Drugs For Diabetes Mellitus

Front 1

What are hyperglycemic states?

Back 1

Type I Diabetes
Type II Diabetes
Gestational Diabetes

Front 2

What treatments are used in type I Diabetes?

Back 2

Diet
Self-monitoring of blood glucose levels
Insulin replacement

Front 3

What treatments are used in Type II Diabetes?

Back 3

Diet
Exercise
Insulin/oral hypoglycemic agents

Front 4

What is used to monitor Glucose Levels?

Back 4

Blood Glucose Monitoring - machines that need to be calibrated.
Urine Glucose Monitoring - Blood sugar must be > 180 before glucose is in urine.
Glycated Hemoglobin (HbA1C) - average of glucose levels over 2-3 months. HbA1c < 7% is good.

Front 5

What is insulin used for?

Back 5

Manage hyperglycemia by promoting cellular glucose uptake and metabolism.
Mandatory for type 1 diabetes and may be needed in type 2 diabetes.

Front 6

How does insulin vary?

Back 6

Vary by peak, onset, and duration of action
Recombinant DNA (human) is now the standard source:
Animal sources are still available.

Front 7

What are the types of Insulin?

Back 7

Classified according to time course
Short acting
(Rapid acting, Slower acting)
Intermediate acting
Long acting

Front 8

Name three short acting insulins.

Back 8

Lispro (Humalog)
Aspart (NovoLog)
Regular (Short-Acting) Insulin

Front 9

What is the onset, peak, and duration for Lispro (Humalog)?

Back 9

Onset: 15 – 30 min
Peak: 0.5 - 2.5 hours
Duration: 3 - 6.5 hours

Front 10

How is Lispro (Humalog) used?

Back 10

Used in continuous subcutaneous insulin infusion pumps
Patient titrates dose delivered depending on their glucose level
Can be administered immediately before eating

Front 11

What is the onset, peak, and duration for Aspart (NovoLog)?

Back 11

Onset: 10 – 20 min
Peak: 1.0 - 3 hours
Duration: 3 - 5 hours

Front 12

What precautions should be taken with Aspart (NovoLog)used?

Back 12

Eating should begin within 5 – 10 minutes of injection or immediately after

Front 13

What is the onset, peak, and duration for Regular (Short-Acting) Insulin?

Back 13

Onset: 30-60 minutes
Peak: 1-5 hours
Duration: 6-10 hours

Front 14

How is Regular (Short-Acting) insulin used?

Back 14

Only insulin used for IV insulin infusions.
Check your institution policy – insulin adheres to PVC tubing.
Used for sliding scale coverage.

Front 15

Name two intermediate acting insulins.

Back 15

NPH (Intermediate-Acting) Insulin & Lente (Intermediate-Acting) Insulin

Front 16

What is the onset, peak, and duration for NPH (Intermediate-Acting) Insulin?

Back 16

Onset: 1 - 2 hours
Peak: 6 - 14 hours
Duration: 16 – 24+ hours

Front 17

What is the onset, peak, and duration for NPH/Regular 70/30 insulin?

Back 17

Onset: 30-60 min
Peak: 1.5 – 16 hours
Duration: up to 24 hours

Front 18

What is the onset, peak, and duration for Lente (Intermediate-Acting)?

Back 18

Time course similar to NPH.

Front 19

Name 2 long-acting insulins.

Back 19

Ultralente (Long-acting) & Lantus (Long-acting) Insulin

Front 20

What is the onset, peak, and duration for Ultralente (Long-Acting)?

Back 20

Onset: 4-6 hours
Peak: 8-20 hours
Duration: 24-28 hours

Front 21

What is the onset, peak, and duration for Lantus (Long-Acting) insulin?

Back 21

Onset: 70 minutes
Peak: none
Duration: 24 hours

(Creates a steady rate; usually used to treat type 2 diabetes in PO form)

Front 22

What precautions should you take with Lantus insulin?

Back 22

Do NOT confuse with Lente. Should not be administered in same syringe with other insulins.

Front 23

What are some Patient Teaching points?

Back 23

Proper administration - rotate within site.
Diet Modifications
Exercise
Testing for Blood Glucose
Storage of Insulin
Disposal of used needles and syringes
Ambulatory Pumps - needle stays in 1-3 days.

Front 24

What is the prototype for Sulfonylurea?

Back 24

glyburide (DiaBeta)

Front 25

What is the therapeutic effect of Sulfonylurea?

Back 25

Stimulates insulin release and reduces glucagon levels

Front 26

What are the adverse effects of Sulfonylurea?

Back 26

Common adverse effects:
Contraindicated in pregnancy
If mixed with alcohol causes nausea (disulfirem)

Front 27

What is the prototype for Biguanide?

Back 27

metformin (Glucophage)

Front 28

What is the therapeutic effect of Biguanide?

Back 28

Used in type 2 diabetes.
Suppresses hepatic glucose production, enhances insulin sensitivity in the muscle, and promotes glucose uptake.

Front 29

What is the prototype for Thiazolidinediones?

Back 29

rosiglitazone (Avandia)

Front 30

What are the therapeutic effects of Thiazolidinediones?

Back 30

Used in Type 2 diabetes.
Lowers the blood glucose levels by improving the cellular response to insulin.
Monitor liver enzyme function pretherapy and closely throughout the first year of therapy.

Front 31

What are the adverse effects of Thiazolidinediones?

Back 31

Adverse effect: Fluid retention. Need base liver values. Anorexia, nausea, vomitting, billius urine

Front 32

What is the prototype for Alpha Glucosidase Inhibitor?

Back 32

acarbose (Precose)

Front 33

What are the therapeutic effects of Alpha Glucosidase Inhibitor?

Back 33

Delays the digestion of carbohydrates, resulting in a smaller postprandial rise of blood glucose.

Front 34

What are the adverse effects of Alpha Glucosidase Inhibitor?

Back 34

Adverse Effects: Flatulance, cramps, GI problems, decrease absorption of iron, and long-term therapy can lead to liver disfunction.

Front 35

What precautions should be taken with Alpha Glucosidase Inhibitor?

Back 35

Use oral glucose tablets if hypoglycemia occurs, because cane sugar found in candy and orange juice will not be absorbed.

Front 36

How do you treat hypoglycemia?

Back 36

First line - Intravenous Glucose given as a drug therapy to restore consciousness in extreme hypoglycemia.
Glucagon Stimulates glycogenolysis in the peripheral tissues
Given as a drug therapy to restore consciousness in extreme hypoglycemia

Front 37

Total distruction of pancreatic cells.

Back 37

Type 1 Diabetes

Front 38

Usually adult onset; non-insulin dependent; insuin resistance.

Back 38

Type 2 Diabetes

Front 39

What are possible outcomes from diabetes 1 and 2?

Back 39

Heart disease, numbness and tingling, amputation, hypertension.

Front 40

What are normal glucose levels before meals and at betime?

Back 40

80-120 before each meal
100-140 at betime

Front 41

What constitutes for a diagnosis of diabetes?

Back 41

Need 2 positive readings on 2 different dates. Needs to be > 126. If it is an oral glucose tolerance test or a casual plasma glucose test, must be > 200.

Front 42

What are the adverse effects of Biguanide?

Back 42

Decrease absorption, decrease appetite, patients w/ renal insufficiency can become toxic. Does't cause hypoglycemia.

Front 43

What is the prototype of Meglitinides?

Back 43

repaglinide (Prandin)

Front 44

What nursing administration/Patient education should you do with Meglitinides?

Back 44

Patients should eat within 30 minutes

Front 45

What is the therapeutic effect of Meglitinides?

Back 45

Stimulates insulin release

Front 46

What is the adverse effect of Meglitinides?

Back 46

Hypoglycemia

Front 47

What are symptoms of hypoglycemia?

Back 47

Flushed, hot, cold sweat, confusion. (Patients of betablockers may not show signs)