Languha Ngati

Pharmacology discussion Question

Chapter 38, Agents to control blood glucose levels

Instructor: CarolAnn Marchand

3-12-2020
Written Assignments

1. Briefly describe the pathophysiology of diabetes mellitus including alterations in metabolic

pathways and changes to basement membranes.

- Diabetes mellitus is a disease in which the capillary basement membranes are

substantially altered.

- This diabetic micro angiopathy is characterized by a thickening of the basement

membrane and changes in its permeability characteristic due to a disturbance in the

production and distribution of its functional components.

- Glucose metabolism and insulin imbalance have been implicated in these basement

membrane modifications.  

2. You are caring for a 3-year~old child newly diagnosed with type 1 diabetes mellitus. The child

will be started on insulin. What nursing considerations are essential for caring for this child?

Provide the rationale for all nursing considerations.

- The onset of the action of insulin is 1/2 to 1 hour. The peak action occurs in 2 to 4

hours. The child needs to be checked for a hypoglycemic reaction (shaking, feelings

of anxiety, and decreased level of consciousness) 2 hours after the insulin is given.

- Lente insulin is not given in an intravenous solution. Only regular insulin is given

through the intravenous route.

- It is not necessary to force fluids on the child. Because there is no information that

indicates the child is unable to take fluids and foods by mouth, it is not necessary to

give a dextrose solution at this time.

 - Hypoglycemia can usually be prevented if a child with diabetes eats more food before

or during exercise.

- Because exercise with adolescents isn't commonly planned, carrying additional

carbohydrate foods such as crackers or fruit is a good preventive measure. 

3. You are caring for a 33-year-old pregnant female diagnosed with gestational diabetes mellitus.

The patient will be started on insulin. What nursing considerations are essential for caring for

this adult? Provide the rationale for all nursing considerations.

- All pregnant women be tested for gestational diabetes. Knowing and treating

gestational diabetes can reduce the risk of pregnancy complications.

- After a patient diagnosed with gestational diabetes, the patient will need to make

changes in what they eat and will also need to learn how check blood sugar level.

- In some cases, patients will also need to learn how to give themselves insulin

injections.

- The main goal of treatment for gestational diabetes is to reduce the risk of high and

low blood sugar complications during pregnancy.

- One of the main complications is an overly large baby (weighs greater than 9 to 10

lbs. at birth). A large baby most of the time are likely to cause injury to the mother

during the delivery.

- Women start by giving one shot of insulin per day. If your blood sugar levels are high

after eating, you may need to give a shot two or three times per day. Instructions for

drawing up and giving insulin shots are available separately.

 - If you take insulin, you should check your blood sugar level at least four times per

day.

- You also need to write down your results and how much insulin you give and review

these records at each prenatal visit, keeping accurate records helps to adjust insulin doses

and can decrease the risk of complications.

4. You are caring for a 74-year-old adult diagnosed with type 2 diabetes mellitus. The patient

will be started on glimepiride to control the diabetes mellitus. What nursing considerations are

essential for caring for this older adult? Provide the rationale for all nursing considerations.

- Glimepiride is an oral blood sugar-lowering drug in a class of medicines for

controlling diabetes. Glimepiride lowers the sugar level in the blood by stimulating

insulin to be secreted from the pancreas into the blood.

- Nausea and upset stomach may occur. Instruct patient to take medication at same time

each day.

- Take missed doses as soon as remembered unless almost time for next dose. Do not

take if unable to eat.

- Explain to patient that this medication controls hyperglycemia but does not cure

diabetes. Therapy is long term.

- Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia

occurs, advise patient to drink a glass of orange juice or ingest 2– 3 tsp of sugar,

honey, or corn syrup dissolved in water or an appropriate number of glucose tablets

and notify health care professional.

 - Encourage patient to follow prescribed diet, medication, and exercise regimen to

prevent hypoglycemic or hyperglycemic episodes. 

- Instruct patient in proper testing of serum glucose and ketones. These tests should be

closely monitored during periods of stress or illness and health care professional notified

if significant changes occur

5. Prepare an index card listing the onset, peak, and duration of action of the different types of

insulin. Compare and contrast these different types of insulin.

Table of Insulin Action

Detemir 1 hr. Flat, Max effect in 5 Regular ½-1 hr. 2-4 6-8

hrs. hr. hr.

Glargin        1.5 Flat, Max effect in 5 Lyspro/ Aspart/ <15 1-2 4-6

e hr. hrs. Glulisine min. hr. hr.

Group Assignment

1. As a group, construct a table that compares and contrasts the prototype drugs insulin,

chlorpropamide, Glyburide, and metformin with other antidiabetic and glucose-elevating agents.

Discuss similarities and differences among drugs in each classification and across classifications.

- Metformin is an oral hypoglycemic drug, which increases activity of AMPK. GI

distress is the most common side effect of metformin lactic acidosis is also one of the

adverse effect.

- Poor and variable bioavailability micronized glyburide tablets quicker peak serum

concentrations; not bioequivalent.

- Liver elimination glimepiride long half-life; 24-hour duration; liver elimination;

increased glucose uptake compared to glyburide

- Chlorpropamide: Treating type 2 diabetes in patients who cannot control blood sugar

levels by diet and exercise alone. It is used along with diet and exercise. It may be

used alone or with other antidiabetic medicines.

- Is also a sulfonylurea antidiabetic medicine? It works by causing the pancreas to

release insulin, which helps to lower blood sugar. Side effects are Hypoglycemia,

Nausea, and Weight Gain.

- Glyburide: If a single dose proves to be unsatisfactory divide daily dose and give

twice daily.

- Patients receiving less than 20 units of insulin per day may be switched to

Micronase  2.5 mg or 5 mg and their insulin discontinued. Glyburide is a transition

period needed when switching from other oral hypoglycemic agents.

- Stimulates insulin synthesis and release. May also improve binding between insulin

and insulin receptors. Most side effects are: Hypoglycemia, Weight Gain, and Weight

Loss 
 Citation

Medscape. 2020. Novel Agent Helps To Control Blood Glucose Levels. [online] Available at:

<https://www.medscape.com/viewarticle/457394> [Accessed 12 March 2020].