Nursing Considerations: antidiabetics
,Blood glucose monitoring (CBG & A1C)
Proper injection techniques for insulin or continuous pump therapy
Emphasize non-pharm: weight & dietary management, exercise, foot care,
eye care
Use of medic alert bracelet
Keep hypoglycemic kit on hand
Oral hypoglycemics may cause photosensitivity
Administration, handling and storage of insulin Box 33.2, p. 643
Thorough patient education is essential regarding:
Disease process
Diet and exercise recommendations
Self-administration of insulin or oral drugs
Potential complications
When insulin is ordered, ensure:
Correct drug
Correct route
Correct type of insulin
Correct dosage
Insulin order and prepared dosages are second-checked with another
registered nurse (or per agency policy).
Insulin
Check blood glucose level before giving insulin.
To mix suspensions, roll vials between hands instead of shaking them.
Ensure correct storage of insulin vials.
Only use insulin syringes, calibrated in units, to measure and give insulin.
Ensure correct timing of insulin dose with meals.
When drawing up two types of insulin in one syringe, always withdraw the
regular or rapid-acting (clear) insulin first.
Provide thorough patient education regarding self-administration of insulin
injections, including timing of doses, monitoring of blood glucose levels,
and injection site rotations.
Oral antidiabetic drugs
Always check blood glucose levels before administering.
Usually given 30 minutes before meals
α-Glucosidase inhibitors are given with the first bite of each main meal.
Metformin is taken with meals to reduce gastrointestinal effects.
Metformin will need to be discontinued if the patient is to undergo studies
with contrast dye, because of possible renal effects; check with the
prescriber.
Assess for signs of hypoglycemia.
, If hypoglycemia occurs:
o Administer oral form of glucose if the patient is conscious.
o Give the patient glucose tablets, liquid, or gel; corn syrup; honey; fruit
juice or nondiet soft drink; or have the patient eat a small snack, such as
crackers or a half sandwich.
o Deliver D50W or IV glucagon if the patient is unconscious.
o Monitor blood glucose levels.
Monitor therapeutic response.
Decrease in blood glucose levels to the level prescribed by physician
Measure HbA1c to monitor long-term compliance with diet and drug
therapy.
Watch for and monitor hypoglycemia and hyperglycemia.
thyroid augmentation drugs
Give this one a try later!
Synthetic thyroid preparations: Levothyroxine; Eltroxin or Synthroid (T4 -
preferred drug) Liothyronine (T3)
Work the same way as endogenous thyroid hormones Metabolic rate (lipid,
carbs, protein) increase O2 Consumption, temp, blood volume cell growth
increased myocardial β receptors (increased cardiac output) increase
kidney blood flow (GFR; diuretic effect)
Never discontinue abruptly
Give same time each day to maintain consistent blood levels Take in am
to decrease insomnia
· Some suggestions that evening achieves better therapeutic levels
· Do not interchange brands
CO: MI, Adrenal insufficiency, hyperthyroidism
AE (like HYPERthyroidism)
· Cardiac dysrhythmia with the risk for fatal irregularities
· Insomnia, tremors, headache, anxiety
· Nausea diarrhea, appetite changes, cramps
· Weight loss, menstrual irregularities, sweating, heat intolerance, fever
INT:
· Enhance warfarin so reduce dose
, · Reduce efficacy of digoxin and insulin so increased dosage may be
needed
· Increased sensitivity to epinephrine
· Cholestyramine, calcium and aluminum bind in GI tract and reduce
absorption both drugs
Pharmacokinetics:Half-Life: (average is 7 days; min=3-5 days; max=9-10
days) Why?? Because its an hormone
Sulfonylureas
Give this one a try later!
oral antidiabetic
Gliclazide
· Stimulate insulin secretion from β cells (NEED FUNCTIONING CELLS)
· Enhance action of insulin in muscle, liver, adipose tissue
· Prevent liver from breaking down insulin as fast
· Typically 2nd gen
· rapid onset and short duration of action
· rapid onset allows it to work like the pancreas during meals
· type II, rapidly stimulates the pancreases to release insulin which
transports excess glucose from the blood into the cells
INT:
o Increased effect of hypoglycemic: Alcohol*, anabolic steroids, β
blockers, chloramphenicol, MAOI's, oral anticoagulants, sulfonamides,
garlic, ginseng
o Decreased effect: Adrenergics, corticosteroids, thiazides, thyroid drugs
CO: liver and kidney failure, active hypoglycemia, and not used in
pregnancy
o *Alcohol may cause a reaction similar to Antabuse (induced vomiting and
hypertension)
o *Potential cross allergic reaction if allergic to sulfa drugs
Nursing Considerations: antihypertensives
,Blood glucose monitoring (CBG & A1C)
Proper injection techniques for insulin or continuous pump therapy
Emphasize non-pharm: weight & dietary management, exercise, foot care,
eye care
Use of medic alert bracelet
Keep hypoglycemic kit on hand
Oral hypoglycemics may cause photosensitivity
Administration, handling and storage of insulin Box 33.2, p. 643
Thorough patient education is essential regarding:
Disease process
Diet and exercise recommendations
Self-administration of insulin or oral drugs
Potential complications
When insulin is ordered, ensure:
Correct drug
Correct route
Correct type of insulin
Correct dosage
Insulin order and prepared dosages are second-checked with another
registered nurse (or per agency policy).
Insulin
Check blood glucose level before giving insulin.
To mix suspensions, roll vials between hands instead of shaking them.
Ensure correct storage of insulin vials.
Only use insulin syringes, calibrated in units, to measure and give insulin.
Ensure correct timing of insulin dose with meals.
When drawing up two types of insulin in one syringe, always withdraw the
regular or rapid-acting (clear) insulin first.
Provide thorough patient education regarding self-administration of insulin
injections, including timing of doses, monitoring of blood glucose levels,
and injection site rotations.
Oral antidiabetic drugs
Always check blood glucose levels before administering.
Usually given 30 minutes before meals
α-Glucosidase inhibitors are given with the first bite of each main meal.
Metformin is taken with meals to reduce gastrointestinal effects.
Metformin will need to be discontinued if the patient is to undergo studies
with contrast dye, because of possible renal effects; check with the
prescriber.
Assess for signs of hypoglycemia.
, If hypoglycemia occurs:
o Administer oral form of glucose if the patient is conscious.
o Give the patient glucose tablets, liquid, or gel; corn syrup; honey; fruit
juice or nondiet soft drink; or have the patient eat a small snack, such as
crackers or a half sandwich.
o Deliver D50W or IV glucagon if the patient is unconscious.
o Monitor blood glucose levels.
Monitor therapeutic response.
Decrease in blood glucose levels to the level prescribed by physician
Measure HbA1c to monitor long-term compliance with diet and drug
therapy.
Watch for and monitor hypoglycemia and hyperglycemia.
thyroid augmentation drugs
Give this one a try later!
Synthetic thyroid preparations: Levothyroxine; Eltroxin or Synthroid (T4 -
preferred drug) Liothyronine (T3)
Work the same way as endogenous thyroid hormones Metabolic rate (lipid,
carbs, protein) increase O2 Consumption, temp, blood volume cell growth
increased myocardial β receptors (increased cardiac output) increase
kidney blood flow (GFR; diuretic effect)
Never discontinue abruptly
Give same time each day to maintain consistent blood levels Take in am
to decrease insomnia
· Some suggestions that evening achieves better therapeutic levels
· Do not interchange brands
CO: MI, Adrenal insufficiency, hyperthyroidism
AE (like HYPERthyroidism)
· Cardiac dysrhythmia with the risk for fatal irregularities
· Insomnia, tremors, headache, anxiety
· Nausea diarrhea, appetite changes, cramps
· Weight loss, menstrual irregularities, sweating, heat intolerance, fever
INT:
· Enhance warfarin so reduce dose
, · Reduce efficacy of digoxin and insulin so increased dosage may be
needed
· Increased sensitivity to epinephrine
· Cholestyramine, calcium and aluminum bind in GI tract and reduce
absorption both drugs
Pharmacokinetics:Half-Life: (average is 7 days; min=3-5 days; max=9-10
days) Why?? Because its an hormone
Sulfonylureas
Give this one a try later!
oral antidiabetic
Gliclazide
· Stimulate insulin secretion from β cells (NEED FUNCTIONING CELLS)
· Enhance action of insulin in muscle, liver, adipose tissue
· Prevent liver from breaking down insulin as fast
· Typically 2nd gen
· rapid onset and short duration of action
· rapid onset allows it to work like the pancreas during meals
· type II, rapidly stimulates the pancreases to release insulin which
transports excess glucose from the blood into the cells
INT:
o Increased effect of hypoglycemic: Alcohol*, anabolic steroids, β
blockers, chloramphenicol, MAOI's, oral anticoagulants, sulfonamides,
garlic, ginseng
o Decreased effect: Adrenergics, corticosteroids, thiazides, thyroid drugs
CO: liver and kidney failure, active hypoglycemia, and not used in
pregnancy
o *Alcohol may cause a reaction similar to Antabuse (induced vomiting and
hypertension)
o *Potential cross allergic reaction if allergic to sulfa drugs
Nursing Considerations: antihypertensives
