C H A P T E R 3 8
Agents to control blood glucose levels
581
pregnancy and breastfeeding to monitor glucose levels
closely and adjust the insulin dose accordingly. Insulin
does not cross the placenta; therefore, it is the drug of
choice for managing diabetes during pregnancy. Insulin
does enter breast milk, but it is destroyed in the GI tract
and does not affect the breastfeeding infant. However,
insulin-dependent mothers may have inhibited milk
production because of insulin’s effects on fat and
protein metabolism. The effectiveness of breastfeed-
ing the infant should be evaluated periodically. People
with allergies to beef or pork products should use only
human insulins.
Adverse effects
The most common adverse effects related to insulin use
are hypoglycaemia and ketoacidosis, which can be con-
trolled with proper dose adjustments. Local reactions at
injection sites, including lipodystrophy, can also occur.
Clinically important drug–drug interactions
Caution should be used when giving a person stabil
ised on insulin any drug that decreases glucose levels
Insulin, pioglitazone and rosiglitazone work here
Diazoxide, glucagon and
metformin work here
Glucose
glycogen
Amino acids
proteins
Sulfonylureas
and repaglinide
work here
Acarbose
works here
Glucose
absorbed
alpha cells
Decreased
glucose level
Insulin
receptor sites
Cells
Insulin released
beta cells
delta cells
Replacement
insulin works
Stomach
Pancreas
Exenatide
works here
Broken down by DPP-4
GLP-1 release
Sitagliptin
works here
FIGURE 38.3
Sites of action of drugs used to treat diabetic conditions.
Safe medication administration
Insulin is usually given by subcutaneous injection. Using an
insulin syringe with a 25-gauge, 1.3-centimetre needle, inject
the insulin into the loose connective tissue underneath the
skin (Figure 38.4). The areas of the body that are best able
to be pinched up to access this tissue are the abdomen, the
upper thigh and the upper arm. Inject the needle quickly at an
angle of 45° to 90°, depending on the amount and turgor of
the tissue. Inject the insulin. Remove the needle and syringe
and apply gentle pressure at the injection site. Rotate sites
regularly to prevent tissue damage.
Insulins should only be drawn up into insulin-specific
syringes due to potential for drug errors with regular
syringes.
FIGURE 38.4
Inject the needle quickly at an angle of 45° to 90°,
depending on the amount and turgor of the tissue. [Photo by Rick
Brady. With permission from Taylor, C., Lillis, C. & LeMone, P.
(2005).
Fundamentals of Nursing: The Art and Science of Nursing
Care
(5th edn). Philadelphia: Lippincott Williams & Wilkins.]
