Karch Focus on Pharmacology Chapter 38- Agents to Control Blood Glucose Levels

The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb? Anise Garlic Basil Oregano

Garlic Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.

Polyphagia

increased hunger; sign of diabetes when cells cannot use glucose for energy and feel that they are starving, causing hunger

Polydispia

increased thirst; seen in diabetes when loss of fluid and increased tonicity of the blood lead the hypothalamic thirst center to make the patient feel thirsty

A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching? "From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs." "People always tried to encourage me to lose weight, and I suppose they might have been right." "I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." "I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences."

"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections."

The nurse has just completed discharge instructions to a client who will be using a pen device to deliver his insulin dose. What statement by the client indicates a need for further instruction? "If I forget to take my insulin pen, I will be able to use the one that my wife uses." "This will make it easier for me to give my own insulin because of my poor eyesight." "I need to turn the dial on the pen and listen for the locking ring before administering my insulin." "I determine my dosage by the number of clicks that I hear."

"If I forget to take my insulin pen, I will be able to use the one that my wife uses." Insulin pens are client-specific because the needle may be used multiple times and may be contaminated with blood. Also, the pen is prefilled with a specific type of insulin. The client selects the desired units by turning a dial and listening for a locking ring. The insulin dose is determined by the number of clicks heard. It is a useful method for clients who have poor eyesight.

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." "Insulin is used to move carbohydrate particles from the gastrointestinal system to the liver." "Insulin causes fat to be broken down to provide energy for the body." "Insulin is stimulated by the liver to break down proteins and provide the body with nutrients."

"Insulin assists glucose molecules to enter the cells of muscle and fat tissues." 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.

A client has been newly diagnosed with type 2 diabetes. What statement would be appropriate for the nurse to include in the teaching? "If you drink alcohol, it may be necessary for you to increase your oral antidiabetic medication." "Regular exercise makes your body better able to use the insulin it produces." "Until you need to start insulin injections, you do not have to check your blood sugar." "Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines."

"Regular exercise makes your body better able to use the insulin it produces." Exercise is an extremely strong hypoglycemic agent, so the nurse should encourage the practice. Diabetics need to check their blood sugar level regardless of whether they are prescribed insulin. The need for insulin injections is determined by the function of the pancreas and its ability to produce sufficient quantities of insulin. -It is not correct to assume diet is the only factor in this process.

The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use? Allergy to sulfonamides The ingestion of carbohydrates Increase in alkaline phosphatase A diagnosis of hypertension

Allergy to sulfonamides Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glyburide.

The nurse is working with a client who uses an insulin pump for management of type 1 diabetes. The nurse should remind the client that the needle on the pump needs to be changed how often? Every one month Every 1-3 days Every 5-7 days Every two weeks

Every 1-3 days For an insulin pump, the needle is changed every 1 to 3 days

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? Check the dosage with another nurse. Ensure a meal tray is available. Check the client's blood sugar again. Administer the insulin to the client.

Check the dosage with another nurse 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.

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

Client's average blood glucose is above normal 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.

After teaching a group of students about the various insulin preparations, the instructor determines that the teaching was successful when the students identify that which type of insulin cannot be mixed with other types? Lispro Regular Detemir Lente

Detemir Insulin detemir cannot be mixed in solution with any other drug, including other insulins. -Regular, lente, and lispro can be mixed.

Hyperglycemia

Elevated blood glucose levels leading to multiple signs and symptoms and abnormal metabolic pathways

Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable? Storage of glucagon in the cells Entry of glucose into the cells Interruption of glucose movement across the membrane Release of glucagon from the cells

Entry of glucose into the cells After insulin-receptor binding occurs, cell membranes become highly permeable to glucose and allow rapid entry of glucose into the cells.

The health care provider has ordered a change of prescription from rapid-acting insulin to an intermediate-acting type. Which adverse effect must the nurse closely monitor for in the client? Bradycardia Lipodystrophy Hypotension Hypoglycemia

Hypoglycemia Changing the type of insulin requires caution, and the client should be carefully monitored for hypoglycemia or hyperglycemia, either of which may occur as the body adjusts to the different pharmacokinetics of the preparation.

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

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

The client, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurse's best response? increase of aqueous humor in the eye inability of oxygen to diffuse to tissues in the eye loss of innervation throughout the eye inability of cells in the eye to reproduce

Inability of oxygen to diffuse to tissues in the eye The body's inability to effectively cope with carbohydrate, fat, and protein metabolism over a long period of time results in a thickening of the basement membrane in large and small blood vessels. This thickening leads to changes in oxygenation of the lining of the vessels causing damage and narrowing of the vessels. The decreased blood flow through the vessels results in the inability of oxygen to rapidly diffuse across the membrane to the tissues of the eye. The tiny vessels of the eye are narrowed and closed, which causes loss of vision. -Increase of aqueous humor is seen in glaucoma. -Inability of cell replication and decrease in nerve innervations throughout the eye is not associated with retinopathy.

When administering insulin, what would be most appropriate? Insert the needle at a 45-degree angle for injection. Firmly spread the skin of the area of the intended site of injection. Shake the vial vigorously to ensure thorough mixing before drawing up the dose. Massage the injection site firmly after removing the needle and syringe.

Insert the needle at a 45-degree angle for injection The needle is inserted at a 45-degree angle for subcutaneous administration. -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. -Gentle pressure should be applied at the injection site.

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

Inspect the previous injection site for inflammation 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 types of insulin cannot be mixed with any other drug, including other insulins?

Insulin glargine (Lantus, Toujeo) and insulin detemir (Levemir) cannot be mixed in solution with any other drug, including other insulins.

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. The client most likely does not exercise enough to control his glucose levels. More insulin is needed than that which the client can produce naturally. The insulin is more effective in establishing control of blood glucose levels initially.

Insulin is needed because the beta cells of the pancreas are no longer functioning 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.

Which would be appropriate to include in teaching a client with type 2 diabetes? If you drink alcohol, it may be necessary to increase your oral antidiabetic medication. Until you need to start insulin injections, you do not have to check your blood sugar. It is possible with weight loss and exercise to discontinue the use of antidiabetic medication. Clients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines.

It is possible with weight loss and exercise to discontinue the use of antidiabetic medication Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent.

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as a biguanide? Metformin Glipizide Miglitol Tolbutamide

Metformin Metformin is classified as a biguanide. -Miglitol is an alpha-glucosidase inhibitor. -Tolbutamide is a first generation sulfonylurea. -Glipizide is a second generation sulfonylurea.

________________ is the only oral antidiabetic drug approved for children. It has established dosing for children 10 years of age and older.

Metformin With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested.

A client who has been prescribed metformin is scheduled to undergo diagnostic testing with the administration of parenteral radiographic contrast media containing iodine. What fact should direct the nurse's plan of care for this client? Insulin will be temporarily substituted for the metformin to address the risk of potential kidney failure. The client needs to be encouraged to drink 1 to 2 L of water to flush the contrast media out of the kidneys. Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. The client will be prescribed an extra dose of metformin to address the contrast media effect on the body.

Metformin should be discontinued at least 48 hours before and after diagnostic tests that use contrast medias. Metformin should be discontinued at least 48 hours before diagnostic tests are performed with contrast media and should not be resumed for at least 48 hours after the tests are done and tests indicate renal function is normal. None of the other options are required.

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

Observe the patient for hypoglycemic episodes As the ongoing assessment activity, the nurse should observe the patient for hypoglycemic episodes. -Documenting family medical history and assessing the patient's skin for ulcers, cuts, and sores on the body is a pre-administration assessment activity performed by the nurse. -Lipodystrophy occurs if the sites of insulin injection are not rotated.

The nurse monitoring a client receiving insulin glulisine notices the client has become confused, diaphoretic, and nauseated. The nurse checks the client's blood glucose and it is 60 mg/dL (3.33 mmol/L). Which can a nurse give to treat a client with a hypoglycemic episode? (Select all that apply.) Insulin detemir (Levemir) Orange or other fruit juice Hard candy Glucose tablets Insulin glargine (Lantus)

Orange or other fruit juice Hard candy Glucose tablets

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? Jet injector External pump Subcutaneous injection Insulin pen

Subcutaneous injection 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 patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient? Tachycardia Flatulence Myalgia Epigastric discomfort

Tachycardia The nurse should monitor for tachycardia, congestive heart failure, sodium and fluid retention, hyperglycemia, and glycosuria as the adverse reactions in the patient receiving diazoxide drug therapy. -Myalgia, fatigue, and headache are the adverse reactions observed in patients undergoing pioglitazone HCl drug therapy. -Flatulence is one of the adverse reactions found in patients receiving metformin drug therapy. -Epigastric discomfort is one of the adverse reactions observed in patients receiving acetohexamide drugs.

A client diagnosed with type 1 diabetes reports recurrent hypoglycemia late in the morning. After collecting the health history, what finding should the nurse suspect is most likely causing the late morning hypoglycemia? The client often eats an early lunch, between 11:00 and 11:30. The client eats oatmeal early in the morning for breakfast. The client likes to nap shortly after eating lunch. The client goes to the gym each day before work.

The client goes to the gym each morning before work Physical exercise changes insulin requirements and may result in a delayed hypoglycemic reaction.

glycosylated hemoglobin (HbA1C)

a blood glucose marker that provides a 3-month average of blood glucose levels

With what client should the nurse question the administration of human insulin? a client with type 2 diabetes, controlled with oral antidiabetic agents, who has a systemic infection a client who has been diagnosed with gestational diabetes a client who has been living with type 1 diabetes for 20 years a client whose type 2 diabetes is controlled by diet and exercise

a client whose type 2 diabetes is controlled by diet and exercise Insulin is recommended for treatment of type 2 diabetes in clients whose diabetes cannot be controlled by diet or other pharmacotherapeutic agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. -Human insulin can be used in clients with gestational diabetes or clients with type 1 diabetes of many years standing. -The presence of an infection may require the use of insulin in a client whose diabetes is normally controlled by oral medications.

Diabetes mellitus

a metabolic disorder characterized by high blood glucose levels and altered metabolism of proteins and fats; associated with thickening of the basement membrane, leading to numerous complications

Glucagon-like peptide 1 (GLP-1)

a peptide produced in the GI tract in response to carbohydrates that increases insulin release, decreases glucagon release, slows GI emptying, and stimulates the satiety center in the brain

Ketosis

breakdown of fats for energy, resulting in an increase in ketones to be excreted from the body

The nurse suspects the client diagnosed with diabetes may be having a hypoglycemic reaction when what manifestation is assessed? flushing of the face fruity breath diaphoresis unpredictable behaviors

diaphoresis Diaphoresis and cool clammy skin are signs of hypoglycemia. -Fruity breath accompanies ketoacidosis. -Flushing of the face is associated with hyperglycemia. -The client's level of consciousness often changes, but uncharacteristic or unpredictable behaviors do not normally occur.

Dipeptidyl Peptidase-4

enzyme that quickly metabolizes glucagon-like polypeptide-1

A client diagnosed with type 1 diabetes presents to the diabetes educator and asks about a change in insulin. The client's occupation requires long international flights, and the client does not want to administer insulin on the plane. What kind of insulin would best meet this client's needs? glargine aspart glulisine lispro

glargine Glargine has a duration of 24 hours, which may prevent the client from having to administer insulin on the airplane. -Lispro has a duration of 2 to 5 hours and a peak time of 30 to 90 minutes. -Glulisine has a duration of 1 to 2.5 hours and a peak time of 30 to 90 minutes. -Aspart has a duration of 3 to 5 hours and a peak time of 1 to 3 hours. These would likely require administration on the plane.

Adiponectin

hormone produced by adipocytes that acts to increase insulin sensitivity, decrease the release of glucose from liver, and protect the blood vessels from inflammatory changes

Insulin

hormone produced by the beta cells in the pancreas; stimulates insulin receptor sites to move glucose into the cells; promotes storage of fat and glucose in the body

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

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

insulin lispro 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.

Rosiglitazone is being considered for the treatment of diabetes in an adult client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn? platelet count creatinine liver enzymes d-dimer

liver enzymes Rosiglitazone has been associated with hepatotoxicity and requires monitoring of liver enzymes. Liver function tests (e.g., serum aminotransferase enzymes) should be checked before starting therapy and every 2 months for 1 year, then periodically. -Platelets, d-dimer, and tests of renal function are less significant to the safety and efficacy of treatment.

Hypoglycemia

lower-than-normal blood sugar; often results from imbalance between insulin or oral agents and patient's eating, activity, and stress; symptoms of hypoglycemia may be seen if blood sugar is 70 mg/dL or lower

What antidiabetic agent is approved for the nurse to administer to clients 10-years-old and older with type 2 diabetes? metformin repaglinide pioglitazone liraglutide

metformin Metformin is the only oral antidiabetic drug approved for children. It has established dosage for children 10 years of age and older. With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested. -Because metformin is the only drug approved for use with children, pioglitazone, repaglinide, and liraglutide would not be appropriate.

Sulfonylureas

oral antidiabetic agents used to stimulate the pancreas to release more insulin

Incretins

peptides that are produced in the GI tract in response to food that help to modulate insulin and glucagon activity

Glycosuria

presence of glucose in the urine

The nurse should question what medication order for a client diagnosed with diabetes and who is currently taking insulin? propranolol 10 mg orally t.i.d. metoclopramide 20 mg PO cefaclor 250 mg orally every 8 hours furosemide 60 mg/d orally

propranolol 10 mg orally t.i.d. Propranolol is a beta-blocker and should be avoided in combination with insulin. The blocking of the sympathetic nervous system also blocks many of the signs and symptoms of hypoglycemia, hindering the client's ability to recognize problems. If propranolol must be taken, the nurse will need to teach this client other ways to recognize hypoglycemia. -Furosemide, cefaclor, and metoclopramide do not cause drug-drug interactions with insulin.

Endocannabinoid receptors

receptors found in the adipose tissue, muscles, liver, satiety center, and GI tract that are part of a signaling system within the body to keep the body in a state of energy gain

Glycogen

storage form of glucose; can be broken down for rapid glucose level increases during times of stress

A client with diabetes is undergoing testing for glycosylated hemoglobin. The nurse instructs the client that this test measures average blood glucose over what time period? the past 12 to 24 hours the past 1 or 2 months the past 7 to 10 days the past 3 or 4 months

the past 3 or 4 months Glycosylated hemoglobin measures glucose control over the past 3 to 4 months. When blood glucose levels are high, glucose molecules attach to hemoglobin in the red blood cell. The longer the hyperglycemia lasts, the more glucose binds to the red blood cell and the higher the glycosylated hemoglobin. This binding lasts for the life of the red blood cell (about 4 months) so the other time frames would not be accurate.