Action: Antidiabetics are divided into the insulins that decrease blood glucose, phosphate, and potassium and increase blood pyruvate and lactate; and orasl antidiabetics that cause functioning b-cells in the pancreas to release insulin, improve the effect of endogenous and exogenous insulin.

Uses: Insulins are used for ketoacidosis and diabetes mellitus types 1 and 2; oral antidiabetics are used for stable adult-onset diabetes mellitus type 2.

Side effects / Adverse reactions: The most common side effect of insulin and oral antidiabetics is hypoglycemia. Other adverse reactions to oral antidiabetics include blood dyscrasias, hepatotoxicity, and rarely, cholestatic jaundice. Adverse reactions to insulin products include allergic responses ans more rarely, anaphylaxis.

Contraindications: Hypersensitive reactions may occur, and allergies should be identified before these products are given. Oral antidiabetics should not be used in juvenile or brittle diabetes, diabetic ketoacidosis, severe renal disease, or severe hepatic disease.

Precautions: Oral antidiabetics should be used with caution in the elderly, in cardiac disease, pregnancy, lactation, and in the presence of alcohol.

Interactions: Interactions vary widely among products. Check individual monographs for specific information.

Possible nursing diagnoses:
» Altered nutrition: more than body requirements [uses]

Nursing Considerations

» Blood, urine glucose levels during treatment to determine diabetes control (oral products)
» Fasting blood glucose, 2 hr PP (60-100 mg/dl normal fasting level) (70-130 mg/dl normal 2-hr level)
» Hypoglycemic reaction that can occur during peak time

» Insulin after warming to room temperature by rotating in palms to prevent lipydystrophy from injecting cold insulin
» Human insulin to those allergic to beef or pork
» Oral antidiabetic 30 minutes before meals

» Rotation of injection sites when giving insulin; use abdomen, upper back, thighs, upper arm, buttocks; rotate sites within one of these regions; keep a record of sites

» Therapeutic response, including decrease in polyuria, polydipsia, polyphagia, clear sensorium, absence of dizziness, stable gait

Teach patient/family:
» To avoid alcohol and salicylates except on advice of prescriber
» Symptoms of ketoacidosis: nausea, thirst, polyuria, dry mouth, decreased B/P; dry, flushed skin; acetone breath, drowsiness, Kussmail respiration
» Symptoms of hypoglycemia: headache, tremors, fatigue, weakness; and that candy or sugar should be carried to treat hypoglycemia
» To test urine for glucose/ketones tid if this drug is replacing insulin
» To continue weight control, dietary restrictions, exercise, hygiene
» Obtain yearly eye exams

Selected Generic Names

Insulin aspart
Insulin glargine
Insulin lispro
Insulin, regular
Insulin, regular concentrated
Insulin, zinc suspension (Lente)
Insulin, zinc suspension (Ultralente)
Insulin, zinc suspension, prompt (Semilente)

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