Diabetes Mellitus:

Conference #2
MEDICATIONS:

Insulin (High Alert Medication)

Oral Agents (High Alert Medications)
Nutrition Therapy

Jackie Dorsey RN, MS, ANP

High Alert Medications

As described by the FDA, HighAlert Medications are those
most likely to cause significant
harm to patients of any age,
even when used as intended by
the prescriber. While errors in
these medications are not more
common than in others, highalert medications more
commonly cause harm and their
adverse reactions are usually
more serious, especially in the
geriatric population.
Some examples listed

adrenergic agonists, IV (e.g.,

epinephrine, phenylephrine,
norepinephrine)
adrenergic antagonists, IV (e.g.,
propranolol, metoprolol,
labetalol)
anesthetic agents, general,
inhaled and IV (e.g., propofol,
ketamine)
antiarrhythmics, IV (e.g.,
lidocaine, amiodarone)
antithrombotic agents
(anticoagulants), including
warfarin, low-molecular-weight
heparin, IV unfractionated
heparin, Factor Xa inhibitors
(fondaparinux), direct
thrombin inhibitors (e.g.,
argatroban, lepirudin,
bivalirudin), thrombolytics

Nursing Management of a patient With Diabetes Mellitus

Collaborative Care of Patient with DM

Goals:
1. Reduce Symptoms
2. Promote well-being
3. Prevent acute complications
4. Delay onset of long term complications

Nursing Management of a patient With Diabetes

Mellitus
Collaborative Care of Patient with DM
Method:
Goals are accomplished by thorough patient
teaching and encouraging patient to be an active
participant in their own care!

Nursing Management of a patient With Diabetes Mellitus

Collaborative Care of Patient with DM

Team:
Providers
Nursing
Diabetes Educators
Registered Dieticians
Pt/family/Significant others

PRECONFERENCE ACTIVITY
Readings on Nutritional
Therapy
National Guidelines
ChooseMyPlate.gov

Calorie Meal Plan

This content (pages 20-22) is Pre-conference
learning and answers will be posted on Angel.

View VHS-006
Putting Carbohydrate Counting into Practice
Note taking Guide provided p 23

Goals of Nutritional Therapy

Maintain blood glucose
Achieve lipid profiles and blood pressure levels
Modify lifestyle
Improve health
Address individual nutritional needs

Nutritional Therapy
DIFFERENCES

TYPE 1

TYPE 2

Total calories

Possible necessary to achieve

desirable body weight

Decrease calories for overweight or

obese patients.

Effect of diet

Diet & insulin necessary for

glucose control

Diet alone may be sufficient

Emphasis is on achieving glucose,
lipid and BP goals.

Distribution of calories

Equal distribution of CHO for

insulin activity

Equal distribution recommended

Consistency of CHO at meals
desirable

Consistency of daily intake

Necessary

Desirable

Uniform timing of meals

Crucial if on intermediate or long

acting insulin

Desirable

Between meal and bedtime

snack

Frequently necessary

Not usually recommended

Nutritional supplement for

exercise.

Adjusted for exercise

May need adjustment for exercise

Antidiabetic Medications Insulin Therapy

(High Alert Medications)

Classification
Generic Name
Trade Name

Normal Insulin Secretion in the Body

Medication Card: Insulin

(High Alert Medication)
Classification
Types
Indications for Use
Action
Side/adverse effects
Storage

Types: High Alert Medications

Insulin Lispro (Humalog)
Regular Insulin(Humulin R)
NPH Insulin (Humulin N)
Insulin Glargine (Lantus)

Insulin Lispro (Humalog)

Clear
SC
Rapid Acting

15-20 minutes
60-90 minutes
3-4 hours

Regular Insulin (Humulin R)

Clear
SC or IV
Short Acting
30-60 minutes
2-3 hours
3-6 hours

NPH Insulin (Humulin N)

Cloudy
SC
Intermediate Acting
2 hours
4-10 hours
10-16 hours

Insulin Glargine (Lantus)

Clear
SC

Long Acting
1-2 hours
No significant peak
24+ hours

Site Selection
Abdomen
fastest absorption

Back of arms
second fastest absorption

Anterior thighs
Buttocks
slowest absorption

Site Rotation

Rotate injection site within a particular

anatomical area (checkerboard)
Rotation to different anatomical sites no
longer recommended
Prevention of lipodystrophy- Lumps and
dents from repeated injections
20

Lipodystrophy

Alternate Administration Methods

Insulin Pump
Delivers predetermined amount of insulin on a
continuous rate via a subcutaneous needle
Closely mimics basal supply of insulin
Insertion sites changed every 2-3 days
Requires close BG monitoring
22

Alternate Administration Methods

Insulin
Pump

High Alert Medication Review Insulin

Post-Conference Activity
Complete table on the bottom of p 27
See Angel for answers

Insulin Practice Questions

Post-Conference Activity or faculty may do on the
board if time allows.

CRITICAL THINKING ACTIVITY

What is Humulin 70/30 Insulin (high alert medication)?
Answer:
Combination insulin preparation
70% of dose NPH insulin
30% of dose Regular insulin

More convenient for some patients

There is a second form of 70/30 insulin made with
NPH/Humalog

CRITICAL THINKING ACTIVITY

A patient has an order for Humalog (high alert
medication) ac. The patient receives 10 units of insulin at
0730 and eats breakfast at 0800 . At what time would a
hypoglycemic episode most likely occur?
Answer:
Between 0830 and 0900 when Lispro insulin is peaking

CRITICAL THINKING ACTIVITY

What nursing interventions would the RN
implement for a hypoglycemic reaction?
Answer:
Follow the 15-15 Rule:
Give 15 gm of simple CHO
120-180 ml juice
180-200 ml regular soda
After 15 minutes check BG if < 60 treat with another 15 gm
of fast acting CHO
If no relief, another 15 gm of simple CHO
Keep doing so until BG gets to > 60. Call MD if no change
Follow with longer lasting CHO like skim milk

CRITICAL THINKING ACTIVITY

A 5 year old child is a newly diagnosed Type 1
diabetic. His mother asked you what she should do
about giving him Lispro (Humalog) insulin (high alert
medication) before he eats. The mother states that
the child is such a finicky eater.
Answer:
This insulin is fast-acting and provides better control for
finicky eaters
Humalog insulin can be given immediately after he eats &
the dose could be adjusted based on what and how much
he eats

Post-conference Activity

Why are Lispro and Lantus used together?

(Refer to text)

Oral Antidiabetic Agents

Oral agents are not oral insulin nor are they a
substitute for insulin

Antidiabetic Medications for Type 2 DM Oral Agents

(high alert medication)
Classification (Insulin Secretagogues insulin
secretion)
Sulfonylureas
Biguanides
Dipeptidyl-peptidase-4 inhibitor

Sulfonylureas

Biguanide

Dipeptidyl-peptidase-4 inhibitor

Oral Agents and Patient Teaching

Store in tight container/cool environment
Symptoms of hypo/hyperglycemia & treatment
Medications must be used daily.
Consequences of discontinuing medication
abruptly
Diet plan to prevent hypoglycemia
Avoid OTC medications unless prescribed
Carry emergency ID-Provider name and meds
Diabetes is lifelong disease-meds are no cure

NCLEX Review Questions

1. Answer: 1
Text Reference: Lewis p. 1266, Table 49-7

2. Answer: 1
Text Reference: Lewis p. 1267, Table 49-8