C H A P T E R 3 8
Agents to control blood glucose levels
585
SULFONYLUREAS AND OTHER
HYPOGLYCAEMIC AGENTS
Other hypoglycaemic agents may be used in individu-
als who still have a functioning pancreas. These agents
include the sulfonylureas and other agents that do not
fit into a specific classification (see Table 38.3). The
sulfonylureas were the first oral agents introduced to
treat type 2 diabetes. They stimulate the pancreas to
release insulin. Other agents discussed in this section
have been introduced more recently for use in people
with type 1 and type 2 diabetes. These agents interact
Cardiovascular: pulse, 110 beats/minute; blood pressure,
155/92 mmHg.
Respiratory: respiratory rate, 24/minute; lungs clear on
auscultation; rapid respiratory rate is indicative of
acidosis.
Laboratory tests: urinalysis—negative for glucose, positive
for ketones; blood glucose level, 72 mg/dL.
Implementation
Provide teaching regarding drug name, dosage, adverse
effects, precautions, warning signs to report and proper
administration technique.
Assist M.J. to restore blood glucose to normal levels by
using insulin and constantly monitoring blood glucose
levels during normal times and during times of stress
and trauma so that insulin dose can be adjusted to
needed amount.
Review proper subcutaneous injection technique and site
rotation.
Provide support and reassurance to help M.J. deal with drug
injections, this hypoglycaemic episode and her lifetime
need for insulin.
Teach M.J. how to store insulin in a cool place away from
light and to use caution when mixing insulin types.
Review with M.J. the name and type of insulin, dosage,
adverse effects, precautions, warning signs of adverse
effects to report and proper administration technique.
Evaluation
Evaluate drug effects: return of glucose levels to normal.
Monitor for adverse effects: hypoglycaemia and/or
injection-site reaction.
Monitor for drug–drug interactions as indicated for insulin.
Evaluate the effectiveness of teaching program and
comfort and safety measures.
TEACHING FOR M.J.
• Diet modifications and increased exercise are very
important aspects of your diabetes management. You
should also practise good skin care and hygiene measures.
Check for any injury or sign of infection regularly.
• Insulin is a hormone that is normally produced by your
pancreas. It helps to regulate your energy balance by
affecting the way the body uses sugar and fats. The lack
of insulin produces a disease called diabetes mellitus.
By injecting insulin each day, you can help your body use
the sugars and fats in your food effectively.
• Check the expiration date on your insulin. Store the insulin
at room temperature, and avoid extremes of heat and
light. Gently rotate the vial between your palms before
use to dispense any crystals that may have formed. Do not
shake the vial because vigorous shaking can inactivate the
drug. Rotate your injection sites on a regular basis.
• A prescription is required to get the syringes that you will
need to administer your insulin. Keep the syringes sealed
until ready to use and dispose of them appropriately. Rotate
your injection sites regularly to prevent tissue damage and
to ensure that the proper amount of insulin is absorbed.
• You should be aware of the signs and symptoms of
hypoglycaemia (too much insulin). If any of these occur,
eat or drink something high in sugar, such as a lolly,
orange juice, honey or sugar. The signs and symptoms
to watch for include the following: nervousness, anxiety,
sweating, pale and cool skin, headache, nausea, hunger
and shakiness. These may happen if you skip a meal,
exercise too much or experience extreme stress. If these
symptoms happen very often, notify your healthcare
provider. If you cannot eat because of illness or other
problems, do not take your usual insulin dose. Contact
your healthcare provider for assistance.
• Avoid the use of any over-the-counter medications
or herbal therapies without first checking with your
healthcare provider. Several of these medications and
many commonly used herbs can interfere with the
effectiveness of insulin. Avoid the use of alcohol because
it increases the chances of having hypoglycaemic attacks.
• Tell any doctor, nurse or other healthcare provider
involved in your care that you are taking this drug. You
may want to wear or carry a MedicAlert tag showing that
you are on this medication. This would alert any medical
personnel taking care of you in an emergency to the fact
that you are taking this drug.
• Report any of the following to your healthcare provider:
loss of appetite, blurred vision, fruity odour to your breath,
increased urination, increased thirst, nausea or vomiting.
• While you are taking this drug, it is important to have
regular medical follow-up, including blood tests to
monitor your blood glucose levels, to evaluate you for any
adverse effects of your diabetes.
• Keep this drug and your syringes out of the reach of
children. Use proper disposal techniques for your needles
and syringes. Do not give this medication to anyone
else or take any similar medication that has not been
prescribed for you.
