Insulin administration and diabetes management

Drugs for Pituitary Disorders

• Drugs used to treat pituitary disorders

Growth Hormones

• Growth hormones treat deficiency of growth hormones
• Examples of growth hormones: mecasermin and somatropin
• Side effects that can occur with growth hormones: headache, vomiting, fatigue, and muscle pain

Growth Hormone Receptor Antagonist

• Growth hormone receptor antagonist treats acromegaly
• Examples of growth hormone receptor antagonist: Pegvisomant and Octreotide
• Side effects: diarrhea, nausea, and blurred vision

Antidiuretic Hormones

• Antidiuretic hormones treat diabetes insipidus
• Examples of antidiuretic hormones: Vasopressin and Desmopressin acetate
• Side effects: water intoxication and hypertension
• Intervention: monitor weight, intake, and output

Drugs for Thyroid Disorders

• Drugs used to treat thyroid disorders

Hypothyroidism

• Drugs used to treat hypothyroidism: Levothyroxine
• Side effects: signs of hyperthyroidism
• Interventions: Monitor T3, T4, and TSH levels, administer drug in the morning 30-60 minutes before meals, and monitor pulse rate

Hyperthyroidism

• Drugs used to treat hyperthyroidism: Propylthiouracil (PTU), Methimazole, Potassium iodide, Iodine solution, and Iodine 131
• Side effects: signs of hypothyroidism
• Interventions: Monitor T3, T4 & TSH levels, monitor weight, and take with meals

Foods that Block Thyroid Gland Function

• Cruciferous vegetables, Cauliflower, Cabbage, Turnips, Strawberries, Peaches, Spinach, Kale, Brussels sprouts, Radish, and Peas block thyroid gland function

PTU

• Propythiouracil causes agranulocytosis
• Monitor for fever and sore throat
• Check the CBC with differential for neutropenia

Parathyroid Drugs

• Drugs used to treat parathyroid disorders

Vitamin D Supplements

• Ergocalciferol (Vit. D₂) and Cholecalciferol (Vit. D3) are Vitamin D Supplements
• Hypervitaminosis D is a side effect of Vitamin D Supplements

Biphosphonates and Calcium Regulating Drugs

• Alendronate, Calcitonin salmon, Zoledronate, Risedronate sodium, Ibandronate, and Etidronate disodium are Biphosphonates and Calcium Regulating Drugs
• Stomach pain, Constipation, Diarrhea, Flatulence, and nausea are side effect of Biphosphonates and Calcium Regulating Drugs

Oral Calcium Supplements

• Calcium carbonate (Tums) and Calcium acetate are Oral Calcium Supplements
• Gastric upset is a side effect of Oral Calcium Supplements

Hyperparathyroidism and Hypercalcemia Drugs

• Drugs used to treat hyperparathyroidism and hypercalcemia
• Gallium nitrate, Cinacalcet hydrochloride, Paricalcitol, and Doxercalciferol are drugs to treat hyperparathyroidism and hypercalcemia
• Side effects: nausea, vomiting, and diarrhea
• Interventions: avoid foods rich in Calcium

Hyperparathyroidism and Hypercalcemia

• Vitamin D enhances absorption of calcium in the gastrointestinal tract
• Calcitonin decreases serum calcium and inhibits bone breakdown (resorption)

Mineralocorticoids

• Type of steroid hormone

Fludocortisone Acetate

• Fludocortisone acetate replaces hormones in Addison's disease
• Side effects of Fludocortisone include signs of Cushing's syndrome and gastrointestinal bleeding
• Interventions include taking drugs with food or milk and consuming a high potassium diet

Glucocorticoids

• Type of steroid hormone
• Glucocorticoids fight inflammation, treat allergies, and help cope with stress
• Examples of Glucocorticoids: Dexamethasone, Prednisone, and Hydrocortisone
• Side effects can include: Cushing's syndrome, Hypernatremia, Hypokalemia, Hyperglycemia, Osteoporosis, Weight gain, Mood swings, Cataracts, and Acne
• Interventions include: Monitor blood sugar, High potassium diet, Monitor for gastrointestinal bleeding and administer the drug take in the morning

Androgens

• A type of sex hormone like testosterone

Methyltesterone

• Methyltesterone replaces androgen hormones, and treats certain types of breast cancers
• Risk for prostate cancer is a side effect of Methyltesterone
• Additional side effects: Masculinization, Priapism, and Acne
• Interventions include monitoring for menstrual irregularities and changes in libido, and taken with food or snacks

Steroid Drugs

• Steroid drugs should not be stopped abruptly to allow the adrenal gland to produce its own steroids after prolonged use
• Steriod dose must be tapered to prevent a fatal adrenal crisis

Drugs for Diabetes Mellitus

• Drugs used to treat Diabetes Mellitus

Rapid Acting Insulin

• Rapid acting insulin is clear
• Other names include: Insulin asparat (Novolog), Insulin glulisine (Apidra), and Insulin lispro (Humalog)
• Onset -> 15 minutes
• Peak -> 30 - 90 minutes
• Duration -> 3-5 hours
• Implications: Given immediately before meals and SQ or IV and can be mixed with NPH insulin

Short Acting Insulin

• Short acting insulin is clear
• Other names include: Insulin regular (Humulin R, Novolin R)
• Onset -> 30-60 minutes
• Peak -> 2-4 hours
• Duration -> 5-8 hours
• Implications: Given 30 minutes before meals and via SQ or IV and can be mixed with NPH insulin

Intermediate Acting Insulin

• Intermediate acting insulin is cloudy
• Other names include: Insulin NPH human (Humulin N, Novolin N)
• Onset -> 1-3 hours
• Peak -> 8 hours
• Duration -> 12-16 hours
• Implications: Lowers blood glucose elevations when RA insulins stop working, given SQ and can be mixed with RA or SA insulin

Long Acting Insulin

• Long acting insulin is clear
• Other names include: Insulin glargine (Lantus, Toujeo) and Insulin detemir (Levemir)
• Onset -> 1 hour
• Peak: Lantus: No Peak, Levemir: 6-8 hours
• Duration -> 20-24 hours
• Implications: Lowers blood glucose elevations when RA insulin stops working, given SQ, usually taken once a day and may be mixed with RA or SA insulin

Mixed Insulin

• Mixed insulin is cloudy
• Other names include: Humulin 70/30, Novolin 70/30, Relion 70/30
• Onset -> 30 mins
• Peak -> 2-12 hours
• Duration -> 24 hours
• Implications: Usually taken once daily, Given SQ, do not mix with other insulins

Insulin Administration Tips

• Always know the peak times of insulin medications to avoid hypoglycemia or insulin reactions

FAQs for Insulin Injections

• Insulin is destroyed by gastric secretions, so it must be injected, not taken orally
• Preferred injection sites: abdomen, posterior arm, anterior thigh, and hips
• Injection sites should be rotated to prevent lipodystrophy and erratic absorption

Needle Gauge And Preparation

• An appropriate needle gauge ranges between 27-29 gauge and 1/2 inch in length is needed for insulin injections
• The insulin vial should be rolled between the palms before preparation to properly dissolve the insulin solution
• An insulin vial should not be shaken, bubbles will expand insulin volume
• Insulin should be drawn from clear vial first then the cloudy to maintain the purity and clarity of the clear solution

Insulin Compatibility and Administration

• Glargine (Lantus) and Insulin detemir (Levemir) are not compatible for mixing with other types of insulin
• During injection, give insulin subcutaneously at a 45-90 degree angle, or 45 - 60 degrees in thin clients
• Aspiration is not needed when injecting insulin
• Rapid acting insulin and Short acting insulin can be given IV

Complications: Dawn Phenomenon

• In the Dawn Phenomenon, hyperglycemia occurs between 2:00 and 8:00 AM due to the decreased effect of a bedtime insulin dose
• To counter it, increase the nightly insulin dose

Complications: Somogyi Phenomenon

• In the Somogyi Phenomenon, there is a rebound hyperglycemia in response to low blood glucose at night
• Decreasing the insulin dose or providing snacks at bedtime can prevent it

Hypoglycemia Tips

• Check blood sugar level between 2:00 and 3:00 AM to check for Hypoglycemia
• If hypoglycemia is consistently present, one should suspect Somogyi phenomenon
• If blood glucose level is usually high or normal, one should suspect Dawn Phenomenon

Oral Hypoglycemic Agents

• Oral hypoglycemic agents stimulate insulin secretion and increase sensitivity

• Sulfonylureas (Stimulator): Stimulates pancreatic insulin secretion, examples include Glipizide, Chlorpropamide, Glimepiride, Glyburide, and Tolbutamide

• Meglitinides (Stimulator): Stimulates pancreatic insulin secretion, examples include Nateglinide and Repaglinide

• Biguanides (Sensitizer): Increases insulin sensitivity, example includes Metformin

• Alpha Glucosidase Inhibitors: Blocks the metabolism of carbohydrates, examples include Acarbose and Miglitol

• Thiazolidinediones (Sensitizer): Increases insulin sensitivity and decreases glucose production by the liver, examples include Pioglitazone and Rosiglitazone

Amylinomimetic

• Amylinomimetic reduces glucagon secretion after meals
• Example: Prmlintide
• Side effects: Anorexia, weight loss, and hypoglycemia
• Interventions: Avoid drinking alcohol

DPP-4 Inhibitors

• DPP-4 Inhibitors reduce glucagon and have a risk for pancreatitis
• Examples: Oogliptin, Saxagliptin, Sitagliptin, and Linagliptin
• Side effects: headache, runny nose, and chills
• Interventions: Report severe abdominal pain (pancreatitis)

Glucagon-Like Peptides (GLP-1 Receptor Agonists)

• Glucagon-Like Peptides increase insulin and decrease glucagon and must be administered via injection (subcutaneous)
• These are Incretins, hormones that stimulate insulin secretion after eating, before blood glucose becomes elevated
• Examples: Albiglutide, Exenatide, Liraglutide, and Dulaglutide
• Side Effects: Nausea and vomiting, Diarrhea, and Dizziness
• Interventions: Report severe abdominal pain (pancreatitis)

Sodium Glucose Transporter 2 (SGLT2) Inhibitors

• Sodium Glucose Transporter 2 (SGLT2) Inhibitors prevent the kidney from retaining glucose
• Examples: Dapagliflozin (Farxiga), Empagliflozin, and Canagliflozin
• Side Effects: Hypotension, Dehydration, Glycosuria, and Weight Loss
• Interventions: Monitor for dehydration

Inhaled Insulin

• Is an Ultra-rapid acting insulin (faster than rapid acting insulins)
• Example is Afrezza
• Side effects: Hypoglycemia, cough, and sore throat
• Should be avoided in clients with asthma and COPD

This quiz covers insulin administration techniques, mixing insulins, and potential side effects, client education for various diabetes medications like Pramlintide and DPP-4 inhibitors, intravenous administration of insulin and monitoring for side effects.