NUR 112 Pharmacology: Antidiabetic

What is Sliding Scale mean?

Sliding Scale mean what they are at the current time

What are the symptoms of hypoglycemia?

Tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue. Also convulsions, coma, death.

Nursing Actions/Teaching for containing insulin after opened?

Teach patient Container of insulin lasts longer if put in the frig (usually last about 3 months)

Antidiabetic Parenteral Insulin Use

Treatment of Type I diabetes (may be used for Type II also)

Antidiabetic Oral Antidiabetics use

Treatment of Type II diabetes Requires intact pancreatic function

Nursing Actions/Teaching for Intermediate acting Insulin

cannot give insulin which will make hypoglycemia during sleeping. ok to give insulin in the afternoon or early evening with the bed time snack.

What are the symptoms of hyperglycemia?

dry mouth, increased thirst, deep ,rapid breathing (increase respiration), warm and dry skin, weakness, headache, blurred vision, frequent urination

Nursing Actions/Teaching for Rapid Acting Insulin

eat quickly for Rapid Acting insulin

What are the symptoms of hyperglycemia (high blood glucose)?

extreme thirst, need to urinate often, dry skin, hungry, blurry vision, drowsy, slow healing wounds

Metformin 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets will the nurse administer?

4

How many type of Antidiabetic Parenteral Insulin?

4 1. Rapid Acting 2. Short Acting 3. Intermediate Acting 4. Long acting

The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different from of metformin? 1. This medication has a wax matrix frame that is difficult to crush 2. The medication has an unpleasant taste, which most clients find intolerable if crushed. 3. If crushed, this medication irritates mucosal tissue and can cause oral and esophageal ulcer formation. 4. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring.

4. Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring. The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed.

A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1. I will take the medication with food 2. I must swallow my medication whole and not crush or chew it 3. I will notify my doctor if I develop muscular or abdominal discomfort 4. I will stop taking metformin for 24 hours before and after having a test involving dye.

4. I will stop taking metformin for 24 hours before and after having a test involving dye. Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis.

What is the side effect of Glucophage (metformin)?

Can cause lactic acidosis

Oral Antidiabetics drugs

Glucophage (metformin) Glucotrol (glipizide)

What is the Rapid Acting insulin?

Humalog (lispro insulin), Novolog (aspart insulin) Onset 15 minutes, Peak: 45-90 minutes, Duration 4 hours Used for Sliding Scale

Antidiabetic Oral Antidiabetics Side effect

Hypoglycemia

What is the Long acting insulin?

Lantus (glargine insulin) Onset: 1 hour, Peak: No Peak!, Duration 24 hours Only insulin that is safely given at bedtime, NOT USED FOR SLIDING SCALE

Nursing Actions/Teaching for Long Acting Insulin

Long Acting: it is the only one can give at the bed time

Short acting insulin

Regular insulin (Humulin R, Novolin R)

What are the causes of hypoglycemia (low blood glucose)?

Too little food or skipping a meal; too much insulin or diabetes pills; more active than usual.

What are the causes of hyperglycemia (high blood glucose)?

Too much food, too little insulin or diabetes pill, illness or stress.

What are the symptoms of hypoglycemia (low blood glucose)?

shaky, fast heartbeat, dizzy, anxious, sweating, hungry, blurry vision, weakness or fatigue, headache, irritable

Sliding Scale Example

One touch ac and hs with sliding scale insulin as follows , cover with Humulin R subcutaneously: If below 60, notify MD 60-150= 0 units 151-200= 2 units 201-250=4 units 251-300=6 units 301-350=8 units 351-400=10 units >400= 10 units and call MD

Oral Antidiabetics and pregnancy

Oral agents are not routinely used during pregnancy.....insulin is the drug of choice during pregnancy if medication is needed.

What is the side effect of Glucotrol (glipizide)?

Photosensitivity, pancytopenia

Which action by the client indicates the need for further instruction on insulin administration? select all apply 1. Aspirating before administering the dose 2. Using a 27-gauge needle to administer the insulin 3. Administering rapid-acting insulin in the abdomen 4. Holding the needle in place for several seconds after administering the insulin 5. Identifying areas where 1 inch of subcutaneous fat can be pinched for insulin administration

1. Aspirating before administering the dose

Nursing Actions/Teaching for using Parenteral Insulin

1.Monitor for S&S of hypoglycemia 2. Monitor blood sugar level (one touch, etc..) 3. Several different types of insulin s o be sure to check the label to ensure that the right insulin is being given 4. Use only insulin syringes to give insulin 5. Must check dosage with another nurse. Must check dose with another nurse to ensure that the correct type and amount is being given! 6. Check expiration date, usually good for about a month after opening 7. Teach patient that this is not a cure and treatment will be long term 8. Teach S&S of hypo and hyperglycemia 9. Need med alert bracelet

Daily regular insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 am. When should the nurse monitor the client for a potential hypoglycemic reaction? 1 At breakfast 2 Before lunch 3 Before dinner 4 In the early afternoon

2 Before lunch Regular insulin is short acting and peaks in 2-4 hours, which in this case will be at or before lunch.

A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? 1. Before noon 2. In the afternoon 3. Within 30 minutes 4. During the evening

2. In the afternoon NPH insulin is an intermediate-acting insulin that peaks approximately 6 to 8 hours after administration. It was administered at 7:00 Am, so 1:00 PM and 3:00 PM is when the nurse would anticipate that a hypoglycemic reaction would occur.

Which responses would the nurse expect a client experiences hypoglycemia to exhibit? select all that apply 1. Nausea 2. Palpitations 3. Tachycardia 4. Nervousness 5. Warm, dry skin 6. Increased respirations

2. Palpitations 3. Tachycardia 4. Nervousness

What are the symptoms of lactic acidosis

Chills, diarrhea, dizziness hypotension, muscle pain, bradycardia- report immediately

Antidiabetic Oral Antidiabetics Precaution / Contradictions

Contraindications: Hypoglycemia (Regular glucose is 70-110) Precautions: Infection or stress may alter requirements. If patient has stress, we have to change doses

Antidiabetic Parenteral Precaution / Contradictions

Contraindications: Hypoglycemia (Regular glucose is 70-110) Precautions: Infection or stress may alter requirements. If patient has stress, we have to change doses

What is the Short Acting insulin?

Humulin R, Novolin R (regular insulin) Onset: 30 minutes, Peak: 2-4 hours, Duration: 6-8 hours Can be used for Sliding Scale, Can be given IV only

Antidiabetic Parenteral Side effect

Hypoglycemia

Antidiabetic Parenteral Insulin Interaction

Interactions: Increased risk of hypoglycemia if given with other agents that decrease glucose.

Antidiabetic Oral Antidiabetics Interaction

Interactions: Increased risk of hypoglycemia if given with other agents that decrease glucose. NSAIDS, warfarin and aspirin may increase likelihood of hypoglycemia

Why does Intermediate acting Insulin look cloudy?

Intermediate-acting insulins contain added substances (buffers) that make them work over a long time and that may make them look cloudy.

What is lactic acidosis?

It is caused by increased anaerobic glucose metabolism and consequent lactate accumulation in the bloodstream. Lactic acidosis is not a disease-specific complication of diabetes mellitus; it is triggered by precipitating factors and is most frequently and nonspecifically seen in patients with shock.

What is the intermediate acting insulin?

NPH, Humulin N, Novolin N (isophane insulin) Onset: 1-2 hours, Peak 4-12 hours, Duration: 18-24 hours Need a bedtime snack, NOT USED FOR SLIDING SCALE COVERAGE