McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 3 8 Agents to control blood glucose levels

Cardiovascular: pulse, 110 beats/minute; blood pressure, 155/92 mmHg. Respiratory: respiratory rate, 24/minute; lungs clear on auscultation; rapid respiratory rate is indicative of acidosis. Laboratory tests: urinalysis—negative for glucose, positive for ketones; blood glucose level, 72 mg/dL. Implementation Provide teaching regarding drug name, dosage, adverse effects, precautions, warning signs to report and proper administration technique. Assist M.J. to restore blood glucose to normal levels by using insulin and constantly monitoring blood glucose levels during normal times and during times of stress and trauma so that insulin dose can be adjusted to needed amount. Review proper subcutaneous injection technique and site rotation. Provide support and reassurance to help M.J. deal with drug injections, this hypoglycaemic episode and her lifetime need for insulin. Teach M.J. how to store insulin in a cool place away from light and to use caution when mixing insulin types. Review with M.J. the name and type of insulin, dosage, adverse effects, precautions, warning signs of adverse effects to report and proper administration technique. Evaluation Evaluate drug effects: return of glucose levels to normal. Monitor for adverse effects: hypoglycaemia and/or injection-site reaction. Monitor for drug–drug interactions as indicated for insulin. Evaluate the effectiveness of teaching program and comfort and safety measures. TEACHING FOR M.J. • Diet modifications and increased exercise are very important aspects of your diabetes management. You should also practise good skin care and hygiene measures. Check for any injury or sign of infection regularly. • Insulin is a hormone that is normally produced by your pancreas. It helps to regulate your energy balance by affecting the way the body uses sugar and fats. The lack of insulin produces a disease called diabetes mellitus. By injecting insulin each day, you can help your body use the sugars and fats in your food effectively.

fit into a specific classification (see Table 38.3). The sulfonylureas were the first oral agents introduced to treat type 2 diabetes. They stimulate the pancreas to release insulin. Other agents discussed in this section have been introduced more recently for use in people with type 1 and type 2 diabetes. These agents interact • Check the expiration date on your insulin. Store the insulin at room temperature, and avoid extremes of heat and light. Gently rotate the vial between your palms before use to dispense any crystals that may have formed. Do not shake the vial because vigorous shaking can inactivate the drug. Rotate your injection sites on a regular basis. • A prescription is required to get the syringes that you will need to administer your insulin. Keep the syringes sealed until ready to use and dispose of them appropriately. Rotate your injection sites regularly to prevent tissue damage and to ensure that the proper amount of insulin is absorbed. • You should be aware of the signs and symptoms of hypoglycaemia (too much insulin). If any of these occur, eat or drink something high in sugar, such as a lolly, orange juice, honey or sugar. The signs and symptoms to watch for include the following: nervousness, anxiety, sweating, pale and cool skin, headache, nausea, hunger and shakiness. These may happen if you skip a meal, exercise too much or experience extreme stress. If these symptoms happen very often, notify your healthcare provider. If you cannot eat because of illness or other problems, do not take your usual insulin dose. Contact your healthcare provider for assistance. • Avoid the use of any over-the-counter medications or herbal therapies without first checking with your healthcare provider. Several of these medications and many commonly used herbs can interfere with the effectiveness of insulin. Avoid the use of alcohol because it increases the chances of having hypoglycaemic attacks. • Tell any doctor, nurse or other healthcare provider involved in your care that you are taking this drug. You may want to wear or carry a MedicAlert tag showing that you are on this medication. This would alert any medical personnel taking care of you in an emergency to the fact that you are taking this drug. • Report any of the following to your healthcare provider: loss of appetite, blurred vision, fruity odour to your breath, increased urination, increased thirst, nausea or vomiting. • While you are taking this drug, it is important to have regular medical follow-up, including blood tests to monitor your blood glucose levels, to evaluate you for any adverse effects of your diabetes. • Keep this drug and your syringes out of the reach of children. Use proper disposal techniques for your needles and syringes. Do not give this medication to anyone else or take any similar medication that has not been prescribed for you.

SULFONYLUREAS AND OTHER HYPOGLYCAEMIC AGENTS

Other hypoglycaemic agents may be used in individu- als who still have a functioning pancreas. These agents include the sulfonylureas and other agents that do not