Diabetic Drugs

Diabetes should be encouraged to eat

Complex Carbohydrates

The major Side Effect of Sulfonylureas is

Hypoglycemia

The use of Actos (Pioglitazone) , a TZD drug has _________ because of incidence of Bladder cancer and other forms of cancer associated with its use.

Decreased

α-Glucosidase Inhibitors are

Known as "starch blockers" (Decreases absorption of carbohydrates)

If mixing Insulin, the ADA recommends that ______ Insulin be drawn into the syringe first.

Regular Insulin (Humulin R or Novolin R)

GLP1- Receptor agonist like Victoza (liraglutide) act on the body in what two ways?

Stimulates release of insulin from pancreas Decreases release of glucose from liver

A diabetic patient should eat ______hour before exercising

1

Short acting insulin normally has an onset of

10 min to 1 hour

Potential complications with Insulin Therapy

Allergic reaction Lipodystrophy Somogyi Effect Dawn Phenomenon

Steven John has type 1 diabetes mellitus and receives insulin. Which laboratory test will the nurse assess? A. Potassium B. AST (aspartate aminotransferase) C. Serum amylase D. Sodium

Answer: A. Potassium Insulin causes potassium to move into the cell and may cause hypokalemia. There is no need to monitor the sodium, serum amylase, and AST levels.

Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells the nurse that she likes to have a glass of wine with dinner. What will the best plan of the nurse for client education include? A. The alcohol could cause pancreatic disease. B. The alcohol could cause serious liver disease. C. The alcohol could predispose you to hypoglycemia. D. The alcohol could predispose you to hyperglycemia.

Answer: C. The alcohol could predispose you to hypoglycemia. Alcohol can potentiate hypoglycemic, not hyperglycemic, effects in the client. Alcohol can cause pancreatic disease, but the client's pancreas is not producing any insulin currently. Alcohol can cause liver disease, but the more immediate concern is hypoglycemia.

If a Patient is receiving Lantus or Levemir in the morning, he/she may also receive sliding scale Insulin with each meal. The sliding scale insulin acts as a _______ dose of insulin that the body would normally produce when food is ingested.

Bolus

If a Patient is taking Metformin(Glucophage) and has to have a diagnostic procedure that requires the use of iodine contrast, what should they do?

Discontinue medication 1 to 2 days in advance and then resume medication 48 hours after procedure. (Metformin interacts with iodine contrast medium)

It is necessary to clean injection sites with alcohol before each injection.(T/F)

False

The goal of the basal bolus dose of insulin (Long acting: Lantus of Levemir) is to Keep blood sugar levels between 70 and 130 after meals.(T/F)

False. (the goal is to keep blood sugar levels between 70 and 130 before meals)

If TZDs are used in combination with other Hypoglycemic drug, Patients taking both medications are a risk for experiencing

Hypoglycemia

If a Diabetic Patient is exercising, where should you advise him/her not to inject their insulin

In the legs

Somogyi effect is characterized by

Nocturnal hypoglycemia followed by rebound hyperglycemia

Sulfonylureas(end in -ide, Glipizide; Glyburide; Glimepiride (Amaryl)) Increase Insulin ___________

Production

The only Insulin that can be mixed with NPH (Humilin N or Novolin N) insulin are

Regular Insulin (Humulin R or Novolin R) or Rapid acting Insulin (Humalog or Novalog)

If Insulin is unopened it does not have to be refrigerated.(T/F)

True

Victoza (liraglutide) can only be given as a SubQ injection.(T/F)

True

The basal bolus process of Insulin administration is to mimic what the body normally does.(T/F)

True. (basal insulin is the minimum amount of insulin the body has at all times. Insulin is continually released into the bloodstream in small increments)

Complex sugars (carbohydrates) will

bring blood glucose to an appropriate level and maintain it there

Nutritional therapy for Type 1 Diabetes is based on usual food intake and balanced with

insulin & exercise

DPP-4 Inhibitors Increases insulin production and release once a ______ is consumed

meal

SGLT2 is the transporter responsible for

reabsorbing a majority of glucose that is filtered by the kidney

TZDs (Thiazolidinediones) make the body more ______ to the presence and use of insulin, therfore they are used to treat insulin ________

sensitive, resistance

If flocculation occurs, the insulin is bound and has become inactive. What should be done with the insulin?

throw the insulin away

Symlin(Pramlintide) is used with insulin in order to(3):

decreases gastric emptying Reduces post-prandial blood sugar, increases satiety and reduces calorie intake

Flocculation, a frosted adherent coating can occur when

extremes of temperature

Intermediate acting Insulin normally has an onset of

1 to 4 hours

Long acting Insulin normally has an onset of

1 to 4 hours

When administering rapid onset Insulin (which has an onset of 5 to 15 mins). Insulin must be given within ______ minutes before the Patients meal.

15

Rapid acting Insulin normally has an onset of

5 to 15 minutes

A diabetic patient who has an exercise regimen, should take his/her blood sugar levels

Before he/she exercises

What type of side effects may result fromα-Glucosidase Inhibitors decreasing absorption of starch

Gastrointestional

DPP-4 is an enzyme stored in the intestine that alerts the body to release ________ once food is ingested.

Insulin

Symlin (pramlintide) is usually used in conjunction with

Insulin

A nurse should ________ add any other Insulin to Long acting insulin Glargine(Lantus) or Detemir(Levemir)

Never

Simple sugars(carbohydrates) cause the blood sugar to

go up quickly and go down quickly

Short Acting(Regular) insulin like Humulin R or Novolin R( which has an onset of 30 to 60 mins). Insulin must be given within _______ minutes before the Patients meal.

30 to 45

Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with diabetes mellitus. When will the nurse administer this medication? A. When the client is eating B. Thirty minutes before meals C. fifteen minutes before meals D. When the meal trays arrive on the floor

Answer: A. When the client is eating The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must be given when the client is eating to prevent hypoglycemia. It must be given when the client is eating, not when the meal trays arrive on the floor and not thirty minutes before meals.

Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply. A. The nurse could have given the insulin subcutaneously. B. The nurse should have contacted the physician. C. The nurse should have used regular insulin (Humulin R). D. The nurse used the correct insulin.

Answer: B, C Regular insulin is the only insulin that can be given intravenously (IV). The nurse did not use correct insulin as it was not regular insulin. Contact the provider to clarify the order, regular insulin is the only insulin that can be given intravenously (IV). The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV).

Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with regard to patient education with this drug? Select all that apply. A. It stimulates the pancreas to produce more insulin. B. It must be taken with meals. C. It decreases sugar production in the liver. D. It inhibits absorption of carbohydrates. E. It reduces insulin resistance.

Answer: B, C, E Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect. It does not stimulate the pancreas to produce more insulin and does not inhibit the absorption of carbohydrates.

Rosemary has been taking Glargine (Lantus) to treat her condition. One of the benefits of Glargine (Lantus) insulin is its ability to: A. Release insulin rapidly throughout the day to help control basal glucose. B. Release insulin evenly throughout the day and control basal glucose levels. C. Simplify the dosing and better control blood glucose levels during the day. D. Cause hypoglycemia with other manifestation of other adverse reactions.

Answer: B. Release insulin evenly throughout the day and control basal glucose levels. Glargine (Lantus) insulin is designed to release insulin evenly throughout the day and control basal glucose levels.

Harry is a diabetic patient who is experiencing a reaction of alternating periods of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting which of the following? A. Uncontrolled diabetes B. Somogyi phenomenon C. Brittle diabetes D. Diabetes insipidus

Answer: B. Somogyi phenomenon Somogyi phenomenon manifests itself with nocturnal hypoglycemia, followed by a marked increase in glucose and increase in ketones.

Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol what this means. What is the best response by the nurse? Select all that apply. A. "Your alpha cells should be able to secrete insulin, but cannot." B. "The exocrine function of your pancreas is to secrete insulin." C. "Without insulin, you will develop ketoacidosis (DKA)." D. "The endocrine function of your pancreas is to secrete insulin." E. "It means your pancreas cannot secrete insulin."

Answer: C, D, E One function of your pancreas is to secrete insulin. The endocrine function of the pancreas is to secrete insulin. The endocrine, not the exocrine, function of the pancreas is to secrete insulin. Insulin is secreted by the beta, not the alpha, cells of the pancreas. A consequence of diabetes mellitus type 1 is that without insulin, severe metabolic disturbances, such as ketoacidosis (DKA) will result.

Serge who has diabetes mellitus is taking oral agents, and is scheduled for a diagnostic test that requires him to be NPO. What is the best plan of the nurse with regard to giving the client his oral medications? A. Administer the oral agents immediately after the test. B. Notify the the diagnostic department and request orders. C. Notify the physician and request orders. D. Administer the oral agents with a sip of water before the test.

Answer: C. Notify the physician and request orders. It is best to notify the client's physician and request orders. The client should not receive the medication during NPO status unless directed by the physician. The medications should not be given upon return unless the physician orders this; the client may still need to be NPO. The radiologist in the diagnostic department might give orders, but it would be best to check with the client's physician first.

Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase), is to: A. Induce hypoglycemia by decreasing insulin sensitivity. B. Improve insulin sensitivity and decrease hyperglycemia. C. Stimulate the beta cells of the pancreas to secrete insulin. D. Decrease insulin sensitivity by enhancing glucose uptake.

Answer: C. Stimulate the beta cells of the pancreas to secrete insulin. Sulfonylureas such as glyburide are used only with patients who have some remaining pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor sites for interaction with insulin.

A clinical instructor teaches a class for the public about diabetes mellitus. Which individual does the nurse assess as being at highest risk for developing diabetes? A. The 50-year-old client who does not get any physical exercise B. The 56-year-old client who drinks three glasses of wine each evening C. The 42-year-old client who is 50 pounds overweight D. The 38-year-old client who smokes one pack of cigarettes per day

Answer: C. The 42-year-old client who is 50 pounds overweight Obesity increases the likelihood of developing diabetes mellitus due to over stimulation of the endocrine system. Exercise is important, but lack of exercise is not as big a risk factor as obesity. Smoking is a serious health concern but is not a specific risk factor for diabetes. Consuming alcohol is associated with liver disease but is not as high a risk factor for diabetes as obesity.

Nurse Andy has finished teaching a client with diabetes mellitus how to administer insulin. He evaluates the learning has occurred when the client makes which statement? A. "I should check my blood sugar immediately prior to the administration." B. "I should provide direct pressure over the site following the injection." C. "I should use the abdominal area only for insulin injections." D. "I should only use calibrated insulin syringe for the injections."

Answer: D. "I should only use calibrated insulin syringe for the injections." To ensure the correct insulin dose, a calibrated insulin syringe must be used. Insulin injections should be rotated to the arm and thigh, not just the abdominal area. There is no need to apply direct pressure over the site following an insulin injection. There is no need to check blood glucose immediately prior to the injection.

Gary has diabetes type 2. Nurse Martha has taught him about the illness and evaluates learning has occurred when the client makes which statement? A. "My cells have increased their receptors, but there is enough insulin." B. "My peripheral cells have increased sensitivity to insulin." C. "My beta cells cannot produce enough insulin for my cells." D. "My cells cannot use the insulin my pancreas makes."

Answer: D. "My cells cannot use the insulin my pancreas makes." With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. Peripheral cells have a decreased, not an increased, sensitivity to insulin. The beta cells continue to produce insulin with type 2 diabetes. There is a decrease, not an increase, in receptor sites with type 2 diabetes.

An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has been ill with pneumonia. The client's intake has been very poor, and she is admitted to the hospital for observation and management as needed. What is the most likely problem with this patient? A. Insulin resistance has developed. B. Diabetic ketoacidosis is occurring. C. Hypoglycemia unawareness is developing. D. Hyperglycemic hyperosmolar non-ketotic coma.

Answer: D. Hyperglycemic hyperosmolar non-ketotic coma. Illness, especially with the frail elderly patient whose appetite is poor, can result in dehydration and HHNC. Insulin resistance usually is indicated by a daily insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute metabolic condition, usually is caused by absent or markedly decreased amounts of insulin.

Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What will the best assessment of the nurse reveal? A. The client will be very thirsty. B. The client will complain of nausea. C. The client will need to urinate. D. The client will have moist skin.

Answer: D. The client will have moist skin. Moist skin is the sign of hypoglycemia, which the client would experience if he injected himself with insulin and did not eat. Thirst, nausea, and increased urination are signs of hyperglycemia.

Serious side effects of Invokana(Canagliflozin SGLT-2 inhibitor) are

Bleeding problems and stroke

What is the diabetic drug of choice that most Physicans will start a newly diagnosed Type 2 diabetic or Pre-diabetic Patient on?

Metformin (T=Biguanides)

Open bottles of insulin can be stored in the refrigerator for up to 28 days(T/F)

True

Oral antidiabetics agents are only used for Type 2 Diabetes. (T/F)

True

SGLT-2 Inhibitor drugs (Dapagliflozin (Farxiga), Empagliflozin (Jardiance) ,Canagliflozin (Invokana))

decreases reabsorption (in the blood) and increases urinary excretion of glucose

Refrigerated NPH insulin (Intermediate-acting) should be inspected for __________, which is a frosted whitish coating inside of the bottle.

flocculation