McKenna's Pharmacology for Nursing, 2e

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P A R T 6  Drugs acting on the endocrine system

(e.g. monoamine oxidase inhibitors, beta-blockers, salicylates, alcohol). Dose adjustments are needed when any of these drugs are added or removed. Care should also be taken when combining insulin with any beta- blocker. The blocking of the SNS also blocks many of the signs and symptoms of hypoglycaemia, hinder- ing the person’s ability to recognise problems. People taking beta-blockers need to learn other ways to recog- nise hypoglycaemia. Individuals should also be warned about possible interactions with various herbal and complementary therapies and over-the-counter prepara- tions (Box 38.6). People being treated with hypoglycaemic therapies are at an increased risk of developing hypoglycaemia if they use juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root or celery. If a person uses these therapies, blood glucose levels should be monitored closely and appropriate dose adjustment made in the prescribed drug. Herbal and alternative therapies BOX 38.6

Care considerations for people taking insulin

Assessment: History and examination

■ ■ Assess for contraindications or cautions: any known allergy to any insulin and current status of pregnancy or breastfeeding so that appropriate monitoring and dose adjustments can be completed, including possible need to use animal source insulin. ■ ■ Perform a physical assessment to establish a baseline before beginning therapy , and during therapy to evaluate the effectiveness of therapy and for any potential adverse effects. ■ ■ Assess for presence of any skin lesions; orientation and reflexes; baseline pulse and blood pressure; respiration or adventitious breath sounds, which could indicate response to high or low glucose levels and potential risk factors in giving insulin. ■ ■ Assess body systems for changes suggesting possible complications associated with poor blood glucose control. ■ ■ Investigate nutritional intake, noting any problems with intake and adherence to prescribed diet that could alter the anticipated response to insulin therapy.

Prototype summary: Insulin Indications: Treatment of type 1 diabetes; treatment of type 2 diabetes when other agents have failed; short-term treatment of type 2 diabetes during periods of stress; management of diabetic ketoacidosis, hyperkalaemia and marked insulin resistance. Actions: Replacement of endogenous insulin. Pharmacokinetics: Route Onset Peak Duration regular (neutral) 30–60 mins 2–4 hours 8–12 hours semilente isophane 1–1.5 hours 5–10 hours 12–16 hours isophane (Humulin NPH ) 1–1.5 hours 4–12 hours 24 hours lispro ( Humalog ) <15 mins 30–90 mins 2–5 hours aspart ( NovoRapid ) 15 mins 1–3 hours 3–5 hours glargine ( Lantus ) 60–70 mins None 24 hours glulisine ( Apidra ) 2–5 mins 30–90 mins 1–2.5 hours detemir ( Levemir ) 1–2 hours 6–8 hours 24 hours

Combination insulins neutraland isophane

30–60 mins,

2–4 hours, then

6–8 hours, then

(Humulin 70/30 ,

then 1–2 hours

6–12 hours

18–24 hours

Mixtard 70/30 ) T 1/2 : Varies with each preparation; metabolised at the cellular level. Adverse effects: Hypersensitivity reaction, local reactions at injection site, hypoglycaemia, ketoacidosis.