absorption of oral meds. Educate- patients to take fast-acting oral meds at least 1hr before injecting these meds. Drug alert for Byetta- acute pancreatitis andkidney problems have been associated with its use, Drug alert for Victoza andTrulicity- do not use in patients with a personal or family history of medullarythyroid cancer, acute pancreatitis has been associated with use of these drugs.oAmylin Analogs-Pramlintide (Symlin) is the only available amylin analog.Amylin, a hormone secreted by the B cells of the pancreas in response to foodintake, slows gastric emptying, reduces glucagon secretion, and increases satiety.Used in addition to mealtime insulin in patients with type 1 or type 2 who haveelevated blood glucose levels on insulin therapy. Given before meals SUBQ intothigh or abd. Cannot be injected into the arm because absorption from this site istoo variable. Cannot be mixed in same syringe with insulin either. The use of thisdrug and insulin increases the risk for hypoglycemia during the 3 hrs afterinjection, more common in the patients with type 1. Educate patients to eat a mealwith at least 250 calories and keep a form of fast-acting glucose on hand in casehypoglycemia does occur. When this medication is used the bolus dose of insulinshould be reduced.oOther drugs affecting Blood Glucose levels-Patient and HCP must be aware ofdrug interaction that can potentiate hypo and hyperglycemia effects. B-adrenergicblockers mask symptoms of hypoglycemia and prolong hypoglycemic effects ofinsulin. Thiazide and loop diuretics can worsen hyperglycemia by inducingpotassium loss, although low-dose thiazide therapy is usually considered safe.Signs and symptoms for hypoglycemiaoBlood glucose < 70 mg/dLoCold, clammy skinoNumbness of fingers, toes, mouthoTachycardiaoEmotional changesoHeadacheoNervousness, tremorsoFaintness, dizzinessoUnsteady gait, slurred speechoHungeroChanges in visionoSeizures, comaoDeath
Treatments for hypoglycemiaoInitialCheck blood glucoseDetermine cause of hypoglycemia (after correction of condition)oConscious patientHave patient eat or drink 15 g of quick-acting carb (4-6 oz of regular soda,5-8 lifesavers, 1 Tbsp syrup or honey, 4 tsp jelly, 4-6 oz orange juice,commercial dextrose products) (per label instructions).Wait 15 min. Check blood glucose again.If blood glucose is still <70 mg/dL, have patient repeat treatment of 15 gof carbs.Once glucose level is stable, give patient additional food of carb plusprotein or fat (ex: crackers with peanut butter or cheese) if the next meal ismore than 1 hour away or patient is engaged in physical activity.Immediately notify HCP or emergency service (if patient outside hospital)if symptoms do not subside after 2-3 doses of quick-acting carbs.oWorsening symptoms or unconscious patientSubcutaneous or IM injection of 1 mg glucagon or IV admin of 20-50 mLof 50% glucose.
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