Insulin: DM 1, DM 2, Gestational Diabetes HYPOGLYCEMIA IS A DANGEROUS ADVERSE EFFECT AND HIGH PRIORITY FOR TREATMENT 1. What types of insulin are ordered before meals and at bedtime? Lispro and Regular are not ordered before bedtime; Lispro and Regular are usually given before meals; Lantus is given before bedtime; In the elderly especially, lantus is sometimes split into a morning and evening dose. Why? SUGAR DROPS OVERNIGHT and this can be DANGEROUS so NO NPH at bedtime; NPH is often given only in the morning. 2. What type of insulin is sometimes given at bedtime, has the longest duration of all the insulins, CANNOT BE MIXED WITH OTHER INSULINS, and for elderly patients is often split into two doses (one in the morning and one at bedtime)? Insulin Glargine (Lantus) is usually given once a day at bedtime. Elderly individuals often have their dose split in two and are administered one dose in the morning and one dose at night; In addition, sometimes insulin lispro is given in a sliding scale with a snack in the evening. It doesn’t last throughout the night-that’s what we want to avoid. *Insulin aspart protamine in combo with insulin aspart would NOT be given in the evening, as it lasts too long. *NPH would peak at exactly the WRONG TIME. Do not give that one at bedtime. Why is a nurse concerned for a beta-blocker/insulin combination? Beta Blockers can mask some of the symptoms of hypoglycemia What do you assessfor? What symptoms could be concealed by taking a beta blocker while on insulin? • Symptoms of hypoglycemia: • Feeling shaky. • Being nervous or anxious. • Sweating, chills and clamminess. • Irritability or impatience. • Confusion. • Fast heartbeat. • Feeling lightheaded or dizzy. • Hunger. You will need to know the following chart:  Peak: Usually when the medicine is at its highest level, and you get the highest effect (in this case it equates to the times when you see the lowest blood sugars). Duration: How long the medication is going to last in effectiveness (how long is it going to affect blood sugars). MOST ORAL ANTI-DIABETICS (ORAL HYPOGLYCEMICS): Type 2 Diabetes, Most do not work for type 1 diabetes, Don’t risk it with babies we use regular insulin for gestational diabetes. Glipizide (Glucotrol): o How does it work? is in a class of medications called sulfonylureas. Glipizide lowers blood sugar by causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the body) and helping the body use insulin efficiently. o What diagnosis is it effective for (be specific)? Type 2, lessthan 5 years, no end organ damage, young enough o What classification(s) doesit fit into? Oral hypoglycemic, Anti-diabetic, o What are the side/adverse effects? Hypoglycemia, diarrhea.constipation, nausea, vomiting, upset stomach, loss of appetite. Headache, weight gain, o What are contraindications? o low blood sugar. o pituitary hormone deficiency. o a condition where the adrenal glands produce less hormones called Addison's disease. o glucose-6-phosphate dehydrogenase (G6PD) deficiency. o hepatic porphyria. o a type of blood disorder where the red blood cells burst called hemolytic anemia. o alcoholism. o o Are there drug-drug interactions? o Do not take if allergic to sulfa o Are there drug-alcohol interactions? Do not take with alcohol o Are there drug-food interactions? Take with breakfast o Please note that this person will still need to be checking their BS at least once a day lOMoARcPSD|12263423 Downloaded by Anna Maina (annamurugijoe@gmail.com) Metformin o How does it work? works by reducing the amount of sugar your liver releases into your blood. It also makes your body respond better to insulin. o What diagnosis is it effective for (be specific)? Type 2, lessthan 5 years, no end organ damage, young enough o What classification(s) doesit fit into? Oral hypoglycemic, Anti-diabetic o What are the side/adverse effects? Can be harsh on end organs, esp. kidneys, . It's best to take metformin with a meal to reduce the side effects. IF SOMEONE IS GOING TO HAVE CONTRAST FOR A CT: THE METFORMIN IS STOPPED PRIOR TO HAVING THE CONTRAST. If they are taking metformin, and they come into an ER and a CT with contrast is ordered, do not blindly send the patient to CT, LET THE PROVIDER KNOW AND THEY WILL ORDER IT WITHOUT CONTRAST. Since it is so hard on the kidneys, drink plenty of water. o What are contraindications? Kidney disease, heart attack;stroke; diabetic ketoacidosis(blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease Acarbose: o How does it work? What diagnosis is it effective for (be specific)? by slowing the action of certain chemicals that break down food to release glucose (sugar) into your blood. Slowing food digestion helps keep blood glucose from rising very high after meals o What classification(s) doesit fit into? alpha-glucosidase inhibitors, which also includes miglitol (Glyset); anti-diabetic, oral hypoglycemic agent o What are the side/adverse effects? Diarrhea o What are contraindications? hypersensitivity, diabetic ketoacidosis, liver cirrhosis, inflammatory bowel disease, or colonic ulceration o Are there drug-drug interactions? Avoid taking a digestive enzyme such as pancreatin, amylase, or lipase at the same time you take acarbose. o Are there drug-alcohol interactions? Do not mix, it may cause sudden hypoglycemia o Are there drug-food interactions? No grapefruit juice D50W Emergency Med Given IV o How does it work? What diagnosis is it effective for (be specific)? Direct Sugar for Body o What classification(s) doesit fit into? Hyperglycemic agent o What are the side/adverse effects? Hyperglycemia Glucagon Emergency Med Given IM or SUBQ o How does it work? What diagnosis is it effective for (be specific)? Glucagon's role in the body is to prevent blood glucose levels dropping too low. To do this, it acts on the liver in several ways: It stimulates the conversion of stored glycogen (stored in the liver) to glucose, which can be released into the bloodstream. This process is called glycogen