Pharmacology Exam 2
Regulation of Blood Glucose Review
Glucose essential for cellular function
- Normal BG 70-120 mg/dl maintained by insulin and counter-regulatory hormones
Insulin from beta cells of pancreas opens cell to allow glucose entry
-Basal rate and bolus (with meals)
Counter-regulatory hormones released with low blood glucose levels
- Fast release of glucose
o Glucagon from alpha cells of pancreas
o Epinephrine from medulla of adrenal glands
- Slow release of glucose
o Cortisol from cortex of adrenal glands
o Growth hormone from anterior pituitary gland
Diagnostic Criteria for Diabetes
Fasting blood glucose > 126 mg/dL
HbA1c > 6.5%
HbA1c (%) Fasting blood glucose
6 126
8 183
10 240
12 298
Pharmacology Overview for Diabetes
Goals of interventions
- Control blood glucose
- Prevent complications
o Lifestyle modifications with pharmacologic therapy
Type 1 DM – no insulin
- Insulin
- Combination
o Long acting
o Rapid-acting
Type 2 DM – some insulin
- Oral agents
- Non-insulin injectable(s)
, - Insulin
o Long acting
o Rapid-acting
Class: Insulin
MOA: Replacement of endogenous insulin
- Promote cellular uptake of glucose, amino acids, potassium; protein synthesis, glycogen formation/storage,
fatty acid storage
Indication: T1DM, T2DM, DKA (regular insulin only), hyperkalemia
AE: Hypoglycemia; lipohypertrophy, lipodystrophy at injection site; diarrhea, hypokalemia
Insulin: Rapid Acting
Generic (Brand) Onset (min) Peak Duration (hours)
Lispro (Humalog) 5-15 min 30-60 min 3-4
Aspart (Novolog) 10-20 min 1-3 hours 3-5
Route: Subcutaneous injection
Dose: Up to 4 times daily (meals and HS)
Risk for hypoglycemia = peak action time
Nursing: Rapid Acting Insulin
Always check blood glucose prior to administration
-Prior to eating
Admin med 0-15 minutes prior to start of meal
- Rotate injection sites
Verify orders, follow facility protocol for admin
- Set dose (ex: 5 units with meal)
- Sliding scale (units to admin based on BG level; add to routine dose)
Hold parameters
- Do not give rapid insulin if BG less than ….. (check order)
- Consider NPO status
Insulin Delivery Devices
Insulin by syringe
- Widely used; inexpensive
- Multi-dose vial
o Keep unopened vials refrigerated; once open, room temp for 30 days
- Syringe one time use
Insulin by pen
- Pre-filled syringe
- Multi-dose syringe – disinfect with alcohol
- New needle attached for each use
- Prime pen first, then dial for dose
Infusion set insertion device
, - Cannula in SQ tissue and tubing
- Risk for infection at insertion site
Insulin reservoir
- Slow insulin release + bolus (rapid for short acting insulin)
Frequent BG monitoring
- Continuous glucose monitoring communicates with pump
Insulin Delivery Devices: Intravenous (IV) Insulin Drip
Indications:
- Diabetic ketoacidosis
- Hyperosmolar state
- Critical care
- Peri-operative period
- NPO type 1 diabetes
- Labor and delivery
- Glucose exacerbated by high dose glucocorticoid therapy
- TPN
Peripheral or central line
- Insulin on IV pump to deliver continuous drip of medication based on BG level
- BG checked hourly
- Standing orders
Non-insulin Agents: T2DM only
Mechanism of actions
- Increase insulin releasee
- Decreased glucagon release
- Slow GI absorption of glucose
- Block glucose reabsorption in the kidneys (excrete more glucose in urine)
May be used in combination or with insulin to achieve BG targets
Many new drugs being developed for treatment of T2DM
Class: Biguanides Prototype: metformin (Glucophage)
MOA: increases insulin sensitivity; decreases hepatic glucose production and decreases GI glucose absorption
Indications: T2DM
Route: Oral
AE: GI effects (n/v/d); lactic acidosis
Nursing: Low risk for hypoglycemia; hold 2 days prior and 2 days after IV contrast (risk AKI)
Class: Sulfonylureas, Second Generation Prototype: glipizide (Glucotrol)
MOA: increases insulin receptor sensitivity and increases insulin secretion; decreases hepatic production glucose
Route: Oral
Caution: Sulfa allergy
Regulation of Blood Glucose Review
Glucose essential for cellular function
- Normal BG 70-120 mg/dl maintained by insulin and counter-regulatory hormones
Insulin from beta cells of pancreas opens cell to allow glucose entry
-Basal rate and bolus (with meals)
Counter-regulatory hormones released with low blood glucose levels
- Fast release of glucose
o Glucagon from alpha cells of pancreas
o Epinephrine from medulla of adrenal glands
- Slow release of glucose
o Cortisol from cortex of adrenal glands
o Growth hormone from anterior pituitary gland
Diagnostic Criteria for Diabetes
Fasting blood glucose > 126 mg/dL
HbA1c > 6.5%
HbA1c (%) Fasting blood glucose
6 126
8 183
10 240
12 298
Pharmacology Overview for Diabetes
Goals of interventions
- Control blood glucose
- Prevent complications
o Lifestyle modifications with pharmacologic therapy
Type 1 DM – no insulin
- Insulin
- Combination
o Long acting
o Rapid-acting
Type 2 DM – some insulin
- Oral agents
- Non-insulin injectable(s)
, - Insulin
o Long acting
o Rapid-acting
Class: Insulin
MOA: Replacement of endogenous insulin
- Promote cellular uptake of glucose, amino acids, potassium; protein synthesis, glycogen formation/storage,
fatty acid storage
Indication: T1DM, T2DM, DKA (regular insulin only), hyperkalemia
AE: Hypoglycemia; lipohypertrophy, lipodystrophy at injection site; diarrhea, hypokalemia
Insulin: Rapid Acting
Generic (Brand) Onset (min) Peak Duration (hours)
Lispro (Humalog) 5-15 min 30-60 min 3-4
Aspart (Novolog) 10-20 min 1-3 hours 3-5
Route: Subcutaneous injection
Dose: Up to 4 times daily (meals and HS)
Risk for hypoglycemia = peak action time
Nursing: Rapid Acting Insulin
Always check blood glucose prior to administration
-Prior to eating
Admin med 0-15 minutes prior to start of meal
- Rotate injection sites
Verify orders, follow facility protocol for admin
- Set dose (ex: 5 units with meal)
- Sliding scale (units to admin based on BG level; add to routine dose)
Hold parameters
- Do not give rapid insulin if BG less than ….. (check order)
- Consider NPO status
Insulin Delivery Devices
Insulin by syringe
- Widely used; inexpensive
- Multi-dose vial
o Keep unopened vials refrigerated; once open, room temp for 30 days
- Syringe one time use
Insulin by pen
- Pre-filled syringe
- Multi-dose syringe – disinfect with alcohol
- New needle attached for each use
- Prime pen first, then dial for dose
Infusion set insertion device
, - Cannula in SQ tissue and tubing
- Risk for infection at insertion site
Insulin reservoir
- Slow insulin release + bolus (rapid for short acting insulin)
Frequent BG monitoring
- Continuous glucose monitoring communicates with pump
Insulin Delivery Devices: Intravenous (IV) Insulin Drip
Indications:
- Diabetic ketoacidosis
- Hyperosmolar state
- Critical care
- Peri-operative period
- NPO type 1 diabetes
- Labor and delivery
- Glucose exacerbated by high dose glucocorticoid therapy
- TPN
Peripheral or central line
- Insulin on IV pump to deliver continuous drip of medication based on BG level
- BG checked hourly
- Standing orders
Non-insulin Agents: T2DM only
Mechanism of actions
- Increase insulin releasee
- Decreased glucagon release
- Slow GI absorption of glucose
- Block glucose reabsorption in the kidneys (excrete more glucose in urine)
May be used in combination or with insulin to achieve BG targets
Many new drugs being developed for treatment of T2DM
Class: Biguanides Prototype: metformin (Glucophage)
MOA: increases insulin sensitivity; decreases hepatic glucose production and decreases GI glucose absorption
Indications: T2DM
Route: Oral
AE: GI effects (n/v/d); lactic acidosis
Nursing: Low risk for hypoglycemia; hold 2 days prior and 2 days after IV contrast (risk AKI)
Class: Sulfonylureas, Second Generation Prototype: glipizide (Glucotrol)
MOA: increases insulin receptor sensitivity and increases insulin secretion; decreases hepatic production glucose
Route: Oral
Caution: Sulfa allergy
