Nursing Application: Diabetes Drugs

In doing the discharge instructions for John, which of the following may indicate he may need more education? (Select all that apply)

*"If my blood sugar remains normal over the next couple of weeks I can stop this medication." *"I want my hemoglobin a1c to be less than 7%. *"If I have diarrhea, I should stop this medication."

John's hemoglobin a1c is up to 9%, and he is on the following medications: -glipizide 20mg twice daily​ -metformin 850mg twice daily He does not want insulin because he is unable to give himself the injections. Which of the following medications could the nurse anticipate might be started next?​ Select all that apply.

*pioglitazone *repaglinide *canagliflozin *sitagliptin

John is a 56 year old male who presents to the clinic with complaints of fatigue, frequent urination, frequent thirst, and frequent hunger. His hemoglobin A1C is measured at 7%. The provider has diagnosed him with type II diabetes. Which of the following medications would cause the least hypoglycemia and show a quick improvement in his blood sugar, in addition to lifestyle changes?

Metformin 500mg by mouth twice daily

Which of the following lifestyle changes can John, a newly diagnosed type II diabetic make, that would reduce potential side effects of metformin?

Stop drinking alcohol

John is back for follow-up in the office one month later. He complains of bloating and diarrhea. In reviewing his medication list, which medication would you suspect may be causing this issue? Select all that apply.

*Metformin 500mg one twice daily *Acarbose 50mg three times daily before meals

Jill is a diabetic who is in the office for a complete physical. Her urinalysis results were: -Spec gravity: 1.0015​ -Ketones: neg​ -Glucose: pos​ -WBC: neg​ -RBC: neg​ -Leuk esterase: neg​ The nurse reviews her results and determines which of the following?​ Select all that apply.

*She is on an SGLT2 inhibitor *Her blood sugar is high and out of control

John calls the office and says that he is feeling really tired, cold, and sweaty. His current medications include: -glipizide 20mg twice daily​ -metformin 850mg twice daily​ -miglitol 50mg three times daily​ In reviewing the medications, which of the following does the nurse consider?​ Select all that apply.

*This is likely hypoglycemia, he should drink some orang juice with two packets of sugar in it. *Finding out what he has eaten within the last hour is helpful

Jill is taking the following diabetic medications: -dapagliflozin 10mg once in the morning​ -metformin 500mg twice daily Which of the following side effects would you expect because of the medications she is on?​ Select all that apply.

*Vaginal yeast infection *Hypoglycemia *Urinary tract infection

1. glipizide 2. repaglinide 3. metformin 4. pioglitazone

1. Sulfonylureas 2. Glinides 3. Biguanides 4. Thiazolidinediones

1. This drug prevents the kidney from reabsorbing glucose, thus causing the body to urinate the extra glucose out. 2. Reduces intestinal absorption and release of stored glucose from the liver. Considered first line treatment for type II diabetes. 3. This medication forces the pancreas to make more insulin, but has a very short half-life and should be taken with each meal. 4. Pretending it is the hormone dipeptidyl peptide, this drug stimulates the pancreas to produce more insulin.

1. SGLT2 inhibitors 2. Biguanides 3. Glinides 4. Incretin mimetics

1. canagliflozin 2. exenatide 3. sitagliptin 4. acarbose

1. SGLT2 inhibitors 2. Incretin mimetics 3. DDP-IV inhibitors 4. Alpha-glucosidase inhibitor

1. One of the first medications available for diabetes type II, this is extra hard on the pancreas by stimulating the beta cells in the pancreas to produce more insulin. 2. This drug genetically alters the peripheral insulin receptors to accept more insulin, in other words, it increases insulin sensitivity. It can take a while for it to work (weeks to months). 3. This medication delays absorption of glucose in the small intestine, but only when there is food present. 4. This is a drug the binds to dipeptidyl peptidase IV to destroy it.

1. Sulfonylureas 2. Thiazolidinediones 3. Alpha-glucosidase inhibitor 4. DDP-IV inhibitors

What is the therapeutic goal for the treatment of diabetes?

Hemoglobin A1C of 6.5% or less

Which of the following is a common side effect of diabetes medication that requires further action?

Hypoglycemia

What is the primary reason to carefully and aggressive manage glucose control in a patient with diabetes type 2?

To prevent complications of diabetes type 2

John was also started on acarbose 50mg three times daily before meals. John admits that he sometimes skips breakfast if he is running late. Which is the best instruction to give him knowing the mechanism of action of this medication? Select all that apply.

You should skip your morning dose if you skip breakfast