SGLT2 inhibitors: new class of oral drugs for the treatment of type 2 DM Canaglifozin (Invokana), dapaglifozin (Farxiga), and empagliflozin (Jardiance) Action: work independently of insulin to prevent glucose reabsorption from the glomerular filtrate, resulting in a reduced renal threshold for glucose and glycosuria Other effects: may increase insulin sensitivity and glucose uptake in the muscle cells and decrease gluconeogenesis Results: improved glycemic control, weight loss, and a low risk of hypoglycemia Hypoglycemia Abnormally low blood glucose level (below 50 mg/dL) Mild cases can be treated with diet—higher intake of protein and lower intake of carbohydrates—to prevent rebound postprandial hypoglycemia Hypoglycemia Symptoms Early o Confusion, irritability, tremor, sweating Late o Hypothermia, seizures o Coma and death will occur if not treated Glucose-Elevating Drugs Oral forms of concentrated glucose o Buccal tablets, semisolid gel 50% dextrose in water (D 50 W) Glucagon Nursing Implications Before giving drugs that alter glucose levels, obtain and document: A thorough history Vital signs Blood glucose level, HbA1C level Potential complications and drug interactions Before giving drugs that alter glucose levels Assess the patient’s ability to consume food. Assess for nausea or vomiting. o Hypoglycemia may be a problem if antidiabetic drugs are given and the patient does not eat. o If a patient is NPO for a test or procedure, consult the primary care provider to clarify orders for antidiabetic drug therapy. Keep in mind that overall concerns for any patient When insulin is ordered, ensure: Correct route Correct type of insulin Timing of the dose Correct dosage Insulin order and prepared dosages are second checked with another nurse. Insulin o Check blood glucose level before giving insulin. o Roll vials between hands instead of shaking them to mix suspensions. o Ensure correct storage of insulin vials. o Only use insulin syringes, calibrated in units, to measure and give insulin. o Ensure correct timing of insulin dose Oral antidiabetic drugs o Always check blood glucose levels before giving o Usually given 30 minutes before meals o Alpha-glucosidase inhibitors are given with the first bite of each main meal. o Metformin is taken with meals to reduce GI effects. o Metformin will need to be discontinued if the patient is to undergo studies with contrast dye because of possible renal effects; check with the prescriber. Assess for signs of hypoglycemia. If hypoglycemia occurs: o Administer oral form of glucose if the patient is conscious. o Give the patient glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink or have the patient eat a small snack, such as crackers or a half sandwich.
with DM increase when the patient: Is under stress Has an infection Has an illness or trauma Is pregnant or lactating Thorough patient education is essential regarding: o Disease process o Diet and exercise recommendations o
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- Spring '17
- blood glucose, blood glucose levels