Peak 1 to 3

Duration 10 to 24 hours

Action: Stimulates beta cells in pancreas to release insulin

type two diabeates

Stomach pain

Diareaha

Loss of apatite

Renal damage

itching

rash

fecal impaction

Kidney or liver issues

take 30 minutes before meals, to prevent hypoglycemia.

Weight gain

This is usually have to buy into lifestyle changes (diet exercise)

Allergies - SULFA

Monitor labs:

• GFR and Cr (kidney damage)

• A1c (3-6 months)

• monitor wt (same time, every day, in the morning)

• triglycerides and cholesterol

• LFT, ALT, AST (liver - assess for jaundice - slows the bile flow)

Exercise

Diet

Take only for intended usage

Not for weightloss FDA approved- can cause rental damage hypoglycemia kidney and liver damage

this does not alter the insulin

A1c <9%

PCOS

agitation

CKD

Liver disease

severe infection

Contraindication if kidneys - GFR < 60 and Cr > 1.5

Swallow extended release whole not crushed

Interacts with alcohol

rosiglitazone - not as Rx'd due to cardiovascular events

Onset: 30 min

Peak: <2 hrs

Duration: Unknown

Rosiglitazone is rarely used and no longer widely available due to concern of increased risk for CV events.

Pioglitazone is used for pts who have contraindication to other oral agents (metformin, sulfonylureas), and who decline injectable therapies.

Edema

Hypoglycemia

Skeletal fractures

Bladder cancer

Monitor for adverse effects

Monitor pt compliance

A1C should be measure 2x yearly in pts meeting glycemic goals and if not meeting goals then every 3 months

weigh daily do assess for HF

Labs:

• A1c

• Liver biochemical test - LFT, AST, ALT

• Ca++/Phos ---> decrease (skeletal fxs and heart)

-Teach s/s of hypoglycemia

-Advise pt to notify prescriber during periods of stress, such as fever, trauma, infection, or surgery, as dosage may need adjustment.

- Advise pt to report blood in the urine, red-colored urine, new or worsening urge to urinate, or pain when urinating: may indicate bladder cancer.

albiglutide, exenatide, dulaglutide, liraglutide

Reduce hepatic glucagon production

Slow gastric emptying,

Mimics the action of the incretin hormone

• Albiglutide: Subq inj, once a week, 30-50mg, peak of 3-5 days with a steady streak reached in 4-5 week

• Exenatide: Subq inj, once a week, steady peak reached in 6-7 weeks

• Dulaglutide: Subq inj, once a week, steady peak reached in 48-72 hours

• Liraglutide: Subq inj, once a day, peak in 8-12 hours

off label uses:

• weight loss

diarrhea or constipation

nervousness

headaches

dizziness

pancreatitis

thyroid tumor

hypoglycemia

gi motility down - obstruction, --> ileus, --> perforation

monitor for s/sx of pancratitis

monotir injection site

Educate on rotating the injection site every couple of weeks

Encourage f/u every 3-6 months

alogliptin, linagliptin, sitagliptin

reduces hepatic glucagon production

Slows gastric emptying

enhances endogenous incretin hormone, and lowers glucose levels

• Alogliptin: PO, 25mg daily, with/without food, peak of 1-2 hours, and a half-life of 21 hours

• Linagliptin: PO, 5mg daily, with/without food, peak of 1.5 hours, and a half-life of >100 hours

• Sitagliptin: PO, 100mg daily, with/without food, peak of 1-4 hours, and a half-life of 12 hours

upset stomach

diarrhea/constipation

headaches

dizziness

weight loss

upper respiratory infection

hypoglycemia

assess patients' medication list (interacts with insulin, glyburide, glipizide, or glimepiride, digoxin, oral contraceptives)

monitor for s/sx of pancriatitis

encourage f/u every 3-6 months

encourage proper foot care

Other types of Rapid-acting insulin: 

• Insulin aspart (NovoLog, Fiasp)

• Insulin glulisine (Apidra)

• Insulin lispro (Humalog, Admelog) 

Onset: 5-30 min

Peak: 0.5-1 h

Duration: 3-5 h

Injection site irritation

-Hypokalemia

-Allergic reaction (severe): angioedema, hypotension, dyspnea, urticaria

-Overdose (reversal: admin rule of 15)

-Administration/Monitoring: check blood glucose regularly (4-6 h) and administer 10 min before meals

-Can only be mixed/given with NPH, no other insulins, and must be administered immediately after being drawn up

labs:

• a1c

• kidney

• liver

• thyroid function

• K+ (makes it go down) Hypokalemia

Can give w/ NPH (intermediate insulin)

DON'T reuse needles

Educate & follow sliding scale as prescribed by provider

Exogenous insulin IS excreted into the breast milk

Onset:30-60min

Peak: 2-3 hr

Duration: 8 hr

pump, IV, IM and SQ

Potential changes in vision

Euglycemia

Phosphate (normal adult=2.5-4.5 mg/dL)

Potassium (normal adult=3.5-5.2 mmol/dL)

Magnesium (normal adult= 1.3-2.1 mEq/L)

Check if they had A1C (nondiabetic=<5.7%, diabetic=<7%)

Check current & past medications

Current Diet/Alcohol intake

Rotate injection site to avoid lipodystrophy

Educate on proper dosage (prescribed by provider)

Educate how to check & monitor BG

Educate S/S of hyper/Hypo glycemia & diet that can effect each

This insulin works fast, caution overdose

Cloudy in color

Protamine added which is a protein that delays inulin absorption which gives this drug its basal effect.

Onset 1-2hr

Peak 4-6hr

Duration 18-24hr

Injection site pain redness or swelling

Coma

30 minutes before dinner if needed

Do not mix with glargine

Draw NPH up last

Teach clients to take same time every day

Teach clients to report symptoms of hypoglycemia low b/p, clammy skin

Onset: 1-2hr

Peak: N/A

Dur: 24hr

Potential changes in vision

Euglycemia

Phosphate (normal adult=2.5-4.5 mg/dL)

Potassium (normal adult=3.5-5.2 mmol/dL)

Magnesium (normal adult= 1.3-2.1 mEq/L)

Check if they had A1C (nondiabetic=<5.7%, diabetic=<7%)

Check current & past medications

Current Diet/Alcohol intake

Rotate injection site to avoid lipodystrophy

Educate on proper dosage (prescribed by provider)

Educate how to check & monitor BG

Educate S/S of hyper/Hypo glycemia & diet that can effect each

Insulin works SLOWER & last LONGER

Onset: SC 5 – 10 min, IM 8 – 10 min, IV 45 seconds 

Peak: SC 10 – 13 min, IM 30 min, IV 5 – 20 min 

Duration: SC 42 min, IM 12 - 27 min, IV 9 – 17 min 

Hypertension 

Dizziness 

Hypokalemia 

Secondary Hypoglycemia 

Be aware of airway- hypoglycemic pts can have seizures and aspirate on any meds, foods, and their own tongues

Be cautious in patients with lactose allergies- glucagon often contains lactose in drug composition

Slowly raising blood sugar is key, so that rebound hypoglycemia does not occur

Keep snacks on self to help prevent severe hypoglycemia from occurring