes prior to injection Avoid storing insulin in direct sunlight or at high-temperatures Prefilled syringes should be stored in the refrigerator
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Sulfonylureas
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Sulfonylureas
Glipizide (Glucotrol), glyburide (Diabeta) Action Stimulates beta cells to secrete insulin, alters sensitivity of peripheral insulin receptors Use Control hyperglycemia in type 2 diabetes Cautions Liver or kidney dysfunction, elderly, malnourished, adrenal or pituitary insufficiency
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Glipizide (Glucotrol)
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Nonsulfonylureas
Biguanides Metformin (Glucophage) Action: increases binding of insulin to receptors Alpha-glucosidase inhibitors Acarbose (Precose) Action: inhibits absorption of sugars from GI tract
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Nonsulfonylureas
Thiazolidinediones Pioglitazone (Actos), rosiglitazone (Avandia) Action: affects insulin receptors by enhancing insulin
sensitivity of cells
Meglitinides Repaglinide (Prandin), neteglinide (Starlix) Action: stimulates release of insulin from pancreatic
islets
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Nonsulfonylureas
Use
Increases binding of insulin to receptors Improves tissue sensitivity to insulin Increases glucose transport into skeletal muscles and fatty tissues Control hyperglycemia in type 2 diabetes mellitus
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Metformin (Glucophage)
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Nursing interventions
Monitor vital signs, glucose levels Administer with food to minimize GI distress Teach client to eat prescribed diet on schedule Teach client to recognize symptoms of hyperglycemia and hypoglycemia Encourage drug compliance Advise client to wear medic-alert tag Warn client to avoid alcohol Teach client the treatment for hypoglycemia and hyperglycemia
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Glucagon
Glucagon
Hyperglycemic hormone secreted by alpha cells of the islets of Langerhans in the pancreas Stimulates breakdown of stored glycogen to glucose in liver
Action
Use
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Case Study
A client has a 6 am blood glucose of 238 mg/dl and is to receive Lispro insulin on a sliding scale.
Critical Thinking
What is the onset, peak, and duration of Lispro insulin compared with other types of insulin?
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1. A client has a 6 am blood glucose of 238 mg/dl and was given regular insulin 12 U on a sliding scale. At what time should the nurse monitor the client for signs of hypoglycemia? a. 6:30-7:00am c. 11:00am-1:00pm b. 8:00-10:00am d. 10:30am-12:00nn 2. A client is about to do his morning routine of exercise. Which of the following instructions will the nurse give when giving a Humulin-R insulin? a. Inject insulin at least 30 mins before exercise b. Inject half of insulin dose before exercise and the other half after exercise c. Do not inject insulin d. Inject insulin 30 mins after exercise
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3. A client was rushed into the ER. Upon assessment the nurse observes a fruity breath with Kausmalls breathing pattern and flushed dry skin and mucous membranes. Random blood glucose was 438 mg/dl. Which of the following types of insulin will the nurse expect the MD will order? a. Lispro c. Lantus b. Humulin R d. NPH
4. A client was given regular insulin 10 U on a sliding scale. Which assessment findings should the nurse monitor the client 4 hours following insulin injections? a. Frequent urination (polyuria) b. Tremors and cold clammy skin c. Kausmalls breathing d. Dry mucous membranes
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5. A client was given Lantus insulin 8 U at 7am. When will the nurse expect to give the next dose of the insulin? a. 7:00 pm same day c. 1:00 pm same day b. 7:00 am next day d. 1:00 am next day
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Practice Question #1
Which time frame would be most appropriate for sliding scale Lispro insulin?
A. B. C. D.
Within 30 minutes of consuming breakfast When the breakfast tray is served and ready to eat Within 1 hour of obtaining blood glucose measurement Within 15 minutes of obtaining blood glucose measurement
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Practice Question #2
A client is prescribed metformin (Glucophage). Which of the following is a side effect/adverse effect common to metformin?
A. B. C. D.
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