33 Antidiabetic Drugs

OBJECTIVES
1. Discuss the normal actions and functions of the pancreas.
2. Contrast age of onset, signs and symptoms, pharmacological and nonpharmacological treatment,
incidence, and etiology of type 1 and type 2 diabetes.
3. Differentiate gestational diabetes from type 1 and type 2 diabetes.
4. Discuss the various factors influencing plasma glucose levels in individuals without diabetes and in
patients with diabetes.
5. Identify the drugs used to manage type 1 and type 2 diabetes.
6. Discuss the mechanisms of action, indications, contraindications, cautions, drug interactions, and
adverse effects of insulin, oral anti-hyperglycemia drugs, and injectable antidiabetic drugs.
7. Compare rapid-, short-, intermediate-, and long-acting insulins in regard to their onset of action,
peak effects, and duration of action.
8. Compare the signs and symptoms of hypoglycemia and hyperglycemia and their related treatments.

READINGS
There are a lot of sections in this chapter, so I have listed only the ones that you need to read. The rest
of the material in the chapter is optional.
pp. 538 Pancreas
pp. 539-542 Diabetes (including gestational diabetes)
Antidiabetic Drugs
 Insulins pp. 543-548
 Oral antihyperglycemic drugs focus on below
 Biguanide pp. 548
 Sulfonylureas – read p. 549
pp. 554 Pharmacokinetic Bridge to Nursing practice
pp. 554-556 Nursing process

DRUG PROFILES/MAKE DRUG CARDS FOR:

Rapid Acting Insulins
Short Acting Insulin
Intermediate-Acting Insulin
Long-Acting Insulin

LEARNING ACTIVITIES

1. Compare and contrast rapid acting insulins, short acting insulins, intermediate-acting insulins, and
long-acting insulins.

2. Frin is 5 feet tall and weighs 81 kg. Laboratory studies from a routine physical indicate an elevated
fasting blood glucose level and a hemoglobin AIC level of 7.6%. The nurse's assessment reveals that
Frin is a smoker with mild hypertension. The physician suspects that Frin has type 2 diabetes. What
2 Chapter 33 Antidiabetic Drugs______________________________

initial treatments (both pharmacological and nonpharmacological) are indicated for Frin? Explain
your answer.

3. Naphne is taking NPH insulin 20 units every morning before breakfast, and then Humulin R before
meals and at bedtime, with the dosage calculated based upon the information in the following
sliding scale.

Blood glucose less than 11.1 mmol/L: no additional coverage

Blood glucose 11.1 to 13.8 mmoVL: 2 units regular insulin
Blood glucose 13.9 to 16.6 mmol/L: 4 units regular insulin
Blood glucose more than 16.7 mmoVL: 6 units regular insulin
Blood glucose more than 19.4 mmol/L: call for orders

How much insulin will Nadine receive in the following circumstances?

a) Before breakfast if her blood glucose level is 15.3 mmol/L

b) Before lunch if her blood glucose level is 10.9 mmol/L
c) Before dinner if her blood glucose level is 18.2 mmol/L

4. A patient who has been taking metformin for type 2 diabetes mellitus needs to have a radiology
examination with contrast dye. What information does the nurse need to ensure is provided to the
patient and the physician?

5. List 6 potential signs/symptoms of hypoglycemia and 6 potential signs/symptoms of hyperglycemia.

6. Navna, who has type 2 diabetes, is 26 weeks pregnant and was placed on insulin therapy during
pregnancy. Navna is concerned about how her diabetes may affect her baby. What teaching points
would the nurse provide?