Diabetes

Treatment
♦ Diet is as important as medication for disease management; carbohydrates do not need to be eliminated from the
diet.
♦ Prevent hyperglycemia and complications of disease.
♦ NIDDM may be diet controlled while IDDM always require extra insulin.
♦ All diabetic patients require teaching regarding care of feet, skin and teeth.

Drug Therapy for Diabetes
♦ Injection of Insulin is required for IDDM and for those whose blood sugars cannot be controlled by diet, weight
reduction, or oral hypogylcemics.
♦ Insulin dosages are regulated by blood glucose levels checked before every meal and at bedtimes.
♦ Oral hypogylcemics are used for NIDDM not controlled by diet alone.


Drug Class: Insulins

Actions
♦ Performs the functions of naturally-occurring insulin when the pancreas fails to produce it
♦ Beef and pork insulins are commonly used preparations
♦ Biosynthetic insulins are now available; fewer allergic reactions

Three factors are important when using insulin: onset, peak and duration

Four types of insulin are available, based on these factors:
1. Rapid acting 3. Intermediate acting (NPH insulin)
2. Short acting (regular insulin) 4. Long acting

⇒ Prescribed based on measurement of blood sugars throughout the day, may have one injection or multiple
injections

Basic Nursing Considerations
♦ Diabetic patients need continuing teaching and counseling to help maintain their diet and lifestyle in order to
manage their disease.
♦ Insulin should be refrigerated until opened; can then be kept at room temperature for one month.
♦ Vial should be rolled, not shaken, to mix contents
♦ Insulins are supplied in many ways: multi-dose vial, pre-filled pens, continuous infusion, etc
♦ When mixing insulins, draw up clear solution first, & then the cloudy solution
♦ Injections should be rotated within a given site (location on the body, e.g. abdomen) to enhance absorption and
prevent infections.
♦ One site should be used for multiple injections, then switch to another site, because there will be different
absorption rates from different sites and if the site is changed every time an injection is given, blood sugar control
may be difficult.

Side Effects
ü Hyperglycemia
ü Hypoglycemia
ü Allergic or hypersensitivity reactions, usually to modifying or carrier agents used with some preparations,
sometimes with allergy to pork or beef
1


Drug Class: Oral Anti-Diabetic Agents (ex. metformin/Glucophage)

Actions
♦ Increases insulin sensitivity in cells
♦ Insulin must be present for it to work

Uses
♦ Prescribed when diet and exercise alone cannot control glucose levels in Type II diabetes.
♦ Does not cause hypoglycemia
♦ May be combined with other hypoglycemic agents
♦ May also cause weight loss and lowered triglyceride and LDL levels and slight elevation in HDL levels


Drug Class: Oral Hypoglycemia Agents (ex. Glyburide/Diabeta)

Actions
♦ Lower blood glucose by stimulating release of insulin from pancreas (beta cells)

Uses
♦ Only effective in Type II diabetics whose pancreas still produce insulin

Nursing Considerations
♦ Review diet and activity levels to match dose requirements
♦ Do not administer to patients with allergy to sulfonamides

2
Drug Class: Antihypoglycemic Agents (ex. glucagon)

Actions
♦ Hormone secreted by pancreas that breaks down glycogen (stored glucose) into glucose, which elevates blood
glucose levels.

Uses
♦ Used to treat hypoglycemic reactions in patients with diabetes.
♦ Effective within 5-20 minutes. If not effective, repeat or give IV glucose

Nursing Considerations
♦ Must know signs and symptoms of hypoglycemia, used if oral treatment is unadvisable