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P A R T 6
Drugs acting on the endocrine system
(e.g. monoamine oxidase inhibitors, beta-blockers,
salicylates, alcohol). Dose adjustments are needed when
any of these drugs are added or removed. Care should
also be taken when combining insulin with any beta-
blocker. The blocking of the SNS also blocks many of
the signs and symptoms of hypoglycaemia, hinder-
ing the person’s ability to recognise problems. People
taking beta-blockers need to learn other ways to recog-
nise hypoglycaemia. Individuals should also be warned
about possible interactions with various herbal and
complementary therapies and over-the-counter prepara-
tions (Box 38.6).
Prototype summary: Insulin
Indications:
Treatment of type 1 diabetes; treatment of type 2 diabetes when other agents have failed; short-term
treatment of type 2 diabetes during periods of stress; management of diabetic ketoacidosis, hyperkalaemia and
marked insulin resistance.
Actions:
Replacement of endogenous insulin.
Pharmacokinetics:
Route
Onset
Peak
Duration
regular (neutral)
30–60 mins
2–4 hours
8–12 hours
semilente isophane
1–1.5 hours
5–10 hours
12–16 hours
isophane
(Humulin NPH
)
1–1.5 hours
4–12 hours
24 hours
lispro (
Humalog
)
<15 mins
30–90 mins
2–5 hours
aspart (
NovoRapid
)
15 mins
1–3 hours
3–5 hours
glargine (
Lantus
)
60–70 mins
None
24 hours
glulisine (
Apidra
)
2–5 mins
30–90 mins
1–2.5 hours
detemir (
Levemir
)
1–2 hours
6–8 hours
24 hours
Combination insulins
neutraland isophane
30–60 mins,
2–4 hours, then
6–8 hours, then
(Humulin 70/30
,
then 1–2 hours
6–12 hours
18–24 hours
Mixtard 70/30
)
T
1/2
:
Varies with each preparation; metabolised at the cellular level.
Adverse effects:
Hypersensitivity reaction, local reactions at injection site, hypoglycaemia, ketoacidosis.
People being treated with hypoglycaemic therapies are
at an increased risk of developing hypoglycaemia if they
use juniper berries, ginseng, garlic, fenugreek, coriander,
dandelion root or celery. If a person uses these therapies,
blood glucose levels should be monitored closely and
appropriate dose adjustment made in the prescribed
drug.
Herbal and alternative therapies
BOX 38.6
Care considerations for
people taking insulin
Assessment: History and examination
■
■
Assess for contraindications or cautions: any
known allergy to any insulin and current status
of pregnancy or breastfeeding
so that appropriate
monitoring and dose adjustments can be
completed, including possible need to use animal
source insulin.
■
■
Perform a physical assessment
to establish a
baseline before beginning therapy
, and during
therapy
to evaluate the effectiveness of therapy and
for any potential adverse effects.
■
■
Assess for presence of any skin lesions; orientation
and reflexes; baseline pulse and blood pressure;
respiration or adventitious breath sounds,
which
could indicate response to high or low glucose
levels and potential risk factors in giving insulin.
■
■
Assess body systems
for changes suggesting
possible complications associated with poor blood
glucose control.
■
■
Investigate nutritional intake,
noting any problems
with intake and adherence to prescribed diet that
could alter the anticipated response to insulin
therapy.
