Chapter 41: Drug Therapy for Diabetes Mellitus

The nurse is discussing diabetes with a group of individuals who are at risk for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?

"Insulin assists glucose molecules to enter the cells of muscle and fat tissues."- Insulin appears to activate a process that helps glucose molecules enter the cells of striated muscle and adipose tissue. It also stimulates the synthesis of glycogen by the liver, promotes protein synthesis, and helps the body store fat by preventing its breakdown for energy.

What instructions would be important to give to a 50-year-old client with type 2 diabetes who has been switched from glyburide , a sulfonylurea, to repaglinide, a meglitinide?

"It stimulates insulin production, so you need to eat soon after taking the medication."

Which are risk factors for type-2 diabetes that a nurse should recognize in a client? Select all that apply:

A nurse should be able to identify all the risk factors for type-2 diabetes in a client. These include: obesity, older age, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, minimal or no physical activity, and race/ethnicity (Black Americans, Hispanic/Latino Americans, Native Americans, and some Asian Americans).

A nurse is preparing to administer insulin glargine to a client. What precaution should the nurse take when administering this drug?

Avoid mixing glargine with other insulins.

A female client visits the health care provider's office after routine labs are drawn. The nurse notes that her A1C is 9. How does the nurse interpret this finding?

Client's average blood glucose is above normal.- The American Diabetes Association (ADA) suggests a target A1C of less than 7%. A1C should be measured every 3 to 6 months. An A1C of 9 indicates that the client's average blood glucose is consistently above normal.

The nurse is educating a client who will be adding an injection of pramlintide to his insulin regimen. What information is most important for the nurse to share with this client to ensure safe medication administration?

Do not give pramlintide in the same site where insulin is administered.- Clients who take pramlintide should not be injected into the same site where insulin is administered.

Which would a nurse identify as an example of a sulfonylurea?

Glyburide- Glyburide is an example of a sulfonylurea. Metformin is classified as a biguanide. Acarbose and miglitol are alpha-glucosidase inhibitors.

A nurse is preparing to administer insulin to the client. Which interventions should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation.

A nurse at a health care facility is assigned to administer insulin to the patient. Which intervention should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation.- The nurse should check the previous injection site before administering each insulin dose. The injection sites should be rotated to prevent lipodystrophy. Prefilled syringes should not be kept horizontally; they should be kept in a vertical or oblique position to avoid plugging the needle. The nurse checks for symptoms of myalgia or malaise when administration of metformin leads to lactic acidosis. Insulin should be kept at room temperature for administration. Insulin is refrigerated if it needs to be stored for up to three months for later use.

A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client?

Insulin is needed because the beta cells of the pancreas are no longer functioning.- Insulin is needed in type 1 diabetes because the beta cells of the pancreas are no longer functioning. With type 2 diabetes, insulin is produced, but perhaps not enough to maintain glucose control or the insulin receptors are not sensitive enough to insulin.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse likely administer?

Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide?

Metformin is classified as a biguanide. Miglitol is an alpha-glucosidase inhibitor. Tolbutamide is a first generation sulfonylurea. Glipizide is a second generation sulfonylurea.

The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose. The client is not allowed to take anything orally following complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client's blood glucose level?

Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV.

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered?

Regular.- Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

A nurse is preparing to administer an insulin that is clear. Which insulin would the nurse likely administer?

Short-acting or regular insulin and rapid-acting insulin such as lispro, aspart, and glulisine are clear, whereas intermediate-acting (Humulin N and Humulin L) and long-acting (Humulin U) insulins are cloudy. There is no insulin classified as ultra-short insulin.

A 35-year-old client has begun the administration of glyburide for treatment of diabetes mellitus type 2. The nurse caring for this client provides education regarding this medication. Which statement would NOT be an appropriate instruction for this client?

The medication should have a fixed dose which cannot be manipulated.- Manipulating the dosing of glyburide can often reduce the unpleasant reactions. The primary adverse effect associated with glyburide (and the other sulfonylureas) is hypoglycemia. Concomitant alcohol use increases the rate of glyburide metabolism and may cause a disulfiram-like reaction. Administer glyburide before breakfast or the first main meal of the day in order to stimulate insulin production. It is important to caution clients to avoid taking OTC medications and herbal or dietary supplements without first consulting the prescriber.

As the first-line treatment, a client with type 2 diabetes has tried diet and exercise. When these fail, what may be added as monotherapy or in combination with metformin to control their disease process?

Thiazolidinediones-Thiazolidinediones (TZDs) may be used as monotherapy with diet and exercise or in combination with metformin a sulfonylurea, or an incretin agent (sitagliptin). Repaglinide, a sitagliptin, or an incretin agent are incorrect answers for this question.

A 2-month-old male child is diagnosed with diabetes. His parents are having difficulty measuring 2 units of insulin in the U-100 syringe. What would the nurse expect the health care provider to order?

U-10 (10 units/mL) insulin- Administration of insulin for infants and toddlers who weigh less than 10 kg or require less than 5 units of insulin per day can be difficult because small doses are hard to measure in a U-100 syringe. Use of diluted insulin allows more accurate administration. The most common dilution strength is U-10 (10 units/mL), and a diluent is available from insulin manufacturers for this purpose. Vials of diluted insulin should be clearly labeled and should be discarded after 1 month.

The nurse is conducting a class for newly diagnosed adult diabetic patients. What would the nurse educate the patients about?

While it would be important to teach the patients about nutrition, the preservation of intact skin and self-care, adults need extensive education about the disease as well as the drug therapy. Warning signs and symptoms should be stressed repeatedly as the adult learns to juggle insulin needs with exercise, stressors, other drug effects, and diet.

The nurse is reviewing a prescription for metformin. The nurse should immediately contact the prescribing health care provider to report a contraindication if the prescription is for which client?

an 82-year-old diagnosed with type 2 diabetes- There is a black box warning against the use of metformin in persons older than 80 years because of the risk for lactic acidosis. Recent surgery, a diagnosis of anorexia, and the use of oral contraceptives do not contraindicate the use of metformin.

The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:

increasing insulin secretion from the pancreas.

The health care provider prescribes glyburide for a client who is a newly diagnosed type 2 diabetic. The nurse knows that this medication produces hypoglycemia by:

increasing insulin secretion from the pancreas.-The hypoglycemic action of glyburide results from the stimulation of pancreatic beta cells, leading to increased insulin secretion.

After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?

insulin glargine- Insulin glargine is an example of a long-acting insulin. Insulin lispro and insulin aspart are rapid-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?

insulin lispro

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse likely administer?

insulin lispro- Insulin lispro is an example of a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulin. Isophane insulin suspension is an intermediate-acting insulin.

Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?

liver enzymes- Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.

A nurse is assessing a client receiving insulin glargine 20 units at bedtime. The nurse determines the insulin requirement may increase when preparing to administer which new drug? Select all that apply.

Corticosteroids (methylprednisolone), estrogens (estradiol), and niacin are among the drugs that can decrease the effect of insulin and require an increase in insulin dosage to control the client's diabetes. Beta blockers and fibrates increase the effect of insulin and thus may require a decrease in the dosage of insulin.

The nurse is preparing to administer insulin glargine to a client. Which actions will the nurse perform when preparing the insulin? Select all that apply.

Prior to administering insulin glargine to a client, the nurse must complete the following preadministration steps: carefully check the health care provider's order for the type and dosage of insulin, check the expiration date on the vial, gently rotate the vial between the palms of the hands, gently tilt end to end before withdrawing the insulin, and remove all air bubbles from the syringe barrel. The nurse should never mix or dilute insulin glargine with any other insulin or solution because the insulin will not be effective.

Which HbA1c result would indicate that a client's diabetes is under good control?

Results vary with the laboratory method used for analysis, but in general, levels between 6.5% and 7% indicate good control of diabetes. Results of 10% or greater indicate poor blood glucose control for the last several months.

A client with hyperinsulinism has been prescribed diazoxide. After administration, which adverse reaction should the nurse prioritize?

The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the client receiving diazoxide drug therapy. Myalgia, fatigue, and headache are the adverse reactions observed in clients undergoing pioglitazone HCl drug therapy. Flatulence is one of the adverse reactions found in clients receiving metformin drug therapy. Epigastric discomfort is one of the adverse reactions observed in clients receiving acetohexamide drugs.

The nurse is assessing a client who was administered metformin and notes hyperventilation, nausea, and somnolence. The nurse determines which nursing diagnosis should be prioritized for this client?

Altered Breathing Pattern-When taking metformin, the client is at risk for lactic acidosis manifested by unexplained hyperventilation, myalgia, malaise, GI symptoms, or unusual somnolence. Thus, a nursing diagnosis of Altered Breathing Pattern would be most likely. There are no problems with fluid balance. Acute Confusion would be appropriate if the client was experiencing hypoglycemia. Anxiety would be appropriate for a client who is newly diagnosed with diabetes and having difficulty accepting the diagnosis.

The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated; and has a blood glucose of 60 mg/dL. Which emergent treatment would the nurse most likely give? Select all that apply.

Methods of terminating a hypoglycemic reaction include the administration of one or more of the following: orange or other fruit juice, hard candy or honey, glucose tablets, glucagon, or glucose 10% or 50% IV.

A client diagnosed with diabetic ketoacidosis has been admitted to the intensive care unit. The client is prescribed an intravenous insulin drip, so the nurse knows that what type of insulin will be administered?

Regular- Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period?

the past 3 or 4 months- Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?

weakness, sweating, and decreased mentation.