Diabetes+Grids.docx

MED GRID: INSULIN (Completed) INDICATION Treat elevated blood glucose ACTION Replace insulin 3 COMMON EXAMPLES Lispro (Humalog) Rapid-acting O: 10-30 min, P: 30-90 min, D: 3-5 hours Regular (Humulin R) Short-acting O: 30-60 min, P: 1.5-3.5 hours, D: 5-7 hours Isophane NPH (Humulin N) Interm...

MED GRID: INSULIN (Completed) INDICATION Treat elevated blood glucose ACTION Replace insulin 3 COMMON EXAMPLES Lispro (Humalog) Rapid-acting O: 10-30 min, P: 30-90 min, D: 3-5 hours Regular (Humulin R) Short-acting O: 30-60 min, P: 1.5-3.5 hours, D: 5-7 hours Isophane NPH (Humulin N) Intermediate-acting O: 1.5 Hours, P: 4-12 Hours, D: 24 Hours Glargine (Lantis) Long acting O: 1.5 Hours, D: 24 Hours SIDE EFFECTS Hypoglycemia Weight gain Lipohypertrophy INTERVENTIONS Check BS before and sometimes after administration Review drugs that can cause increase or decrease in BS when giving meds Double-check type of insulin and dose with another nurse TEACHING Know signs of hypoglycemia and hyperglycemia Know when peak occurs for each type. Medic alert card, tag, or bracelet for diabetic patients MISCELLANEOUS Mixing – regular and NPH; mix clear (regular) to cloudy (NPH) Storage: 1mo at room temperature, 3mo in the fridge. Teach use of orange juice/candy for conscious patients that can tolerate it, glucagon (SQ, IM, or IV) for those that are unconscious. ANTIDIABETICS GRID Sulfonyureas e.g. glipizide (Glucotrol) Acts by stimulating pancreas to produce more insulin. SE: Hypoglycemia, Hyponatremia, Blurred Vision, Nausea, Diarrhea, Weight Gain, Tremors, Nervousness, Confusion Blood cell changes can occur (Decrease in WBC, RBC & Platelets): MONITOR Meglitinides e.g. repaglinide (Prandin) Acts by stimulating pancreas to produce more insulin (brief burst 30-60 min of taking). SE: Hypoglycemia, Weight Gain, Headache, Back Pain, Elevated Liver Enzymes CONTRAINDICATED: In patients with liver dysfunction. Dipeptidyl Peptidase 4 Inhibitors e.g. sitagliptin (Januvia) Acts by allowing incretins to be present and allow insulin to control BG levels. SE: Nasopharyngitis (cold-like symptoms), Diarrhea AR: Hypoglycemia, Allergic Reaction, Pancreatitis, Severe joint pain Biguanides e.g. metformin (Glucophage) Acts by Sensitizing: increased receptor sensitivity & uptake at cellular level. SE: GI Upset, Metallic Taste AR: Lactic Acidosis (especially in patients with Heart Failure/Renal Failure) Thiazolidinediones e.g. pioglitazone (Actos) Acts by decreasing insulin resistance SE: Fluid Retention, Weight Gain, Blurred Vision, Headache, Dizziness, Pulmonary Edema, Peripheral Edema CONTRAINDICATED: In patients with HF. Alpha-Glucosidase Inhibitors e.g. acarbose (Precose) Acts by delaying breakdown of carbohydrates SE: GI Upset (Diarrhea, Bloating, Flatulence) Give at beginning of the meal to help slow the breakdown of carbs consumed. Selective Sodium-Glucose Transporter 2 e.g. dapagliflozin (Farixga) Acts by increasing excretion of glucose in urine SE: Urinary Frequency, Thirst, Weight Loss AR: Hypoglycemia, Vaginal Infections, UTI, Renal Failure, Risk of Bladder Cancer, Hypotension, , Dehydration. Amylin Anologues (SQ) e.g. pramlintide (Symin) *USED FOR DM TYPE 1&2* Acts by delaying gastric emptying, blunts glucose secretion. SE: GI Upset, Fatigue, Diziness AR: Hypoglycemia, Pancreatitis Glucagon-Like Peptide 1 Agonists (SQ) e.g. exenatide (Byetta), semaglutide (Ozempic) Acts by delaying gastric emptying, blunts glucose secretion, increases insulin. SE: GI Upset, Headache, Diziness