EAQ Pharmacology: Diabetes Drugs

Which percentage value of AlC indicates type 2 diabetes?

Above 6.5 Rationale: HbA1C level above 6.5% indicates type 2 diabetes. AlC below 5.7% is considered normal. AlC above 5.7 and below 6.4 is considered prediabetes.

Which category of antidiabetics does metformin belong to?

Biguanides Rationale: Metformin is the only drug that is categorized as a biguanide. Nateglinide and repaglinide are examples of glinides. Glyburide and glimepiride are examples of sulfonylureas. Pioglitazone is an example of thiazolidinediones.

Which drug inhibits the metabolism of metformin?

Cimetidine Rationale: Cimetidine inhibits the metabolism and increases the effect of metformin. Carbamazepine interacts with glipizide and decreases its effectiveness. Erythromycin I fluconazole also interact with glipizide, not metformin, and increase the chances of hypoglycemia.

Which statement by a nursing student about insulin glargine indicates effective learning?

"You cannot mix this insulin in the same syringe with regular insulin." Rationale: Insulin glargine has a duration of action up to 24 hours. It should not be mixed with any other insulin. It is given alone because of the low pH of the diluent. It is a long-acting insulin that can be given at bedtime to provide up to 24 hours of insulin coverage.

The nurse would include which statement when teaching a patient about insulin glargine?

"You cannot mix this insulin with any other insulin in the same syringe." Rationale: Insulin glargine should not be mixed with any other insulins. The insulin is not fast acting. It is a long-acting insulin with a duration of action up to 24 hours.

Which instruction will the nurse give a patient who takes isophane suspension (NPH) insulin?

"You should eat 30 to 45 minutes before taking the NPH insulin." Rationale: Insulin isophane suspension (NPH) is an intermediate-acting insulin product that has an onset of action of 1 to 2 hours. Hence the nurse instructs the patient to eat meals 30 to 45 minutes before administering the injection. It is not necessary to obtain blood glucose levels every hour. Unused vials are stored in the 3 refrigerator for only 3 months to maintain drug stability. It is not necessary to stop insulin for any diagnostic tests, because insulin does not interact with any agents used in diagnostic tests.

Which site should be used for injecting insulin?

Abdomen Rationale: The abdomen has the most consistent absorption capacity, because the blood flow to subcutaneous tissue is not as affected by muscular movements. The deltoid is used for immunization of children and adults. The vastus lateralis is used for immunization of infants. The gluteus maximus is not recommended for injections because of its close proximity to the sciatic nerve and major blood vessels.

Which class of medication increases blood glucose levels when administered with insulin?

Diuretics Rationale: When a diuretic is administered with insulin, an increased blood glucose level will result because the diuretic antagonizes the effect of insulin. Salicylates, sulfa antibiotics, and anabolic steroids increase the risk of hypoglycemia when administered with insulin.

Which technique would the nurse teach the patient about mixing insulin when the patient must administer 30 units regular insulin and 70 units NPH insulin in the morning?

Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. Rationale: Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin. Z-track is an intramuscular technique that is not used with insulin. The medications do not have to be in separate syringes and can be administered together.

Which drug is administered subcutaneously?

Exenatide Rationale: Exenatide is a long-acting analog of GLP-1 antidiabetic drug available in the form of subcutaneous injection. Semaglutide is approved for oral administration. Sitagliptin and alogliptin are examples of oral antidiabetic drugs.

Which condition is seen in a patient with hyperosmolar hyperglycemic syndrome (HHS)?

Extreme hyperglycemia Rationale: Extreme hyperglycemia triggers HHS. Acute pancreatitis is an inflammation of the pancreas. This usually happens due to chronic alcohol abuse or due to a gallstone becoming lodged in the pancreatic ducts. Headaches are not caused by HHS. A patient with HHS may have electrolyte imbalances, which may cause dehydration and weight loss, not weight gain.

Which is a second-generation sulfonylurea? Select all that apply. One, some, or all responses may be correct.

Glipizide Glyburide Glimepiride Rationale: Glipizide, glyburide, and glimepiride are second-generation sulfonylureas. Metformin is a biguanide. Pioglitazone is a thiazolidinedione.

Which laboratory test provides evidence of adequate glucose management and adherence to a diabetes treatment regimen over the past few months?

Glycosylated hemoglobin (HbA1C) Rationale: HbA1C indicates glucose concentrations over the past 3 to 4 months and thus demonstrates patient adherence to therapy and illness management over time. The serum albumin test helps to determine the level of natural protein in blood. The fasting serum glucose test helps to assess whether the patient has elevated blood glucose concentrations. A 2-hour postprandial blood glucose test determines the amount of glucose in the blood after a meal.

Which insulin is administered intravenously?

Humulin R Rationale: Regular insulin is sold under the brand name Humulin R or Novolin R and is administered intravenously. Insulin detemir is sold as Levermir and is given subcutaneously. Tresbia is a long-acting insulin that is administered under subcutaneous tissue. Afrezza an inhalation-based insulin.

Which characteristic is related to glucagon hormone?

Initiates the glycogenolysis process Rationale: Glucagon hormone initiates the glycogenolysis process in the liver and converts glycogen to glucose. Insulin helps in keeping kidneys glucose-free because it facilitates glucose transport. Glucagon increases the level of sugar in the blood. Insulin facilitates carbohydrate metabolism in the adipose tissue and cardiac and skeletal muscle. Insulin helps in the phosphorylation of glucose to glucose-6-phosphate. Glucose-6-phosphate participates in glycogen formation that is stored in the liver and skeletal muscles.

Which long-acting insulin mimics natural basal insulin with its duration of 24 hours?

Insulin glargine Rationale: Insulin glargine has duration of action of 24 hours with no peaks, mimicking natural basal insulin secretion by the pancreas. Insulin aspart is a rapid-acting human insulin analogue used to lower blood glucose and has a different dosage. Regular insulin has a duration of action of 6 to 10 hours, with a peak plasma concentration of 2.5 hours. Ultralente insulin has an active duration of 28 hours.

Which insulin will the nurse administer to supplement basal insulin to imitate the pancreatic surge of insulin that accompanies eating?

Insulin glulisine Rationale: The nurse would administer a rapid-acting form of regular insulin, such as insulin glulisine, because the onset of action occurs 15 minutes after its administration. Insulin detemir and insulin glargine are basal insulins. NPH insulin is an intermediate-acting insulin that would take too long to act in this situation.

A patient with type l diabetes mellitus has been ordered insulin aspart 10 units at 7:00 a.m. Which nursing intervention will the nurse perform after administering this medication?

Make sure the patient eats breakfast immediately. Rationale: Insulin aspart is a rapid-acting insulin that acts in 15 minutes or less. It is imperative that the patient eat as it starts to work. This medication is given subcutaneously, not IV. The patient should have a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine.

Which medication would the nurse withhold for a patient with type 2 diabetes mellitus who is scheduled for a computed tomography (CT) scan with contrast?

Metformin Rationale: Metformin is contraindicated with the use of contrast media. Therefore it should be held due to the risk of renal failure and lactic acidosis the day of the test and for 48 hours after the test. Glipizide, glimepiride, and Humalog insulin are safe to administer with contrast media.

Which medication inhibits the enzyme alpha-glucosidase in the treatment of type 2 diabetes mellitus? Select all that apply. One, some, or all responses may be correct.

Miglitol Acarbose Rationale: Alpha-glucosidase inhibitors are a class of antidiabetic drugs used to inhibit the alpha-glucosidase enzyme. Miglitol and acarbose are drugs that inhibit the alpha-glucosidase enzyme. Glipizide is a sulfonylurea that stimulates the release of insulin. Nateglinide is a glinide that increases insulin secretion. Pioglitazone is a thiazolidinedione that decreases insulin resistance by enhancing the sensitivity of insulin receptors.

Which long-term consequence is associated with macrovascular complication?

Myocardial infarction Rationale: Myocardial infarction is a macrovascular complication that arises due to uncontrolled hyperglycemia. The macrovascular complication is associated with atherosclerotic plaque. Other consequences of macrovascular complication are stroke, foot ulcers, and other peripheral vascular diseases. Complete blindness is an effect of retinal damage that is associated with microvascular complications. Diabetic gastroparesis and bladder dysfunctions occur due to autonomic nerve damage associated with microvascular capillary damage.

Which precaution would the nurse advise about insulin U-500 to a patient with type 2 diabetes?

Need to take three times before mealtime Rationale: A patient with type 2 diabetes needs to administer U-500 two or three times a day before every meal. The U- 500 syringe should not be exchanged with the U-100 syringe, as this will alter the dose of the insulin. U-500 is highly concentrated and should not be administered with any other insulin. U-500 acts as both long-acting and mealtime insulin. Separate mealtime insulin is not required.

Which insulin is an example of intermediate-acting insulin?

Neutral protamin Hagedorn Rationale: NPH insulin (insulin isophane) is the only intermediate-acting insulin available. Neutral protamine Hagedorn is the full form of the acronym NPH. Afrezza is an inhalation-based rapid-acting insulin. Humulin R is regular insulin that is categorized under short-acting insulin. Lantus is the brand name of generic insulin glargine; it is a long-acting insulin.

Which characteristic is associated with type 1 diabetes?

Occurs due to autoimmune destruction of beta-cell Rationale: Type 1 diabetes is characterized by autoimmune destruction of beta-cell, leading to a lack of insulin production. Diabetes type 2 is associated with multifactorial genetic defects, obesity, and insulin resistance. A little amount of endogenous insulin is present in type 1 diabetes. High levels of endogenous insulin are present in type 2 diabetes. Type 1 diabetes is treated with injectable insulin. Oral hypoglycemics, diet, weight loss, and exercise are used to treat type 2 diabetes.

Which statement made by the patient about type 1 diabetes mellitus indicates effective learning?

Patients with type 1 diabetes mellitus require exogenous insulin. Rationale: Type 1 diabetes involves lack of insulin production. Hence patients with type 1 diabetes require exogenous insulin to lower the blood glucose level. There is little or no endogenous insulin, because the patient's body is unable to produce insulin. The disease accounts for 10% of all cases and is usually seen in patients younger than 20 years. Type 1 diabetes results in acute hyperglycemia due to lack of insulin.

Which oral drug is used in patients with type 2 diabetes who have not had success with metformin or glipizide?

Pioglitazone Rationale: Pioglitazone is a glitazone that is reserved for patients who cannot achieve glucose control with metformin or the sulfonylureas. The drug decreases insulin resistance by enhancing the sensitivity of insulin receptors. Glimepiride is a drug that belongs to the class of sulfonylureas. Troglitazone is a glitazone that was a discontinued from the market because it causes liver toxicity. Rosiglitazone is also no longer prescribed because it causes cardiac problems.

Which type of insulin can be given intravenously?

Regular insulin Rationale: Regular insulin is the only type of insulin that can be given intravenously. The other variants of insulin, including insulin glargine, insulin zinc suspension, and isophane insulin suspension (NPH insulin), are administered through the subcutaneous route.

The nurse administers insulin to a patient at 8:30 a.m. and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer if this is true?

Regular insulin Rationale: Regular insulin peaks about 2.5 hours after the drug's administration. If the drug is given at 8:30 a.m., it will have its peak effects at 11:00 a.m., and at that time the nurse would observe for signs of hypoglycemia. Insulin lispro, insulin aspart, and insulin glulisine are all considered rapid-acting insulins. The onset of action for these drugs is about 15 minutes, and the effects do not last as long as with other classes of insulin.

Which clinical indicator of hypoglycemia will the nurse identify for the patient and family? Select all that apply. One, some, or all responses may be correct.

Sweating Headache Tachycardia Rationale: The effects of hypoglycemia are largely attributable to stimulation of the central nervous system, because low blood glucose stresses the body. When hypoglycemia occurs, the sympathetic nervous system responds in an attempt to increase blood glucose. Clinical indicators of hypoglycemia mimic sympathetic nervous system stimulation; they include headaches, diaphoresis, tachycardia, palpitations, and anxiety. Polyphagia, weight loss, and polydipsia are common signs and symptoms of hyperglycemia in diabetes.

Which category of the oral antidiabetic drug can regulate genes involved in glucose metabolism?

Thiazolidinediones Rationale: Thiazolidinediones are oral antidiabetic drugs that regulate genes involved in the metabolism of lipid and glucose. These drugs can increase the sensitivity of the insulin receptors. Biguanides reduce glucose absorption in the intestine and glucose production by the liver. Sulfonylureas decrease glucagon secretion from the pancreas and also bind specific receptors of beta cells to release insulin. Glinides also stimulate the secretion of insulin by binding specific receptors on beta cells. However, their duration of action and structure are different from sulfonylureas.