Diabetes - Part 2 Medications and stuff
A client with type 2 diabetes has recently been prescribed acarbose, and the nurse is explaining how to take this medication. The teaching is determined to be effective based on which statement by the client?
"I will take this medication in the morning, with my first bite of breakfast." P1474 Explanation: Alpha-glucosidase inhibitors such as acarbose and miglitol, delay absorption of complex carbohydrates in the intestine and slow entry of glucose into systemic circulation. They must be taken with the first bite of food to be effective.
Intermediate acting
- NPH (neutral protamine Hagedorn) - (Humulin N, Iletin II Lente, Iletin II NPH, Novolin N [NPH])
Long Acting
Detemir (Levimir) Glargine (Lantus)
After taking glipizide (Glucotrol) for 9 months, a client experiences secondary failure. What should the nurse expect the physician to do?
Switch the client to a different oral antidiabetic agent. P1474 Explanation: The nurse should anticipate that the physician will order a different oral antidiabetic agent. Many clients (25% to 60%) who take glipizide respond to a different oral antidiabetic agent. Therefore, it wouldn't be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent. Restricting carbohydrate intake isn't necessary.
Intermediate acting
Usually taken after meals
Rapid acting - agents
lispro (Humalog) aspart (NovoLog) glulisine (Apidra)
Rapid acting - Agents: lispro (Humalog) onset, peak, and duration
onset: 10-15 minutes peak: 1 hour duration: 2-4 hours
Rapid acting- Agents: glulisine (Apidra) onset, peak, and duration
onset: 5-15 minutes peak: 30-60minutes duration: 2 hours
Rapid acting - Agents: Aspart (NovoLog) onset, peak, and duration
onset: 5-15minutes peak: 40 - 50 minutes duration: 2-4 hours
rapid- and short-acting insulins are expected to cover
the increase in glucose levels after meals
Long acting
used for basal dose
Oral Antidiabetic Agents : (6)
- used for patients with type 2 Diabetes who require more than diet and exercise alone - Combination of oral drugs may be used - Major side effect: hypoglycemia - Nursing Interventions: monitor blood glucose for hypoglycemia and other potential side effects - patient education - need to follow weight loss plan
What is the duration of regular insulin?
4 to 6 hours P1468 The duration of regular insulin is 4 to 6 hours; 3 to 5 hours is the duration for rapid-acting insulin such as Novolog. The duration of NPH insulin is 12 to 16 hours. The duration of Lantus insulin is 24 hours.
A nurse is teaching a client about insulin infusion pump use. What intervention should the nurse include to prevent infection at the injection site?
Change the needle every 3 days P1472 The nurse should teach the client to change the needle every 3 days to prevent infection. The client doesn't need to wear gloves when inserting the needle. Antibiotic therapy isn't necessary before initiating treatment. Sterile technique, not clean technique, is needed when changing the needle.
A client is admitted with diabetic ketoacidosis (DKA). Which order from the physician should the nurse implement first?
Infuse 0.9% normal saline solution 1 L/hr for 2 hours. P1485 Explanation: In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. In dehydrated clients, rehydration is important for maintaining tissue perfusion. Initially, 0.9% sodium chloride (normal saline) solution is administered at a rapid rate, usually 0.5 to 1 L/hr for 2 to 3 hours.
Rapid Acting (LAG) Peak -
Lispro (Humalog) - 1 hour Aspart (Novolog) - 40-50 Glulisine (Apidra) - 30-60minutes
Rapid acting (LAG) Onset -
Lispro (Humalog) - 10-15minutes Aspart (Novolog) - 5-15minutes Glulisine (Apidra) 5-15minutes
Rapid Acting (LAG) Duration
Lispro (Humalog) - 2-4 hours Aspart (Novolog) - 2-4 hours Glulisine (Apidra) - 2 hours
Intermediate Acting - NPH - Onset, peak, and duration
Onset - 2-4 hours Peak - 4-12 hours Duration - 16-20 hours
Short Acting - regular (Humulin R, Novolin R, Iletin II Regular) - Onset, Peak, and Duration
Onset - 30-60 minutes Peak - 2-3 hours Duration: 4 - 6 hours
Short acting (regular) - (Humulin R, Novolin R, Iletin II Regular) - onset, peak, and duration
Onset : 30-60 minutes Peak: 2-3 hours Duration: 4-6 hours
Normal or elevated blood glucose at bedtime, a decrease at 2-3 am to hypoglycemic levels, and a subsequent increase caused by the production of counter-regulatory hormones
Somogyi Effect
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication
The short-acting insulin is withdrawn before the intermediate-acting insulin. P1478 Explanation: When combining two types of insulin in the same syringe, the short-acting regular insulin is withdrawn into the syringe first and the intermediate-acting insulin is added next. This practice is referred to as "clear to cloudy."
Rapid acting indications
Used for rapid reduction of glucose level, to treat postprandial hyperglycemia, and/or to prevent nocturnal hypoglycemia
Short acting indications
Usually given 20-30 minutes before a meal; may be taken alone or in combination with longer-acting insulin
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. He's being converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of:
rapid-acting insulin only. P1471 Explanation: A continuous subcutaneous insulin regimen uses a basal rate and boluses of rapid-acting insulin. Multiple daily injection therapy uses a combination of rapid-acting and intermediate- or long-acting insulins.
Side effect of oral antidiabetic
hypoglycemia
immediately after the injection; the intermediate-acting insulins are expected to cover
subsequent meals
Which of the following insulins are used for basal dosage?
Glarginet (Lantus) P1468 Explanation: Lantus is used for basal dosage. NPH is an intermediate acting insulin, usually taken after food. Humalog and Novolog are rapid-acting insulins.
Intermediate Acting - (Humulin N, Iletin II Lente, Iletin II NPH, Novolin N [NPH])
Onset: 3-4 Peak: 4-12 Duration: 16-20
The nurse is preparing to administer IV fluids for a patient with ketoacidosis who has a history of hypertension and congestive heart failure. What order for fluids would the nurse anticipate infusing for this patient?
0.45 normal saline P1485 Half-strength NS (0.45%) solution (also known as hypotonic saline solution) may be used for rehydration of patients with hypertension or hypernatremia and those at risk for heart failure.
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy?
100 units of regular insulin in normal saline solution P1468 Explanation: Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.
Every morning, a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?
70% NPH insulin and 30% regular insulin P1479 Explanation: Humulin 70/30 insulin is a combination of 70% NPH insulin and 30% regular insulin.
A client is receiving insulin lispro at 7:30 AM. The nurse ensures that the client has breakfast by which time?
7:45 AM P1468 Explanation: Insulin lispro has an onset of 5 to 15 minutes. Therefore, the nurse would need to ensure that the client has his breakfast by 7:45 AM at the latest. Otherwise, the client may experience hypoglycemia.
Rapid acting insulin (LAG)
Lispro Apart(Novolog) Glulisine (Apidra)
Short Acting
Regular (Novolin-R, Humulin-R)
A client receives a daily injection of glargine insulin at 7:00 a.m. When should the nurse monitor this client for a hypoglycemic reaction?
This insulin has no peak action and does not cause a hypoglycemic reaction. P1468 Explanation: "Peakless" basal or very long-acting insulins are approved by the U.S. Food and Drug Administration for use as a basal insulin; that is, the insulin is absorbed very slowly over 24 hours and can be given once a day. It has is no peak action.
long-acting insulins provide a relatively constant level of insulin and act as a
basal insulin
