1
RASMUSSEN COLLEGE
PHARMACOLOGY
CONCEPT REVIEW #2
Diabetes
Type 1
o Insulin-dependent DM
Type 2
o Non-insulin-dependent DM
Normal Blood glucose 70-100
Major symptoms
o Polyuria
Peeing a lot
o Polydipsia
Drink a lot
o Polyphagia
Eating a lot
Managing hypoglycemia
o Diazoxide
Used for patients with Chronic hypoglycemia caused by hyperinsulinism
Not indicated for hypoglycemic reaction
o Dextrose
Given IV
Insulin-induced hypoglycemia
o Glucagon
When it should be administered
Sub Q – when pt has lost consciousness
Feed them – if pt is still awake
o Orange juice
Routes
Sub Q
Assessments pre and post administration
Check blood sugar
What they eat
Frequency of blood glucose checks
Before you give it and after your give it – monitor
o Assessing it and actions
Insulin
o Action: Promote use of glucose by body cells, store glucose as glycogen in
muscles
o Use: Reduce blood glucose, control diabetes mellitus Type 1
o Interactions
Increase glucose with thiazides, glucocorticoids, estrogen, thyroid drugs
Decrease glucose with TCAs, MAOIs, aspirin, oral anticoagulants
o Side Effects
Low Blood Sugar, Rash, Weight Gain – when first starting to use it, Scarring
at injection site if sites are not rotated well
Hypoglycemia, insulin shock
Too much insulin
Nervousness, tremors
Lack of coordination
Cold, clammy skin
Headache, confusion
Somogyi effect
1
, 2
Occurs in predawn hours
Rapid decrease in blood glucose during night stimulates hormonal
release to increase blood glucose
Lipodystrophy
Lipoatrophy – divots
Lipohypertrophy – little fat bumps
Dawn phenomenon
Hyperglycemia upon awakening
Symptoms
o Headache, night sweats, nightmares
Diabetic ketoacidosis
Hyperglycemia
o Patient teaching
Teach patients to recognize and immediately report symptoms of
hypoglycemic (insulin) reaction—such as headache, nervousness,
sweating, tremors, rapid pulse—and those of hyperglycemic reaction
(diabetic acidosis): thirst, increased urine output, and a sweet, fruity
breath odor.
Advise patients that hypoglycemic reactions are more likely to
occur during peak action time. Most diabetic patients know whether
they are having a hypoglycemic reaction, but some have a higher
tolerance to low blood glucose and can have a severe reaction without
realizing it.
Explain that orange juice, sugar-containing drinks, and hard candy
may be used when a hypoglycemic reaction begins.
Teach family members to administer glucagon by injection if a
patient has a hypoglycemic reaction and cannot drink sugar-
containing fluid.
Inform patients that certain herbs may interact with insulin and oral
antidiabetic drugs. A hypoglycemic or hyperglycemic effect might occur
(Complementary and Alternative Therapies 47.1).
Teach patients about the necessity of compliance with prescribed
insulin therapy and diet. HbA1c provides the most accurate picture of
optimal diabetic control.
Advise patients to carry a MedicAlert card, tag, or bracelet that indicates
the health problem and the insulin dosage.
Self-Administration
o Instruct patients on how to check blood glucose with
a glucometer (OneTouch AccuSure, GlucoSure, Accu-Chek).
o Teach patients about the care of insulin containers
and syringes.
Inform patients taking NPH insulin with regular
insulin that regular insulin is drawn up before
NPH insulin.
Diet
o Advise patients taking insulin to eat the prescribed
diet on a consistent schedule. Diet information may be
obtained from the ADA or from a nutritionist.
o Onset, peak and duration of regular, Novolog/Humalog, NPH, Lantus, Levimer
Rapid-acting insulin (clear)
Insulin lispro, insulin aspart, insulin glulisine, oral inhalation insulin
o Onset of action: 5-30 min
o Peak 30 min: – 1.5 hrs
o Duration: 3-5 hrs
2
, 3
Short-acting insulin (clear)
Regular
o Onset of action: 0.5-1 hr
o Peak: 2-5 hrs
o Duration: 4-12 hrs
Intermediate-acting (cloudy)
Insulin isophane NPH
o Onset of action: 1-2 hrs
o Peak: 4-12 hrs
o Duration: 14-24 hrs
Long-acting
Insulin glargine
o Onset of action: 1-2 hrs
o Duration: 6-8 hrs
o Administered at bedtime - 24 hrs
o Mixing insulins and observations for hypoglycemia
Composed of short- and intermediate-acting
Rapid- (FIRST) and intermediate-acting
o Pre-mix
NPH 70/regular 30
NPH 50/regular 50
Storage of insulin
Keep in refrigerator until opened.
Avoid storing insulin in direct sunlight or at high temperatures.
Never shake insulin – always roll
o Interpreting sliding scales
Adjusted doses dependent on individual blood glucose
Monitor blood glucose.
Before meals and at bedtime
Involves rapid or short-acting insulin
EX: If below 60, notify MD
If 60 – 124, no coverage
If 125 – 150, give two units
If 151 – 200, give four units
If 201 – 250, give six units
If 251 – 300, give eight units
If over 300 notify the physician
Oral antidiabetic agents
o Used to treat Type 2 Diabetes
o Not used in pregnancy (woman must take insulin)
o Not used in type 1 diabetes
o How they work
Stimulate pancreatic beta cells to secrete more insulin
Increase tissue response to insulin
Decrease in glucose production
o Special concerns (1st dose hypoglycemia, etc.)
Criteria to go on oral antidiabetic
Onset of diabetes mellitus at age 40 years or older
Diagnosis of diabetes for less than five years
Normal weight or overweight
Fasting blood glucose 200 mg/dL or less
Less than 40 units of insulin required per day
Normal renal and hepatic function
o Patient teaching
3
RASMUSSEN COLLEGE
PHARMACOLOGY
CONCEPT REVIEW #2
Diabetes
Type 1
o Insulin-dependent DM
Type 2
o Non-insulin-dependent DM
Normal Blood glucose 70-100
Major symptoms
o Polyuria
Peeing a lot
o Polydipsia
Drink a lot
o Polyphagia
Eating a lot
Managing hypoglycemia
o Diazoxide
Used for patients with Chronic hypoglycemia caused by hyperinsulinism
Not indicated for hypoglycemic reaction
o Dextrose
Given IV
Insulin-induced hypoglycemia
o Glucagon
When it should be administered
Sub Q – when pt has lost consciousness
Feed them – if pt is still awake
o Orange juice
Routes
Sub Q
Assessments pre and post administration
Check blood sugar
What they eat
Frequency of blood glucose checks
Before you give it and after your give it – monitor
o Assessing it and actions
Insulin
o Action: Promote use of glucose by body cells, store glucose as glycogen in
muscles
o Use: Reduce blood glucose, control diabetes mellitus Type 1
o Interactions
Increase glucose with thiazides, glucocorticoids, estrogen, thyroid drugs
Decrease glucose with TCAs, MAOIs, aspirin, oral anticoagulants
o Side Effects
Low Blood Sugar, Rash, Weight Gain – when first starting to use it, Scarring
at injection site if sites are not rotated well
Hypoglycemia, insulin shock
Too much insulin
Nervousness, tremors
Lack of coordination
Cold, clammy skin
Headache, confusion
Somogyi effect
1
, 2
Occurs in predawn hours
Rapid decrease in blood glucose during night stimulates hormonal
release to increase blood glucose
Lipodystrophy
Lipoatrophy – divots
Lipohypertrophy – little fat bumps
Dawn phenomenon
Hyperglycemia upon awakening
Symptoms
o Headache, night sweats, nightmares
Diabetic ketoacidosis
Hyperglycemia
o Patient teaching
Teach patients to recognize and immediately report symptoms of
hypoglycemic (insulin) reaction—such as headache, nervousness,
sweating, tremors, rapid pulse—and those of hyperglycemic reaction
(diabetic acidosis): thirst, increased urine output, and a sweet, fruity
breath odor.
Advise patients that hypoglycemic reactions are more likely to
occur during peak action time. Most diabetic patients know whether
they are having a hypoglycemic reaction, but some have a higher
tolerance to low blood glucose and can have a severe reaction without
realizing it.
Explain that orange juice, sugar-containing drinks, and hard candy
may be used when a hypoglycemic reaction begins.
Teach family members to administer glucagon by injection if a
patient has a hypoglycemic reaction and cannot drink sugar-
containing fluid.
Inform patients that certain herbs may interact with insulin and oral
antidiabetic drugs. A hypoglycemic or hyperglycemic effect might occur
(Complementary and Alternative Therapies 47.1).
Teach patients about the necessity of compliance with prescribed
insulin therapy and diet. HbA1c provides the most accurate picture of
optimal diabetic control.
Advise patients to carry a MedicAlert card, tag, or bracelet that indicates
the health problem and the insulin dosage.
Self-Administration
o Instruct patients on how to check blood glucose with
a glucometer (OneTouch AccuSure, GlucoSure, Accu-Chek).
o Teach patients about the care of insulin containers
and syringes.
Inform patients taking NPH insulin with regular
insulin that regular insulin is drawn up before
NPH insulin.
Diet
o Advise patients taking insulin to eat the prescribed
diet on a consistent schedule. Diet information may be
obtained from the ADA or from a nutritionist.
o Onset, peak and duration of regular, Novolog/Humalog, NPH, Lantus, Levimer
Rapid-acting insulin (clear)
Insulin lispro, insulin aspart, insulin glulisine, oral inhalation insulin
o Onset of action: 5-30 min
o Peak 30 min: – 1.5 hrs
o Duration: 3-5 hrs
2
, 3
Short-acting insulin (clear)
Regular
o Onset of action: 0.5-1 hr
o Peak: 2-5 hrs
o Duration: 4-12 hrs
Intermediate-acting (cloudy)
Insulin isophane NPH
o Onset of action: 1-2 hrs
o Peak: 4-12 hrs
o Duration: 14-24 hrs
Long-acting
Insulin glargine
o Onset of action: 1-2 hrs
o Duration: 6-8 hrs
o Administered at bedtime - 24 hrs
o Mixing insulins and observations for hypoglycemia
Composed of short- and intermediate-acting
Rapid- (FIRST) and intermediate-acting
o Pre-mix
NPH 70/regular 30
NPH 50/regular 50
Storage of insulin
Keep in refrigerator until opened.
Avoid storing insulin in direct sunlight or at high temperatures.
Never shake insulin – always roll
o Interpreting sliding scales
Adjusted doses dependent on individual blood glucose
Monitor blood glucose.
Before meals and at bedtime
Involves rapid or short-acting insulin
EX: If below 60, notify MD
If 60 – 124, no coverage
If 125 – 150, give two units
If 151 – 200, give four units
If 201 – 250, give six units
If 251 – 300, give eight units
If over 300 notify the physician
Oral antidiabetic agents
o Used to treat Type 2 Diabetes
o Not used in pregnancy (woman must take insulin)
o Not used in type 1 diabetes
o How they work
Stimulate pancreatic beta cells to secrete more insulin
Increase tissue response to insulin
Decrease in glucose production
o Special concerns (1st dose hypoglycemia, etc.)
Criteria to go on oral antidiabetic
Onset of diabetes mellitus at age 40 years or older
Diagnosis of diabetes for less than five years
Normal weight or overweight
Fasting blood glucose 200 mg/dL or less
Less than 40 units of insulin required per day
Normal renal and hepatic function
o Patient teaching
3
