Chapter 41: Drug Therapy for Diabetes Mellitus

A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflexes are present in the patient? A) Administer glucagon by the parenteral route. B) Administer the insulin via insulin pump. C) Administer oral antidiabetics to the patient. D) Give oral fluids or candy.

Give oral fluids or candy. Explanation: The nurse should administer oral fluids or candy to the hypoglycemic patient with swallowing and gag reflexes. If the patient is unconscious the nurse should administer glucose or glucagon parenterally. The nurse should administer insulin through an insulin pump to special categories of diabetic patients, such as pregnant women with diabetes and renal transplantation. Oral antidiabetic drugs are administered to patients with type 2 diabetes.

A young man has been diagnosed with type 2 diabetes and has been prescribed glyburide. Which statement suggests that the nurse should perform further health education?

"I'll plan to take my glyburide each night before I go to bed." Explanation: Glyburide is normally taken in the morning, before breakfast. No drug cures diabetes; the goal of therapy is the maintenance of safe blood glucose levels. The client should check before taking other drugs and should indeed be aware of the risk of hypoglycemia.

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat: A) hyperglycemia. B) hyperkalemia. C) hypokalemia. D) hypoglycemia.

hyperglycemia. Explanation: Glipizide is an antidiabetic agent with the desired action of lowering the blood glucose level. It is used to treat hyperglycemia. It would worsen, not treat, hypoglycemia, and it has no role in treating abnormal potassium levels (hypokalemia or hyperkalemia).

A nurse is teaching a client about the insulin product which has been prescribed. The nurse determines the session is successful when the client correctly chooses which insulin they will be using that acts by lowering the blood glucose by increasing the activity of the beta cells in the pancreas? Select all that apply. -Glyburide -Acarbose -Metformin -Glipizide -Pioglitazone

-Glyburide -Glipizide Explanation: Sulfonylureas, like glyburide and glipizide, help lower blood glucose by increasing the production of insulin by beta cells in the pancreas. The other drugs are oral antidiabetic drugs. Metformin is a biguanide. Pioglitazone is a thiazolidinediones. Acarbose is an alpha-Glucosidase Inhibitor.

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. -Hard candy -Insulin detemir -Glucose tablets -Insulin glargine -Orange or other fruit juice

-Hard candy -Glucose tablets -Orange or other fruit juice Explanation: 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.

The client is scheduled to get a breakfast tray at 07:00. At what time should the client receive a prescribed dose of insulin lispro?

06:45 Explanation: With short-acting insulins like lispro, aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment? A) Assess the most recent hemoglobin A1C levels. B) Arrange to have the client's random blood glucose measured. C) Review and discuss the data contained in the client's written blood glucose log. D) Dialogue with the client about implemented management strategies.

Assess the most recent hemoglobin A1C levels. Explanation: Health care providers look at the glycosylated hemoglobin (hemoglobin A1C) levels to assess the effectiveness of treatment. Because glucose stays attached to hemoglobin for the life of the red blood cell, which is about 120 days, the hemoglobin A1C level reflects the average blood glucose level over the past 3 months. Reviewing blood glucose readings, measuring the client's random blood glucose, and dialoguing with the client are all therapeutic strategies, but hemoglobin A1C is most accurate.

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? A) Client's blood glucose levels are not consistent. B) Client's average blood glucose is above normal. C) Client's blood glucose demonstrates longstanding hypoglycemia. D) Client is in good glycemic control.

Client's average blood glucose is above normal. Explanation: 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 instructs a client who has been prescribed extended-release metformin (Glucophage XR) to take the medication at what time?

With the evening meal Explanation: Extended-release metformin is administered once daily with the evening meal.

A client is receiving glyburide. The nurse assesses the client for a decrease in the drug's effect if which additional drugs are initiated? Select all that apply. -Atenolol -Levothyroxine -Amlodipine -Phenytoin -Lithium

-Atenolol -Levothyroxine -Amlodipine -Phenytoin Explanation: Beta blockers (atenolol), calcium channel blockers (amlodipine), hydantoins (phenytoin), and thyroid agents (levothyroxine), among others, can result in decreased hypoglycemic effects of sulfonylureas (glyburide). Lithium can have an effect on insulin if given concomitantly.

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. Explanation: 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.

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." Explanation: 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.

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? A) insulin aspart B) insulin glargine C) isophane insulin suspension D) insulin lispro

insulin glargine Explanation: 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.

The nurse is preparing to administer a mixture of 12 units regular insulin and 45 units NPH insulin to a client with a blood sugar of 378 mg/dL. After the nurse draws the medication into the syringe, what is the nurse's next action? A) Check the client's blood sugar again. B) Check the dosage with another nurse. C) Administer the insulin to the client. D) Ensure a meal tray is available.

Check the dosage with another nurse. Explanation: After preparing the syringe with insulin, the nurse should then have the medication and dosage checked by a second nurse to make sure that it is correct. It is not necessary to recheck the client's blood sugar again. It is important to know when the client will be eating again; make sure that it is within the next 30 minutes. However, this is not the nurse's next step. Then the nurse will administer the insulin to the client.

When administering insulin, what would be most appropriate?

Insert the needle at a 45-degree angle for injection. Explanation: The vial should be gently rotated and vigorous shaking is to be avoided to ensure uniform suspension of the insulin. Typically the area is pinched to allow access to the loose connective tissue layer. The needle is inserted at a 45-degree angle for subcutaneous administration. Gentle pressure should be applied at the injection site.

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. Explanation: 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.

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat: A) hypokalemia. B) hyperkalemia. C) hyperglycemia. D) hypoglycemia.

hyperglycemia. Explanation: Glipizide is an antidiabetic agent with the desired action of lowering the blood glucose level. It is used to treat hyperglycemia. It would worsen, not treat, hypoglycemia, and it has no role in treating abnormal potassium levels (hypokalemia or hyperkalemia).

A client with type 1 diabetes has been prescribed insulin glargine for the first time. What will the nurse teach the client about this medication? A) "If successful, this will eliminate your need to take other forms of insulin." B) "This insulin will provide a steady amount of insulin over 24 hours." C) "It's important to eat at least every 2 hours while taking insulin glargine." D) "It will be important to time administration carefully around your meal schedule."

"This insulin will provide a steady amount of insulin over 24 hours." Explanation: Long-acting insulin preparations such as insulin glargine provide a basal amount of insulin through 24 hours, similar to normal, endogenous insulin secretion. They do not need to be as closely aligned with meals as other, more rapidly-acting, insulins. They do not normally negate the need for other types of insulin. Regular food intake may be a component of diabetes management but this is not particular to the use of insulin glargine.

A nurse should take what steps prior to administering insulin glargine (Lantus) to a client? Select all that apply. -Check the health care provider's orders for the type and dosage of insulin. -Check the expiration date on the vial. -Mix with short-acting insulin prior to administration. -Shake the vial vigorously. -Remove all air bubbles from the syringe barrel.

-Check the health care provider's orders for the type and dosage of insulin. -Check the expiration date on the vial. -Remove all air bubbles from the syringe barrel. Explanation: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following pre-administration steps: carefully check the 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, and gently tilt end-to-end before withdrawing the insulin, remove all air bubbles from the syringe barrel, and never mix or dilute insulin glargine (Lantus) with any other insulin or solution because the insulin will not be effective.

A nurse should take what steps prior to administering insulin glargine (Lantus) to a client? Select all that apply. -Check the health care provider's orders for the type and dosage of insulin. -Remove all air bubbles from the syringe barrel. -Check the expiration date on the vial. -Mix with short-acting insulin prior to administration. -Shake the vial vigorously.

-Check the health care provider's orders for the type and dosage of insulin. -Remove all air bubbles from the syringe barrel. -Check the expiration date on the vial. Explanation: Prior to administering insulin glargine (Lantus) to a client, the nurse must complete the following pre-administration steps: carefully check the 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, and gently tilt end-to-end before withdrawing the insulin, remove all air bubbles from the syringe barrel, and never mix or dilute insulin glargine (Lantus) with any other insulin or solution because the insulin will not be effective.

The nurse is assessing a client for risk factors associated with type 2 diabetes. Which findings would the nurse prioritize? Select all that apply. -Caucasian race -Impaired glucose tolerance -Obesity -History of gestational diabetes -Younger age

-Impaired glucose tolerance -Obesity -History of gestational diabetes Explanation: 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 (African Americans, Hispanic/Latino Americans, Native Americans, and some Asian Americans).

A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered? A) Diazoxide B) Glucagon C) Regular insulin D) Insulin lispro

Glucagon Explanation: The client is significantly hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an onset of approximately 1 minute. Diazoxide can be used to elevate blood glucose levels, but it must be given orally. Lispro and regular insulin would be used to treat hyperglycemia.

The nurse is caring for a client who is taking a thiazide diuretic, a corticosteroid, and estrogens. The nurse understands that this client is at risk for what condition? A) Congestive heart failure B) Pulmonary hypertension C) Hypoglycemia D) Hyperglycemia

Hyperglycemia Explanation: Renal insufficiency may increase risks of adverse effects with antidiabetic drugs, and treatment with thiazide diuretics, corticosteroids, estrogens, and other drugs may cause hyperglycemia, thereby increasing dosage requirements for antidiabetic drugs.

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? A) Check for symptoms of myalgia or malaise. B) Do not administer insulin kept at room temperature. C) Inspect the previous injection site for inflammation. D) Keep prefilled syringes horizontally.

Inspect the previous injection site for inflammation. Explanation: 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.

Which would be least appropriate when administering insulin by subcutaneous injection? A) Massaging the site after removing the needle B) Inserting the needle at a 45-degree angle C) Injecting the insulin slowly D) Using a 25 gauge 1/2-inch needle

Massaging the site after removing the needle Explanation: Gentle pressure should be applied to the injection after the needle is withdrawn. Massaging could contribute to erratic or unpredictable absorption.

A nurse is caring for a client with diabetes mellitus who is receiving an oral antidiabetic drug. Which ongoing assessments should the nurse prioritize when caring for this client? A) Monitor the client for lipodystrophy. B) Document family medical history. C) Assess the skin for ulcers, cuts, and sores. D) Observe the client for hypoglycemic episodes.

Observe the client for hypoglycemic episodes. Explanation: As the ongoing assessment activity, the nurse should observe the client for hypoglycemic episodes. Documenting family medical history and assessing the client's skin for ulcers, cuts, and sores should be completed before administering the drug. Lipodystrophy occurs if the sites of insulin injection are not rotated.

A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response? A) Perform a blood sugar analysis. B) Administer 1 ampule of 50% dextrose intravenously. C) Administer 10 units of regular insulin subcutaneously. D) Have the client drink a 4-ounce (120-mL) glass of orange juice.

Perform a blood sugar analysis. Explanation: As long as the client is awake and verbally responsive, check the blood glucose level first. Hypoglycemia can make a client feel weak, confused, irritable, hungry, or tired, but assessment must precede interventions; this makes the other options inappropriate.

The home care nurse is caring for an older adult client who has been diagnosed with type 1 diabetes. The client has visual impairment and cannot read the numbers on the syringe when preparing insulin for administration nor afford the cost of prefilled auto syringes. What strategy might the nurse use to help this client comply with insulin needs between visits?

Prepare a week's supply of syringes and refrigerate. Explanation: Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A week's supply of syringes can be prepared and refrigerated for the usual dose of insulin. If the client is using insulin, it is most likely because oral antidiabetic medications don't work. A magnifying glass is impractical because drawing up medication requires two hands and a magnifying glass will not help the client to see well enough to be safe. It is a big imposition to expect a neighbor to be constantly available and this would not be the best choice.

A client is admitted to the intensive care unit with diabetic ketoacidosis. The nurse knows that the client will be placed on an intravenous insulin drip. The only type of insulin that can be administered intravenously is:

Regular

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response? A) Ultralente (Humulin U Ultralente) B) PZI (Humulin U) C) NPH (Humulin N) D) Regular (Humulin R)

Regular (Humulin R) Explanation: Regular insulin has the quickest onset of 30-60 minutes. PZI and ultralente have an onset of 4-8 hours. NPH has an onset of 60-90 minutes.

A nurse is preparing an in-service presentation for a group of staff members on diabetes. Which would the nurse include as the primary delivery system for insulin? A) Subcutaneous injection B) Jet injector C) External pump D) Insulin pen

Subcutaneous injection Explanation: Although other delivery systems are available for insulin administration such as the jet injector, insulin pen, and external pump, subcutaneous injection remains the primary delivery system.

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

Tachycardia Explanation: 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.

When teaching a client about insulin administration, the nurse would instruct the client to administer insulin aspart at which time? A) 30 to 60 minutes before a meal B) immediately before a meal C) immediately after the meal D) at bedtime

immediately before a meal Explanation: Insulin aspart is given immediately before a meal or within 5 to 10 minutes of beginning a meal. Glargine is given subcutaneously once daily at bedtime. Regular insulin is given 30 to 60 minutes before a meal to achieve optimal results. Lispro is given 15 minutes before a meal or immediately after a meal.

The nurse is caring for a client who has been diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this client? A) acarbose B) glyburide C) metformin D) insulin

insulin Explanation: Insulin therapy is the best choice for clients with diabetes during pregnancy and lactation, which are times of high stress and metabolic demands. Oral antidiabetic medications are contraindicated during pregnancy, so metformin, acarbose, and glyburide are not the best choices.

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action? A) Humulin R B) insulin lispro C) isophane (NPH) D) isophane (NPH)

insulin lispro Explanation: Insulin lispro has a 15-minute onset of action. NPH, 70/30, and regular insulin have longer onsets of action, a later peak, and a longer duration of action.

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

insulin lispro Explanation: 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.

A nurse is preparing to administer a rapid-acting insulin. Which medication would the nurse likely administer? A) insulin lispro B) insulin detemir C) insulin glargine D) isophane insulin suspension

insulin lispro Explanation: 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.

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? A) regular B) lispro C) insulin glargine D) isophane insulin (NPH)

regular Explanation: 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? A) long-acting insulin B) intermediate insulin C) Ultra-short-acting insulin D) short-acting insulin

short-acting insulin Explanation: 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.