Antidiabetics Overview Unit 9.1
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Questions and Answers

Which of the following are symptoms of hypoglycemia? (Select all that apply)

  • Headache (correct)
  • Fruity Breath Odor
  • Sweating (correct)
  • Confusion (correct)

    • Which of the following medications is a long-acting insulin?

  • NPH Insulin (Novolin N)
  • Insulin glargine (Lantus) (correct)
  • Insulin regular (Humulin R)
  • Insulin lispro (Humalog)

    • What is the action of Insulin?

  • Decreases blood sugar by stimulating the uptake of glucose into cells (correct)
  • Increases blood sugar by decreasing the production of glucose in the liver
  • Increases blood sugar by stimulating glycogenolysis in the liver
  • Decreases blood sugar by decreasing glucagon secretion

    • A client is scheduled for a procedure at 1300 PM and will be NPO at lunch. They have a client order for NPH and Lispro for 0800 AM. Which of the following is the correct action regarding administration of the 0800 insulin dose?

    <p>Hold the Lispro and give NPH</p> Signup and view all the answers

    What is the main action of Biguanides? For example, Metformin.

    <p>Decrease glucose absorption from the small intestine</p> Signup and view all the answers

    The use of SGLT2 inhibitors results in the excretion of excess sugar in the urine.

    <p>True</p> Signup and view all the answers

    Glucagon is a hormone that increases blood sugar by stimulating glycogenolysis in the liver.

    <p>True</p> Signup and view all the answers

    A ______ is a device that continuously monitors blood glucose levels.

    <p>Continuous Glucose Monitor (CGM)</p> Signup and view all the answers

    What are the most common adverse effects of Semaglutide?

    <p>Nausea, vomiting, diarrhea, constipation, heartburn, belching, injection site itching, redness, early satiety</p> Signup and view all the answers

    What are the major symptoms of diabetes mellitus?

    <p>Polyuria, polydipsia, polyphagia, and fatigue</p> Signup and view all the answers

    Which of the following are types of diabetes mellitus? (Select all that apply)

    <p>Type 2</p> Signup and view all the answers

    What is HbA1c?

    <p>HbA1c is a blood test that measures the average blood sugar level over the past 2-3 months.</p> Signup and view all the answers

    What is the normal HbA1c level?

    <p>Below 5%</p> Signup and view all the answers

    Which of the following is NOT a side effect of insulin?

    <p>Hyperglycemia</p> Signup and view all the answers

    Insulin shock is a hyperglycemic reaction.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a symptom of insulin shock?

    <p>Fruity breath odor</p> Signup and view all the answers

    What is the duration of action for rapid-acting insulin lispro (Humalog)?

    <p>3 to 5 hours</p> Signup and view all the answers

    What is the onset of action for intermediate-acting NPH insulin?

    <p>1 to 2 hours</p> Signup and view all the answers

    What is the duration of action for long-acting insulin glargine?

    <p>24 hours</p> Signup and view all the answers

    Which type of insulin is always administered at bedtime?

    <p>Long-acting</p> Signup and view all the answers

    Insulin types can be mixed together.

    <p>True</p> Signup and view all the answers

    What is the correct action regarding administration of NPH and lispro insulin when a client is scheduled for a procedure at 1300 PM and will be NPO at lunch?

    <p>Hold NPH and give lispro</p> Signup and view all the answers

    Continuous glucose monitors (CGMs) are no longer considered a viable treatment option for people with diabetes.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a method of insulin delivery?

    <p>Insulin patch</p> Signup and view all the answers

    Insulin should be shaken before administering.

    <p>False</p> Signup and view all the answers

    Where should insulin be stored?

    <p>In the refrigerator</p> Signup and view all the answers

    Open insulin can be stored at room temperature for 30 days.

    <p>True</p> Signup and view all the answers

    What is the correct action regarding administration of Metformin when the client is scheduled for a CT scan at noon and had a dose this morning?

    <p>Notify the MD to re-schedule the procedure</p> Signup and view all the answers

    What is the mechanism of action of SGLT2 inhibitors?

    <p>They prevent the kidneys from reabsorbing sugar</p> Signup and view all the answers

    Which of the following is NOT a side effect of SGLT2 inhibitors?

    <p>Increased risk of cardiovascular disease</p> Signup and view all the answers

    Which of the following is a GLP-1 agonist medication? (Select all that apply)

    <p>Victoza</p> Signup and view all the answers

    GLP-1 agonists can be administered either via injection or orally.

    <p>True</p> Signup and view all the answers

    What is the primary action of GLP-1 agonists?

    <p>Increase insulin secretion from the pancreas</p> Signup and view all the answers

    Which of the following is NOT a common side effect of GLP-1 agonists?

    <p>Hypoglycemia</p> Signup and view all the answers

    Glucagon is used to treat hyperglycemia.

    <p>False</p> Signup and view all the answers

    Glucagon is administered intravenously (IV).

    <p>False</p> Signup and view all the answers

    What is lipodystrophy?

    <p>Lipodystrophy is a condition that affects fat distribution in the body, caused by repeated insulin injections in the same area, resulting in either a loss of subcutaneous fat (lipoatrophy) or an accumulation of excess fat (lipohypertrophy).</p> Signup and view all the answers

    What are the guidelines for oral antidiabetic therapy for type 2 diabetes?

    <p>Onset of diabetes at age 40 years or older, diagnosis 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, and normal renal and hepatic function</p> Signup and view all the answers

    What is the primary action of sulfonylureas like glipizide?

    <p>Increase insulin production by the pancreas</p> Signup and view all the answers

    Which of the following is NOT a side effect of sulfonylureas?

    <p>Weight loss</p> Signup and view all the answers

    What is the primary action of biguanides like metformin?

    <p>Decrease hepatic production of glucose</p> Signup and view all the answers

    Metformin is contraindicated in patients with liver dysfunction.

    <p>True</p> Signup and view all the answers

    What is the main mechanism of action of GLP-1 agonists like semaglutide?

    <p>All of the above</p> Signup and view all the answers

    GLP-1 agonists have a long half-life, so they only need to be administered once a week.

    <p>True</p> Signup and view all the answers

    GLP-1 agonists are associated with a lower risk of hypoglycemia compared to other antidiabetic medications.

    <p>True</p> Signup and view all the answers

    Study Notes

    Antidiabetics

    • Diabetes Mellitus is a chronic disease of deficient glucose metabolism
    • Insufficient insulin secretion from pancreatic beta cells is a cause
    • Impaired insulin use is a cause
    • Major symptoms include polyuria, polydipsia, and polyphagia
    • Type 1 diabetes is insulin-dependent
    • Type 2 diabetes is insulin-resistant; body tissues do not respond to insulin
    • Insulin receptors may be unresponsive or deficient in number
    • Secondary diabetes can be caused by medications (glucocorticoids, thiazides, diuretics, epinephrine)
    • Gestational diabetes is caused by hormonal changes during pregnancy
    • Hemoglobin A1c (HbA1c) is a derivative of glucose interaction with red blood cells (RBCs)
    • RBCs have a lifespan of ~120 days; HbA1c reflects average blood glucose over 3 months
    • Treatment goal for diabetes is to keep HbA1c below 7%
    • 5% HbA1c = no diabetes
    • 5.7% - 6.4% HbA1c = prediabetes
    • 6.5% or greater HbA1c = diabetes mellitus
    • Insulin action promotes glucose, amino acid, and fatty acid uptake & storage; reduces blood sugar levels
    • Hypoglycemia (low blood sugar) symptoms: headache, dizziness, confusion, slurred speech, hunger, weakness, nervousness, anxiety, agitation, tremors, sweating, flushing, lethargy; redness, irritation, or swelling at injection sites, tachycardia, palpitations, and hypoglycemic reaction, shock, anaphylaxis, ketoacidosis
    • Interactions: decreased glucose with aspirin, oral anticoagulants, alcohol, other hypoglycemics, beta blockers; increased glucose with thiazides, glucocorticoids, oral contraceptives, thyroid drugs, smoking
    • Contraindications: hypoglycemia and allergy

    Insulin Types

    • Rapid-acting insulin (e.g., Humalog): onset (15-30 min), peak (30-90 min), duration (3-5 hrs)
    • Short-acting insulin (e.g., Regular): onset (30 min), peak (1.5-3.5 hrs), duration (4-12 hrs)
    • Intermediate-acting insulin (e.g., NPH): onset (1-2 hrs), peak (4-12 hrs), duration (14-24 hrs)
    • Long-acting insulin (e.g., glargine): onset (1-1.5 hrs), duration (24 hrs); administered at bedtime

    Insulin Shock vs. Diabetic Ketoacidosis

    • Insulin Shock (Hypoglycemic Reaction): headache, lightheadedness, nervousness, apprehension, tremors, excess perspiration (cold, clammy skin), tachycardia, slurred speech, memory lapse, confusion, seizures; blood glucose <60 mg/dL
    • Diabetic Ketoacidosis (Hyperglycemic Reaction): extreme thirst, polyuria, fruity breath odor, Kussmaul breathing (deep, rapid, labored, distressed, dyspneic), rapid, thready pulse, dry mucous membranes, poor skin turgor; blood glucose >250 mg/dL

    Insulin Types - Combinations

    • Composed of short/intermediate acting or rapid/intermediate acting insulins
    • Examples include Humulin or Novolin 70/30 (NPH 70%, regular 30%) and NPH 50%/regular 50%
    • Can be mixed in other strengths
    • Have two onsets, two peaks, and two durations

    Knowledge Check

    • Client order for NPH and Lispro at 0800 AM, procedure at 1300 PM, NPO at lunch: Hold Lispro and give NPH.
    • Metformin ordered daily, CT scan at noon: Hold Metformin 48 hours before and after the procedure

    Continuous Glucose Monitor (CGMs)

    • Continuously monitor blood glucose (blood sugar)
    • Provides real-time updates
    • Device attached to the body
    • Became popular and more accurate over the years
    • Viable treatment option for people with diabetes

    Insulin Delivery Devices

    • Insulin syringe
    • Insulin pen
    • Jet injector
    • Insulin pump (with wireless pump and infusion set)

    Insulin Administration and Storage

    • Insulin is given Subcutaneous (SQ), absorbing fastest in the abdomen.
    • Use only insulin syringes (U-100)
    • Do not shake insulin; roll it gently.
    • Do not apply heat or massage injection site.
    • Keep unopened insulin refrigerated.
    • Remove from refrigerator 30 minutes before use.
    • Open insulin can be stored at room temperature for 30 days or in the refrigerator for 3 months
    • Avoid direct sunlight and high temperatures

    Sliding-Scale Insulin

    • Doses adjusted based on individual blood glucose
    • Typically administered before meals and at bedtime
    • Usually rapid or short-acting insulin
    • Example dosage adjustments based on glucose levels provided

    Insulin Orders (Morning and Evening Doses)

    • Insulin dosages are provided based on blood glucose levels

    Nursing Process for Insulin

    • Assessment: medication/medical history, insulin type/dosage, vital signs, blood glucose, HbA1c, signs/symptoms of hypo/hyperglycemia
    • Nursing interventions/Teaching: Monitor vital signs and glucose, instruct client on hypo/hyperglycemia reporting, teach how to manage hypoglycemic events, encourage compliance with diet, lifestyle, exercise, advise client to wear medical alert tag, teach client on glucose checking, insulin administration and rotation of sites to prevent lipodystrophy

    Lipodystrophy

    • A condition where there is a loss or abnormal growth of subcutaneous fatty tissue. Can occur where insulin is repeatedly injected.
    • Lipoatrophy (loss of subcutaneous fat)
    • Lipohypertrophy (overgrowth of subcutaneous fat)

    Guidelines for Oral Antidiabetic Therapy for Type 2 Diabetes

    • Age of onset of diabetes for oral therapy, diagnosis, weight, fasting blood glucose, units of insulin per day, renal and hepatic function

    Oral Antidiabetic Drugs

    • Sulfonylureas (Glipizide): used to treat type 2 diabetes, increases insulin production, potential side effects, interactions (alcohol, beta blockers, green tea), contraindications.
    • Biguanides (Metformin): used to treat type 2 diabetes, reduces glucose production and improves insulin use effectiveness, side effects, interactions (alcohol, IV contrast dye, green tea).
    • SGLT2 Inhibitors (Gliflozins): lowers blood sugar, increases urine output, preventing the kidneys from reabsorbing glucose, potentially reduces cardiovascular risk. Adverse effects, contraindications(pregnancy, renal issues).
    • Glucagon-Like Peptide Agonists (GLP-1 Agonists): incretin mimetics; regulate blood sugar in type 2 diabetes, suppress appetite and reduce glucagon effects, slows down gastric emptying; examples of drugs in this category provided. Adverse effects, contraindications, and interactions provided.

    Hyperglycemic Agents (Glucagon)

    • Secreted by alpha cells in the islets of Langerhans
    • Used to treat insulin induced hypoglycemia
    • Parenteral route of administration (subQ, IM, IV)
    • Acts in ~10 minutes
    • Raises blood sugar by triggering glycogenolysis

    GLP-1 Agonist Nursing Implications

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    Unit 9.1 Antidiabetics PDF

    Description

    This quiz provides an overview of antidiabetic agents and their role in managing diabetes mellitus. It covers the causes, symptoms, and treatment goals related to diabetes, including the significance of Hemoglobin A1c in monitoring blood glucose levels. Test your understanding of diabetes management concepts and medication implications.

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