Chapter 47
ANTIDIABETICS
Diabetes Mellitus (1 of 2)
Chronic disease results from deficient
glucose metabolism
Insufficient insulin secretion from beta cells
Insulin resistance
Insulin receptors unresponsive or deficient in
numbers
Major symptoms
Polyuria, polydipsia, polyphagia
2
Diabetes Mellitus (2 of 2)
Types
Type 1
• Insulin-dependent DM
Type 2
• Non-insulin-dependent DM
Secondary
• Due to medications (glucocorticoids, thiazide
diuretics, epinephrine)
Gestational
• Due to hormonal changes
Insulin (1 of 3)
Insulin
Released from beta cells of islets of
Langerhans in pancreas
Secreted in response to increase in blood
glucose
Function
• Promotes uptake of glucose, amino acids, and fatty
acids
• Converts glucose to glycogen in liver and muscle for
future needs
Normal range blood glucose
Hemoglobin A1c
Insulin (2 of 3)
Insulin
Currently manufactured by using
deoxyribonucleic acid (DNA) technology
Human insulin
• Humulin R, Novolin N
• Low incidence allergies, insulin resistance
Human insulin analogs
• Insulin lispro
• Insulin aspart
Storage
Insulin (3 of 3)
Types of insulin
Rapid-acting
Short-acting
Intermediate-acting
Long-acting
Combinations
Insulin Types (1 of 3)
Rapid-acting insulin (clear)
Insulin lispro, insulin aspart, insulin glulisine,
oral inhalation insulin
• Onset of action
• Peak
• Duration
Short-acting insulin (clear)
Regular
• Onset of action
• Peak
• Duration
8
Insulin Types (2 of 3)
Intermediate-acting (cloudy)
Insulin isophane NPH
• Onset of action
• Peak
• Duration
Long-acting
Insulin glargine
• Onset of action
• Duration
• Administered at bedtime
10
Insulin Types (3 of 3)
Combinations
Composed of short- and intermediate-acting or
rapid- and intermediate-acting
NPH 70/regular 30
NPH 50/regular 50
Insulin Resistance and Storage
Insulin resistance
Antibodies develop over time to animal insulin
Antibodies cause insulin resistance and insulin
allergy
Obesity can lead to insulin resistance
Storage of insulin
Keep in refrigerator until opened.
Avoid storing insulin in direct sunlight or at high
temperatures.
Insulins
Action
Promote use of glucose by body cells, store
glucose as glycogen in muscles
Use
Reduce blood glucose, control diabetes mellitus
Interactions
Increase glucose with thiazides, glucocorticoids,
estrogen, thyroid drugs
Decrease glucose with TCAs, MAOIs, aspirin,
oral anticoagulants
Sliding-Scale Insulin
Sliding-scale insulin coverage
Adjusted doses dependent on individual blood
glucose
Monitor blood glucose.
• Before meals and at bedtime
Involves rapid or short-acting insulin
Insulin Side Effects (1 of 2)
Hypoglycemia, insulin shock
Nervousness, trembling
Lack of coordination
Cold, clammy skin
Headache, confusion
Somogyi effect
Response to excess insulin
Occurs in predawn hours
Rapid decrease in blood glucose during night
stimulates hormonal release to increase blood
glucose
16
Insulin Side Effects (2 of 2)
Lipodystrophy
Lipoatrophy
Lipohypertrophy
Dawn phenomenon
Hyperglycemia upon awakening
Symptoms
• Headache, night sweats, nightmares
Diabetic ketoacidosis
Hyperglycemia
Leads to fat catabolism
18
Insulin Administration
Methods of insulin
administration
Insulin pen injectors
Insulin pumps
Insulin jet injectors
Figure 47.1 Sites for Insulin Injection
Nursing Process: Insulin (1 of 2)
Concept
Glucose regulation
Assessment
Determine the patient’s knowledge of diabetes
mellitus and use of insulins.
Check for signs and symptoms of hypoglycemia and
hyperglycemia.
Patient problems
Reduced glucose regulation, hypoglycemia
Planning
The patient will self-administer insulin correctly.
Nursing Process: Insulin (2 of 2)
Nursing interventions
Determine blood glucose levels and report
changes.
Monitor the patient’s HbA1c to provide feedback
of diabetic control.
Teach patient to recognize and report
hypoglycemia and hyperglycemia.
Teach patient how to administer insulin.
Advise patient that hypoglycemic reactions are
more likely to occur during peak action time.
Evaluation
Oral Antidiabetic Drugs (1 of 2)
First- and second-generation sulfonylureas
Used to treat type 2 diabetes
Stimulate pancreatic beta cells to secrete more
insulin
Increase tissue response to insulin
Decrease glucose production
Side effects/adverse reactions
• Hypoglycemia, hyponatremia, blurred vision
• Nausea, diarrhea, weight gain
• Nervousness, tremors, confusion
Oral Antidiabetic Drugs (2 of 2)
Nonsulfonylureas
Biguanide: Metformin
Action
• Decrease hepatic production of glucose from
stored glycogen
• Diminish increase in serum glucose after meals
• Blunt postprandial hyperglycemia
• Decrease glucose absorption from small intestine
• Increase insulin receptor sensitivity
• Increase peripheral glucose uptake at the cellular
level
Alpha-Glucosidase Inhibitors
Do not cause hypoglycemia
Acarbose
Action
• Inhibit digestive enzyme in small intestine
responsible for release of glucose from complex
carbohydrates in the diet
Miglitol
Action
• Inhibit alpha glucosides
Thiazolidinediones
Action
Decreases insulin resistance
Side effects/adverse reactions
Headache, dizziness, blurred vision
Fluid retention, weight gain
Pulmonary and peripheral edema
Do not cause hypoglycemia
Contraindicated in Class III and IV heart
failure
Meglitinides
Action
Stimulate beta cells to release insulin
Short-acting
Side effects/adverse reactions
Hypoglycemia
Headache, back pain, diarrhea
Elevated hepatic enzymes
Contraindicated
Liver dysfunction
Incretin Modifiers
Action
Increase the level of incretin hormones
Increase insulin secretion
Decrease glucagon secretion to reduce glucose
production
Used
Adjunct treatment with exercise and diet to
reduce fasting and postprandial plasma glucose
levels
Guidelines for Oral Antidiabetic
Therapy for Type 2 Diabetes
Criteria for use of oral antidiabetic drugs:
Onset of diabetes mellitus at age 40 years or older
Diagnosis of diabetes for less than 5 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
Glucagon-Like Peptide Agonists
Action
Enhance insulin secretion
Increase beta-cell responsiveness
Suppress glucagon secretion
Slow gastric emptying
Reduce food intake
Common side effects/adverse effects
Headache, dizziness, jitteriness
GI distress
Amylin Analogues
Action
Suppress glucagon secretion
Slow gastric emptying
Modulate appetite by inducing satiety
Approved for type 1 and type 2 diabetes
Common side effects/adverse reactions
Dizziness, GI distress, fatigue
Nursing Process: Oral
Antidiabetics (1 of 2)
Concept
Glucose regulation
Assessment
Determine patient’s knowledge of diabetes mellitus
and use of oral antidiabetics.
Note vital signs and blood glucose levels.
Patient problems
Reduced glucose regulation, hyperglycemia
Planning
The patient’s blood glucose will be within normal
serum levels.
Nursing Process: Oral
Antidiabetics (2 of 2)
Nursing interventions
Administer oral antidiabetics with food to
minimize gastric upset.
Monitor blood glucose levels and report
changes.
Teach patient to recognize symptoms of
hypoglycemia and hyperglycemia.
Teach patient necessity of adherence to diet
and drug regimen.
Evaluation
Hyperglycemics: Glucagon
Glucagon
Hyperglycemic hormone secreted by the
alpha cells of the islets of Langerhans in the
pancreas
Action
Increase blood glucose by stimulating
glycogenolysis
Use
Insulin-induced hypoglycemia when other
methods are not available
Hyperglycemics: Diazoxide
Diazoxide
Action
Increase blood glucose by inhibiting insulin
release from the beta cells
Stimulate release of epinephrine from adrenal
medulla
Use
Hypoglycemia caused by hyperinsulinism
Not indicated for hypoglycemic reaction
Practice Question #1 (1 of 2)
Which time frame would be most appropriate
for administering sliding-scale lispro insulin?
A. Within 30 minutes of consuming breakfast
B. When the breakfast tray is served and ready to
eat
C. Within 1 hour of obtaining blood glucose
measurement
D. Within 15 minutes of obtaining blood glucose
measurement
Practice Question #1 (2 of 2)
Answer:
B. When the breakfast tray is served and ready to
eat
Practice Question #2 (1 of 2)
A patient is prescribed metformin. Which is a
side effect/adverse effect common to
metformin?
A. Seizures
B. Constipation
C. Bitter or metallic taste
D. Polyuria and polydipsia
Practice Question #2 (2 of 2)
Answer:
C. Bitter or metallic taste
Practice Question #3 (1 of 2)
A patient received regular insulin at 7:30 AM.
At 9:30 AM the patient feels slightly hungry
and has a dull headache. The nurse should
A. test the patient’s blood glucose level.
B. ensure that the patient has a meal.
C. provide the patient with 4 ounces of orange juice.
D. administer the next dose of insulin.
Practice Question #3 (2 of 2)
Answer:
A. test the patient’s blood glucose level.
Practice Question #4 (1 of 2)
A nurse gives a patient NPH insulin at 8:00
AM. At 2:00 PM the nurse finds the patient
extremely lethargic but conscious. The
patient is diaphoretic and slightly combative.
The nurse should
A. call the health care provider.
B. ensure that the patient has a meal.
C. provide the patient with 4 ounces of orange
juice.
D. administer the next dose of insulin.
Practice Question #4 (2 of 2)
Answer:
C. provide the patient with 4 ounces of orange juice.
Practice Question #5 (1 of 2)
Which statement by a patient taking glipizide
indicates that more teaching is indicated?
A. “I will use a new needle every time I take the
medication.”
B. “I will take the medication once a day in the
morning.”
C. “I will eat my breakfast very soon after taking my
Glucotrol.”
D. “This medication stimulates my pancreatic cells
to make insulin.”
Practice Question #5 (2 of 2)
Answer:
A. “I will use a new needle every time I take the
medication.”
Practice Question #6 (1 of 2)
When teaching the patient about the
storage of insulin, which statement will the
nurse include?
A. Keep the insulin in the freezer.
B. Warm the insulin in the microwave before
administration.
C. Do not place insulin in sunlight or a warm
environment.
D. Open insulin vials lose their strength after one
year.
Practice Question #6 (2 of 2)
Answer:
C. Do not place insulin in sunlight or a warm
environment.
Practice Question #7 (1 of 2)
The patient experiences the Somogyi effect.
Which statement regarding the Somogyi
effect does the nurse identify as being true?
A. This is a hyperglycemic condition.
B. The condition usually occurs immediately after
dinner.
C. It is a response to excessive insulin.
D. Management usually requires increase of the
bedtime insulin dose.
Practice Question #7 (2 of 2)
Answer:
C. It is a response to excessive insulin.
Practice Question #8 (1 of 2)
A patient with type 1 diabetes mellitus is
ordered insulin therapy once daily to be
administered at bedtime. What is the type
of insulin the patient is most likely
receiving?
A. Insulin glargine
B. Lente insulin
C. Lispro insulin
D. Regular insulin
Practice Question #8 (2 of 2)
Answer:
A. Insulin glargine
