28.2 Insulin and Non-Insulin Injectable Diabetes Drugs

Insulin and non-insulin injectables are key players in diabetes management. Insulin, a hormone that regulates blood sugar, comes in various types with different action times. Non-insulin options like GLP-1 receptor agonists and amylin analogs offer alternative ways to control glucose levels.

These medications work differently but share the goal of maintaining healthy blood sugar. Nurses need to understand how they act, potential side effects, and proper administration techniques. Patient education on injection methods, storage, and hypoglycemia management is crucial for successful treatment.

Insulin and Non-Insulin Injectable Diabetes Drugs

Insulin vs Non-Insulin Injectables

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• Insulin
  • Hormone produced by the pancreas regulates blood glucose levels treats type 1 and type 2 diabetes mellitus
  • Administered subcutaneously with various types having different onsets, peaks, and durations of action
    • Rapid-acting (insulin lispro, insulin aspart)
    • Short-acting (regular insulin)
    • Intermediate-acting (NPH insulin)
    • Long-acting (insulin glargine, insulin detemir)
  • Dosage individualized based on patient's needs and response
• Non-insulin injectable diabetes medications
  • ###Glucagon-Like_Peptide-1_(GLP-1)_Receptor_Agonists_0###
    • Incretin mimetics stimulate insulin secretion and inhibit glucagon release administered subcutaneously to treat type 2 diabetes mellitus (exenatide, liraglutide, dulaglutide, semaglutide)
  • Amylin analogs
    • Synthetic form of amylin, a hormone co-secreted with insulin slows gastric emptying, suppresses glucagon secretion, and promotes satiety (pramlintide)
    • Administered subcutaneously as an adjunct to insulin therapy in type 1 and type 2 diabetes mellitus

Actions, Side Effects, Interactions

• Insulin
  • Actions
    • Lowers blood glucose by facilitating glucose uptake in cells and inhibiting glucose production in the liver
  • Side effects
    • Hypoglycemia, weight gain, lipodystrophy at injection sites
  • Interactions
    • Drugs that increase hypoglycemic effect (sulfonylureas, fibrates, salicylates)
    • Drugs that decrease hypoglycemic effect (corticosteroids, thyroid hormones, sympathomimetics)
• GLP-1 receptor agonists
  • Actions
    • Stimulate glucose-dependent insulin secretion, inhibit glucagon release, slow gastric emptying, promote satiety
  • Side effects
    • Nausea, vomiting, diarrhea, injection site reactions, increased risk of pancreatitis
  • Interactions
    • May delay absorption of orally administered medications due to slowed gastric emptying
• Amylin analogs
  • Actions
    • Slow gastric emptying, suppress glucagon secretion, promote satiety
  • Side effects
    • Nausea, hypoglycemia (when used with insulin)
  • Interactions
    • Increased risk of hypoglycemia when used with insulin or insulin secretagogues

Nursing Considerations

• Assessment
  • Check blood glucose levels before administration assess for signs and symptoms of hypoglycemia or hyperglycemia
• Preparation
  • Verify medication order and dosage select appropriate injection site and rotate sites to prevent lipodystrophy use proper aseptic technique when preparing and administering the medication
• Administration
  • Administer medication at the prescribed time and route for insulin, mix suspensions (NPH) gently before administration observe patient for any adverse reactions
• Monitoring
  • Monitor blood glucose levels regularly and adjust medication dosage as needed assess injection sites for signs of infection, inflammation, or lipodystrophy monitor for signs and symptoms of hypoglycemia or hyperglycemia and treat accordingly
• Documentation
  • Record medication administration, including time, dose, and injection site document patient's response to the medication and any adverse reactions

Patient Education

• Proper injection technique
  • Demonstrate proper injection sites (abdomen, thighs, upper arms) teach how to rotate injection sites to prevent lipodystrophy instruct on proper aseptic technique and disposal of used needles and syringes
• Medication storage
  • Store insulin and GLP-1 receptor agonists in the refrigerator (36-46°F) until opened once opened, store at room temperature (below 86°F) and use within the specified time frame protect medications from extreme temperatures and direct sunlight
• Hypoglycemia management
  • Educate on signs and symptoms of hypoglycemia (shakiness, sweating, confusion) teach the "15-15 rule" for treating mild to moderate hypoglycemia
    1. Consume 15 grams of fast-acting carbohydrates
    2. Recheck blood glucose after 15 minutes and repeat if still low
  • Instruct on when to seek medical attention for severe hypoglycemia
• Lifestyle modifications
  • Encourage regular blood glucose monitoring and keeping a log emphasize the importance of a healthy diet and regular exercise discuss the impact of stress, illness, and travel on diabetes management
• Follow-up care
  • Stress the importance of regular check-ups with healthcare providers encourage patients to report any adverse reactions or concerns to their healthcare team