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Diabetes Medications

QuestionAnswer
What causes Type 1 Diabetes (T1DM)? Autoimmune destruction of pancreatic beta cells → no insulin production.
What causes Type 2 Diabetes (T2DM)? A: Insulin resistance → glucose can’t enter cells effectively.
What is the most common side effect of insulin? Hypoglycemia.
Rapid-acting Example Onset Peak Duration Lispro, Aspart ~15 min 1–3 hr 3–5 hr
Short-acting Example Onset Peak Duration Regular ~30 min 2.5 hr 6–10 hr
Intermediate Example Onset Peak Duration NPH ~60 min 4–12 hr 10–18 hr
Long-acting Example Onset Peak Duration Glargine, Detemir ~60 min None 24 hr
What blood glucose level defines hypoglycemia? < 70 mg/dL (4 mmol/L).
What are symptoms of hypoglycemia? Confusion, tremor, irritability, diaphoresis, tachycardia, seizures, coma, death. Mnemonic: “Cold and clammy? Need some candy.”
Which medications can mask hypoglycemia? Beta-blockers (metoprolol, propranolol).
What is the dawn phenomenon? Morning hyperglycemia due to natural early rise in GH and cortisol. Treatment: Increase evening insulin or adjust timing.
What is the Somogyi effect? Rebound hyperglycemia after nighttime hypoglycemia. Check: 2–4 AM blood glucose (low = Somogyi). Treatment: Lower evening insulin or add bedtime snack.
Can insulin glargine be mixed with other insulins? No — always given separately.
What is the rule for mixing regular/rapid with NPH insulin? Draw up clear before cloudy (Regular before NPH — “RN”).
When should patients eat after insulin? Rapid-acting → within 15 min; Short-acting → within 30 min.
How should insulin be stored? Unopened vials in refrigerator; opened at room temp ≤ 1 month; avoid heat/freezing.
When should regular insulin be given IV? For rapid control (e.g., DKA).
Sulfonylurea medications? Glipizide, Glyburide, Glimepiride
Glipizide, Glyburide, Glimepiride Mechanism of Action Major Side Effects Nursing Considerations MOA: Stimulate insulin release from pancreas. SE: Hypoglycemia, weight gain. Considerations: Give 30 min before meals. Hold if NPO. Avoid alcohol → disulfiram-like reaction (nausea, vomiting, flushing).
Biguanide medications? Metformin
Metformin Mechanism of Action Benefits Key Side Effects Precautions with contrast dye MOA: ↓ hepatic glucose production; does not increase insulin secretion. Benefits: First-line for T2DM; low risk of hypoglycemia. SE: GI upset, lactic acidosis (rare but serious). Precautions: Hold 48 hr before and after to prevent lactic acidosis.
Incretin Mimetic medications? GLP-1 agonists: dulaglutide, semaglutide; DPP-4 inhibitors: sitagliptin, saxagliptin.
GLP1 & DPP-4 Mechanism of Action Side Effects MOA: ↓ glucagon secretion, slow gastric emptying, promote weight loss, ↓ CV risk. SE: Pancreatitis — report severe abdominal pain.
Alpha-Glucosidase Inhibitor medication? Acarbose
Acarbose Mechanism of Action Administration Side Effects MOA: Delays carbohydrate absorption in intestines → prevents post-meal glucose spikes. Admin: Take with the first bite of a meal. SE: GI upset — flatulence, cramping, diarrhea.
SGLT-2 Inhibitor medications? Dapagliflozin, Empagliflozin
Dapagliflozin, Empagliflozin Mechanism of Action Side Effects Edication MOA: Block glucose reabsorption in kidneys → ↑ glucose excretion in urine. SE: Genital/urinary infections Dehydration, hypotension Diuretic effect → frequent urination Education: s/s of infection & dehydration
Thiazolidinedione medications? Pioglitazone, Rosiglitazone
Pioglitazone, Rosiglitazone Mechanism of Action Side Effects Consideration MOA: ↑ insulin receptor sensitivity → ↓ insulin resistance. SE: Fluid retention, weight gain, heart failure. Considerations: Monitor for HF (rapid weight gain, dyspnea, edema).
When mixing regular and NPH insulins, draw up ___ before ___? Clear before cloudy.
Metformin should be held ___ hours before/after ___? 48 hours before/after contrast dye.
Incretins increase risk for ___? Pancreatitis — report severe abdominal pain.
SGLT-2 inhibitors increase risk for ___, ___, and ___? Urinary tract infection, genital infection, dehydration.
Created by: zarina.brewer
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