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P A R T 6
Drugs acting on the endocrine system
Adverse effects
Glucagon is associated with GI upset, nausea and
vomiting.
Clinically important drug–drug interactions
Increased anticoagulation effects have been noted when
glucagon is combined with oral anticoagulants. If this
combination is needed, the dose should be adjusted.
Diabetic patient with hypertension
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Glucose-elevating agents are used to increase glucose
when levels become dangerously low. Imbalance in
glucose levels while taking insulin or oral agents is a
common cause of hypoglycaemia.
■■
Individuals need to be carefully monitored to
determine the effectiveness of therapy with these
drugs and to prevent inadvertent overdose, which
could lead to hyperglycaemia.
CHAPTER SUMMARY
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Diabetes mellitus is the most common metabolic
disorder. It is characterised by high blood glucose
levels and alterations in the metabolism of fats,
proteins and glucose.
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Glucose control is a complicated process affected by
various hormones, enzymes and receptor sites.
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Diabetes mellitus is complicated by many end-organ
problems. These are related to thickening of basement
membranes and the resultant decrease in blood flow
to these areas.
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Treatment of diabetes involves tight control of blood
glucose levels using diet and exercise, a combination
of other agents to stimulate insulin release or alter
glucose absorption, or the injection of replacement
insulin.
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Replacement insulin was once obtained from beef
and pork pancreas. Today, most replacement insulin
is human, derived from genetically altered bacteria.
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The amount and type of insulin given must be
regulated daily. People taking insulin must learn
to inject the drug, to test their blood glucose levels
and to recognise the signs of hypoglycaemia and
hyperglycaemia.
■■
Insulin is used for type 1 diabetes and for type 2
diabetes in times of stress or when other therapies
have failed.
■■
Other oral hypoglycaemic agents include first- and
second-generation sulfonylureas, which stimulate
the pancreas to release insulin, and other agents that
alter glucose absorption, decrease insulin resistance,
decrease the formation of glucose or increase the
urinary excretion of glucose. These agents are often
used in combination to achieve effectiveness.
KEY POINTS
Care considerations for
people taking glucose-elevating agents
Assessment: History and examination
■
■
Perform a complete physical assessment
to
establish a baseline before beginning therapy,
monitor effectiveness of therapy and evaluate for
any potential adverse effects during therapy.
■
■
Assess orientation and reflexes and baseline pulse,
blood pressure and adventitious sounds
to monitor
the effects of altered glucose levels
, and abdominal
sounds and function,
which could be altered by
these drugs.
■
■
Monitor blood glucose levels as ordered
to assess
the effectiveness of the drug and response to
treatment.
■
■
Monitor the results of laboratory tests, including
urinalysis,
to evaluate for glycosuria
, serum
glucose levels
to evaluate response to therapy
, and
renal and liver function tests
to determine the need
for possible dose adjustment or identify possible
toxic effects.
Implementation with rationale
■
■
Monitor blood glucose levels
to evaluate the
effectiveness of the drug.
■
■
Have insulin on standby during emergency use
to
treat severe hyperglycaemia if it occurs as a result
of overdose.
■
■
Monitor nutritional status
to provide nutritional
consultation as needed.
■
■
Provide thorough teaching, including drug name,
dosage and schedule for administration; signs
and symptoms of hyperglycaemia; administration
technique if indicated; signs and symptoms of
adverse effects; need for follow-up monitoring
and laboratory testing if indicated; nutritional
measures; and blood glucose monitoring.
Evaluation
■
■
Monitor response to the drug (stabilisation of
blood glucose levels).
■
■
Monitor for adverse effects (hyperglycaemia,
GI distress).
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects to
watch for and specific measures to avoid them).
■
■
Monitor the effectiveness of comfort measures and
compliance to the regimen.
