0 Diaphoresis o Anxiety o Hunger o Pallor
Hypoglycemia - Altered mental func oning Di culty speaking . Visual disturbances . Stupor Confusion . Coma IV push - D50 amps
Untreated hypoglycemia: Progression of LOC; sz; coma and death Check BG IvIs o <70-begin tx o >70- inves gate further for cause of s/sx If monitoring equip not available; tx should be ini ated Tx: rule of 15 o Consume 15 g of a simple carbohydrate o Fruit juice or regular so drink, 4 to 6 oz Recheck glucose level in 15 minutes . Repeat if s II<70 gm/dL o Avoid foods with fat Decrease absorpon of sugar o Avoid overtreatment :Give complex CHO a er recovery
Tx: In acute care se ngs o 50% dextrose 20 -50 mL IV push o Pt not alert enough to swallow o Glucagon 1 mg IM or subq Explore reasons why occurred
Slides 76-87 Drug Therapy Biguanides (Me ormin): withhold if they're going to surgery or have procedure with contrast medium o Pa ents who are undergoing surgery or any radiologic procedures that involve the use of a contrast medium are instructed to temporarily discon nue me ormin before surgery
or the procedure and to not resume taking me ormin un I 48 hours a er the surgery or the procedure and a er their serum crea nine has been checked and is normal. Do not use in pa ents with kidney disease, liver disease, or heart failure. Lac c acidosis is a rare complica on of me ormin accumula on. Do not use in people who drink excessive amounts of alcohol. o Take with food to minimize GI side e ects. Sulfonylureas: Sulfonylureas include glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase), and glimepiride (Amaryl). The primary ac on of the sulfonylureas is to increase insulin produc on from the pancreas. Therefore, hypoglycemia is the major side e ect of sulfonylureas. Megli nides: o Like the sulfonylureas, repaglinide (Prandin) and nateglinide (Starlix) increase insulin produc on from the pancreas. However, because they are more rapidly absorbed and eliminated than sulfonylureas, they are less likely to cause hypoglycemia. When they are taken just before meals, pancrea c insulin produc on increases during
Instruct pa ents to take megli nides any me from 30 minutes before each meal right up to the me of the meal. These drugs should not be taken if a meal is skipped. Glucosidase Inhibitors o Also known as starch blockers, these drugs work by slowing down the absorp on of carbohydrate in the small intes ne. Taken with the rst bite of each main meal, they are most e ec ve in lowering postprandial blood glucose. Their e ec veness is measured by checking 2-hour postprandial glucose levels. Acarbose (Precose) and miglitol (Glyset) are the available drugs in this class.
TZD 0 Some mes referred to as insulin sensi zers, these agents include pioglitazone (Actos) and rosiglitazone (Avandia). They are most e ec ve for people who have insulin resista