DRUG THERAPY
INSULIN
INSULIN
This genetically engineered hormone is used to regulate blood glucose levels in patients with diabetes mellitus
What is Insulin
Which of the following statements would indicate your patient needs further education regarding their new medication, Levemir detemir?
1. I should inject my insulin 1/2 to 1 inch from my previously injected site and ensure that I also rotate sites.
2. The effectiveness of my insulin may be influenced by temps greater than 86F or less than 32F.
3. I should exercise the same area where I am injecting my insulin to reduce inflammation from the injection into my tissue.
3. I should exercise the same area where I am injecting my insulin to reduce inflammation from the injection into my tissue.
This is the most common OA and the most effective OA for type 2 DM
metformin Glucophage, Fortamet, Glumetza, or Riomet
The OA that influences the CNS for which we do not exactly know how it helps to improve glucose levels
Dopamine Receptor
Cycloset bromocriptine
These 2 types of insulin are administered prior to meals and referred to as "bolus dosing" due to their quicker onset and peak
What is rapid and short acting insulin
This side effect, caused by injection of insulin, leads to a thickening of the subcutaneous tissue, and patients should not inject insulin into the location for ____ months.
Hypertrophy, 6
This OA stimulates the release of insulin from the pancreas, reduces glycogenolysis and gluconeogenesis, and enhances cellular sensitivity to insulin
Sulfonureas
Amaryl glimepiride
Glucotrol or Glucotrol XL glipizide
DiBeta or Glynase glyburide
This OA exerts its effect through decreasing renal glucose absorption and increasing glucose excretion
SGLT2
Invokana canagliflozin
Farxiga dapagliflozin
Jardiance empagliflozin
Steglatro etrugliflozin
These 2 types of insulin, referred to as the "basal dose" are administered once or twice a day and have a duration of 16-24 hours
What is Intermediate or Long acting
Insulin pumps use this type of insulin, and the names of this type of insulin are
Rapid Acting Insulin
Humalog lispro
Novolog aspart
Apidira glulisine
These are the 3 defects oral antidiabetic medications work to correct
1. Insulin resistance
2. Decreased insulin production
3. Increased hepatic glucose production
This medication type can affect the absorption of oral medications. Patients should be taught to wait 1 hour after taking fast acting oral meds before taking.
GLP 1 Receptor Agonist
Generics end in tides
**Patients should be taught to wait 1 hour after taking fast acting oral meds before taking the GLP1
Tanzeum
Trulicity
Byetta
Bydureon
Victoza
Adlyxin
Ozempic
These 3 insulins onset in as little as 10 minutes and peak between 30 minutes and 3 hours
What are
Humalog lispro
Novolog aspart
Apidra glulsine
** Please note the name brand is in caps **
The nurse educating a patient with an insulin pump explains the importance of ensuring the pump is functioning properly to prevent this serious side effect
Diabetic Ketoacidosis
A nurse caring for a patient on an a-glucosidase inhibitor educates a patient on these 3 common side effects
gas, abdominal pain, diarrhea
You are the nurse admitting a patient for an outpatient CT/MRI with contrast and notice the patient had DM type 2. The priority assessment for this patient would be
Assessing if the patient takes any diabetic medications and if so, what is the medication and when was the medication last taken.
Metformin which is very common should be held for patients who are going to receive contrast media. According to the text, the medication should be held for at least 48 hours preceding the administration of contrast to ensure there is no damage to the kidney. While your text specifically notes metformin, I will tell you that most facilities have policies specific to diabetic patients who are going o obtain a CT/MRI with contrast.
These 3 insulins onset around 1 hour, do not have a defined peak, and last between 16-24 hours
What are
Lantus glargine
Levemir detemir
Tresiba degludec
These two types of insulin onset around 90 minutes, can begin to peak around 4 hours, and last 12-18 hours.
Intermediate Acting Insulin
NPH Humulin N and Novolin N
This OA would not be a good choice for a patient with PMHX (past medical history) of MI and stroke
Thiazolidinediones
Actos pioglitizone
Avandia rosiglitazone
This medication is used in conjunction with insulin and patients should be taught to closely monitor for hypoglycemia for 3 hours after injection.
Symlin pramlintide
This is given with insulin, but is NEVER mixed with insulin. Should not be injected to arm, but should instead always be injected into the thigh or abdomen.