NU 300 EXAM 7: DIABETES, URINARY PROBLEMS, EYES & EARS |
COMPREHENSIVE MEDICAL-SURGICAL NURSING STUDY GUIDE 2026/2027
ADA treatment outcomes for diabetes - ANS ✔✔A1C: <7%
pre-meal: 70-130
post-meal: <180
drug therapy for diabetes - ANS ✔✔DMT1: insulin required
DMT2: medications indicated when can't achieve BG control and lifestyle modifications
Insulin Secretagogues - ANS ✔✔Stimulate insulin secretion from pancreas
Must be able to make insulin
DMT2
S/E: hypoglycemia
Ex:
Sulfonylureas, Meglitinide Analogs
Sulfonylureas - ANS ✔✔*table 64-2*
Triggers release of insulin from pancreas
DMT2
Examples:
Glyburide (DiaBeta)
Glipizide (Glucotrol)
S/E: hypoglycemia (because triggering insulin release), weight gain, medication interactions
Short acting
Take 30 min prior to eating (multiple doses/day)
Meglitinide Analogs - ANS ✔✔*table 64-2*
Triggers release of insulin
DMT2
Examples:
Repaglinide (Prandin)
S/E: hypoglycemia (because triggering insulin release)
Take before meals
Insulin Sensitizers - ANS ✔✔Decrease liver production of glucose
,Improves insulin receptor sensitivity
Thiazolidinediones - ANS ✔✔Decrease liver production of glucose
Insulin sensitizer: Does NOT increase insulin secretion
Contraindications:
bladder cancer, heart failure, liver impairment
Examples:
Pioglitazone (Actos), Rosiglitazone (Avandia)
S/E: increase heart related deaths, bone fracture, macular edema, and liver impairment; Actos also
increase risk for bladder CA
Black box warning
8-12 weeks for full response
Biguianides - ANS ✔✔Decreases liver production of glucose & intestinal uptake of glucose
Insulin sensitizer: Does NOT increase insulin secretion
Example:
Metformin (Glucophage)
S/E: diarrhea, N/V, flatulence, indigestion, ovulation
Take with meals to help with GI S/E
*May cause lactic acidosis in patients with renal insufficiency*
Interacts with contrast dye ---> *hold at least 24 h before and 48 h after* to prevent acute kidney injury
Incretins - ANS ✔✔"gut hormone"
Natural hormones released after eating
Stimulate insulin secretion
Suppress appetite/Delay gastric emptying which inhibits glucagon secretion (prevents post-meal BG rise)
Incretin Mimetics - ANS ✔✔act like "gut hormones"
Daily dosing
Subcutaneous injections
, MAJOR S/E: Hypoglycemia
Exenatide (Byetta)
S/E: increased risk for pancreatitis, increased risk for hypersensitivity reactions (SJS)
Liraglutide (Victoza): thyroid CA risk
DPP-4 Inhibitors - ANS ✔✔Keeps gut hormones (incretin) active longer
Sitagliptin (Januvia)
Decrease pre-meal and post meal BG
S/E: Hypoglycemia because keeping incretin active longer (remember it stimulates insulin)
Also increased risk for pancreatitis
Report jaundice, abdominal pain, blue-gray discoloration of abdomen to HCP immediately
Amylin Analogs - ANS ✔✔Delay gastric emptying and trigger fullness
Pramlintide (Symlin)
Subcutaneous injection
S/E: hypoglycemia (esp. if also taking insulin), N/V
Alpha Glucosidase Inhibitors - ANS ✔✔Inhibit gut enzymes, slowing CHO absorption
Take with first bite of meal (need food to inhibit CHO breakdown!)
Prevent post-meal hyperglycemia
Do not cause hypoglycemia because not messing with insulin
Ex: Acarbose, Miglitol
S/E: diarrhea, flatulence
Sodium Glucose Co-Transport Inhibitors - ANS ✔✔Prevent KIDNEY from reabsorbing glucose in blood
stream
Excrete glucose in urine (EXPECTED with this drug)
S/E:
Dehydration (increased UOP)
Hyponatremia (increased UOP)
Hypoglycemia (lowering BG through elimination)
Yeast infection
COMPREHENSIVE MEDICAL-SURGICAL NURSING STUDY GUIDE 2026/2027
ADA treatment outcomes for diabetes - ANS ✔✔A1C: <7%
pre-meal: 70-130
post-meal: <180
drug therapy for diabetes - ANS ✔✔DMT1: insulin required
DMT2: medications indicated when can't achieve BG control and lifestyle modifications
Insulin Secretagogues - ANS ✔✔Stimulate insulin secretion from pancreas
Must be able to make insulin
DMT2
S/E: hypoglycemia
Ex:
Sulfonylureas, Meglitinide Analogs
Sulfonylureas - ANS ✔✔*table 64-2*
Triggers release of insulin from pancreas
DMT2
Examples:
Glyburide (DiaBeta)
Glipizide (Glucotrol)
S/E: hypoglycemia (because triggering insulin release), weight gain, medication interactions
Short acting
Take 30 min prior to eating (multiple doses/day)
Meglitinide Analogs - ANS ✔✔*table 64-2*
Triggers release of insulin
DMT2
Examples:
Repaglinide (Prandin)
S/E: hypoglycemia (because triggering insulin release)
Take before meals
Insulin Sensitizers - ANS ✔✔Decrease liver production of glucose
,Improves insulin receptor sensitivity
Thiazolidinediones - ANS ✔✔Decrease liver production of glucose
Insulin sensitizer: Does NOT increase insulin secretion
Contraindications:
bladder cancer, heart failure, liver impairment
Examples:
Pioglitazone (Actos), Rosiglitazone (Avandia)
S/E: increase heart related deaths, bone fracture, macular edema, and liver impairment; Actos also
increase risk for bladder CA
Black box warning
8-12 weeks for full response
Biguianides - ANS ✔✔Decreases liver production of glucose & intestinal uptake of glucose
Insulin sensitizer: Does NOT increase insulin secretion
Example:
Metformin (Glucophage)
S/E: diarrhea, N/V, flatulence, indigestion, ovulation
Take with meals to help with GI S/E
*May cause lactic acidosis in patients with renal insufficiency*
Interacts with contrast dye ---> *hold at least 24 h before and 48 h after* to prevent acute kidney injury
Incretins - ANS ✔✔"gut hormone"
Natural hormones released after eating
Stimulate insulin secretion
Suppress appetite/Delay gastric emptying which inhibits glucagon secretion (prevents post-meal BG rise)
Incretin Mimetics - ANS ✔✔act like "gut hormones"
Daily dosing
Subcutaneous injections
, MAJOR S/E: Hypoglycemia
Exenatide (Byetta)
S/E: increased risk for pancreatitis, increased risk for hypersensitivity reactions (SJS)
Liraglutide (Victoza): thyroid CA risk
DPP-4 Inhibitors - ANS ✔✔Keeps gut hormones (incretin) active longer
Sitagliptin (Januvia)
Decrease pre-meal and post meal BG
S/E: Hypoglycemia because keeping incretin active longer (remember it stimulates insulin)
Also increased risk for pancreatitis
Report jaundice, abdominal pain, blue-gray discoloration of abdomen to HCP immediately
Amylin Analogs - ANS ✔✔Delay gastric emptying and trigger fullness
Pramlintide (Symlin)
Subcutaneous injection
S/E: hypoglycemia (esp. if also taking insulin), N/V
Alpha Glucosidase Inhibitors - ANS ✔✔Inhibit gut enzymes, slowing CHO absorption
Take with first bite of meal (need food to inhibit CHO breakdown!)
Prevent post-meal hyperglycemia
Do not cause hypoglycemia because not messing with insulin
Ex: Acarbose, Miglitol
S/E: diarrhea, flatulence
Sodium Glucose Co-Transport Inhibitors - ANS ✔✔Prevent KIDNEY from reabsorbing glucose in blood
stream
Excrete glucose in urine (EXPECTED with this drug)
S/E:
Dehydration (increased UOP)
Hyponatremia (increased UOP)
Hypoglycemia (lowering BG through elimination)
Yeast infection
