| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Alpha-Glucosidase Inhibitor | |||
| Acarbose (Precose)—PO 25 mg 3 times daily; may be increased q4–8 wk (range: 50–100 mg 3 times daily) | Type 2 diabetes | Alpha-glucosidase inhibitors/oral hypoglycemic | Overdose signs: flatulence, diarrhea, abdominal discomfort |
| NURSING IMPLICATIONS: Observe for side effects of hypoglycemia; take same time each day; do not double dose; therapy is long term | |||
| Biguanide | |||
| Metformin (Glucophage)—PO 500 mg twice daily; may increase by 500 mg to 2,000 mg/day | Type 2 diabetes Obstetric use: Also used for infertility when the client has polycystic ovary syndrome and gestational diabetes after first trimester. | Decreases hepatic production of glucose; decreases intestinal absorption of glucose | Lactic acidosis; nausea, vomiting, diarrhea, abdominal bloating |
| trimester. NURSING IMPLICATIONS: Monitor glucose levels; take medication as directed; dietary compliance; metallic taste resolves spontaneously | |||
| Sulfonylureas | |||
| Acetohexamide (Dymelor)—PO 200–1,500 mg daily; 1–2 doses/day; duration 12–24 hr | Oral hypoglycemic; antidiabetic Obstetric use: May be used after first trimester of pregnancy for controlling blood sugar in gestational diabetes | Lowers blood glucose by stimulating insulin release from beta cells; effective only if pancreas has ability to produce insulin | Hypoglycemia (profuse sweating, hunger, headache, nausea, confusion, ataxia, coma; skin rashes; bone marrow depression, liver toxicity |
| NURSING IMPLICATIONS: Drug therapy must be combined with diet therapy, weight control, and planned, graded exercise; alcohol intolerance may occur (disulfiram reaction—flushing, pounding headache, sweating, nausea, vomiting); should not be taken at bedtime unless specifically ordered (nocturnal hypoglycemia more likely); take at same time each day; contraindicated in liver disease, renal disease, pregnancy | |||
| Chlorpropamide (Diabinese)—PO 100–500 mg maintenance; not to exceed 750 mg/day; duration 30–60 hr | See Acetohexamide | See Acetohexamide | See Acetohexamide |
| NURSING IMPLICATIONS: See Acetohexamide | |||
| Glimepiride (Amaryl), glipizide (Glucotrol)—PO 1–2 mg once daily; increase slowly up to 8 mg in one dose; 15 mg/day in divided dose | Type 2 diabetes mellitus | Stimulate release of insulin from pancreas | Photosensitivity; hypoglycemia; ingestion of alcohol may induce reaction |
| NURSING IMPLICATIONS: Observe for signs of hypoglycemia; long-term therapy; avoid aspirin, alcohol; follow prescribed diet/exercise program | |||
| Glyburide (Micronase)—PO 2.5–5 mg initially; 1.25–20 mg/day | See Acetohexamide | See Acetohexamide | See Acetohexamide |
| NURSING IMPLICATIONS: See Acetohexamide | |||
| Tolazamide (Tolinase)—PO 100–500 mg; once/day; duration 10–14 hr | See Acetohexamide | See Acetohexamide | See Acetohexamide |
| NURSING IMPLICATIONS: See Acetohexamide | |||
| Tolbutamide (Orinase)—PO 500–3,000 mg; 2–3 doses/day; duration 6–12 hr | See Acetohexamide | See Acetohexamide | See Acetohexamide |
| NURSING IMPLICATIONS: See Acetohexamide | |||
| Insulin—Rapid Acting | |||
| Crystalline zinc insulin (regular) (Humulin R) (clear)—onset 0.5–1.0 hr; peak 2–4 hr; duration 6–8 hr Insulin analogue: lispro (Humalog), aspart (Novolog) | Poorly controlled diabetes; trauma; surgery, coma | Enhances transmembrane passage of glucose into cells; promotes carbohydrate, fat, and protein metabolism More rapid absorption and shorter duration | Hypoglycemia (profuse sweating, nausea, hunger, headache, confusion, ataxia, coma); allergic reaction at injection site |
| NURSING IMPLICATIONS: Monitor blood and urine for glucose and acetone levels; insulin currently being used can be kept at room temperature for 1 mo; refrigerate stock insulin only; rotate injection sites; cold insulin leads to lipodystrophy, reduced absorption, and local reaction; only form of insulin that is given IV; need to eat within 15 min of insulin analogue injection | |||
| Insulin—Intermediate Acting Basal | |||
| NPH insulin (isophane insulin suspension) (cloudy)—onset 1–2 hr; peak 5–8 hr; duration 10–20 hr | Clients who can be controlled by one dose per day | See Crystalline zinc insulin (regular) | See Crystalline zinc insulin (regular) |
| NURSING IMPLICATIONS: Gently rotate vial between palms, invert several times to mix; do not shake; see Crystalline zinc insulin (regular) | |||
| Insulin zinc suspension (lente insulin) (cloudy)—onset 1–3 hr; peak 6–12 hr; duration 18–24 hr | Clients allergic to NPH | See Crystalline zinc insulin (regular) | See Crystalline zinc insulin (regular) |
| NURSING IMPLICATIONS: See Crystalline zinc insulin (regular) | |||
| Insulin—Slow Acting | |||
| Extended insulin zinc suspension (ultralente) (Humulin U)—onset 4–8 hr; peak 12–24 hr; duration 36 hr | Often mixed with semilente for 24-hr curve | See Crystalline zinc insulin (regular) | See Crystalline zinc insulin (regular) IC |
| NURSING IMPLICATIONS: See Crystalline zinc insulin (regular) | |||
| Insulin—Long Acting Basal | |||
| Insulin glargine (Lantus) (clear)—onset 1–2 hr; duration 24 hr | Closely imitates pancreas’s basal insulin release | Absorbs equally over 24-hr period | |
| NURSING IMPLICATIONS: See Crystalline zinc insulin (regular); glargine may cause mild pain at injection site and cannot be mixed with other insulins | |||