Pharmacology · chapter 28 · Diabetic Drugs
Introduction to Diabetes
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Alpha and beta cells
Alpha (α) cells produce glucagon, which breaks down glycogen into glucose in the liver. Beta (β) cells secrete insulin, which regulates glucose metabolism and facilitates absorption of glucose from the bloodstream into cells.
Type 1 means insulin for life
Because the body is destroying the β cells in the pancreas, clients with type 1 diabetes will need to take insulin for the rest of their lives to survive (Holt et al., 2021).
Type 1 onset is sudden
The onset of symptoms with type 1 diabetes is often sudden. It typically appears in adolescents and young adults but can occur in childhood as well.
What happens in type 2
The β cells in the pancreas continue to have some degree of functionality with varying amounts of insulin secretion, resulting in elevated blood glucose levels and insulin resistance.
Type 2 onset is gradual
Unlike type 1 diabetes, type 2 diabetes symptoms are gradual in onset. The disease typically appears in people over age 45; however, it is becoming more common in children, adolescents, and young adults.
Treating gestational diabetes
Gestational diabetes is controlled with dietary management and exercise. Pharmacologic methods are incorporated only if the disease process is unmanageable with diet and exercise and only introduced if safe for both the pregnant person and the fetus.
Later risk after gestational diabetes
Clients with gestational diabetes are at a higher risk of developing type 2 diabetes as they age (American Diabetes Association, n.d.-a).
Prevention
There is no known way to prevent type 1 diabetes. Type 2 diabetes can be prevented with lifestyle modifications such as diet, exercise, weight loss, and developing a diabetes prevention program with the health care provider (American Diabetes Association, n.d.-a).
Signs of hypoglycemia
Signs and symptoms of hypoglycemia include feeling shaky, sweating/chills, clammy skin, dizziness/feeling faint, agitation, confusion, blurred or impaired vision, slurred speech, and tachycardia/bradycardia (American Diabetes Association, n.d.-c).
The 15–15 rule
Treatment of hypoglycemia includes the “15–15 rule”: 15 grams of carbohydrates to raise the blood glucose level and a blood glucose monitoring check 15 minutes after administration of the carbohydrates.
Glucagon when the client cannot eat
Glucagon can be given intravenously, intramuscularly, or subcutaneously if the client is unable to eat or drink or if the client is unconscious.
Signs of hyperglycemia
Signs and symptoms of hyperglycemia include frequent urination (polyuria), increased thirst (polydipsia), increased hunger (polyphagia), blurred vision, restlessness, unintentional weight loss, abdominal pain, vomiting, drowsiness, hot/dry skin, hypotension, and coma (American Diabetes Association, n.d.-b; Sapra Bhandari, 2023).
A1c cut-offs
A HbA1c below 5.7% is normal. A HbA1c between 5.7% and 6.4% represents prediabetes, and a level of 6.5% or higher indicates diabetes (American Diabetes Association, n.d.-a).
Fasting glucose cut-offs
A fasting blood glucose level of 99 mg/dL or lower is normal, 100–125 mg/dL indicates prediabetes, and 126 mg/dL or higher indicates diabetes (American Diabetes Association, n.d.-a).
Terms to know
- Diabetes mellitus
- Diabetes mellitus is a metabolic disease that is characterized by hyperglycemia associated with alterations in carbohydrate, protein, and fat metabolism (Dilworth et al., 2021).
- Type 1 diabetes
- Type 1 diabetes is an autoimmune disorder that causes the body’s immune system to attack and destroy the β cells in the pancreas that make insulin.
- Type 2 diabetes
- Type 2 diabetes occurs when the pancreas does not produce enough insulin or the body is not using insulin effectively.
- Gestational diabetes
- Gestational diabetes is a type of diabetes that can develop during pregnancy in clients who do not already have diabetes.
- Hypoglycemia
- Hypoglycemia occurs when the blood glucose level in the body falls below the normal range.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
A client with diabetes is shaky, sweaty and clammy, and is awake and able to swallow. Blood glucose is 58 mg/dL. What should the nurse do first?
- Give 15 grams of carbohydrates and recheck the blood glucose in 15 minutes.
- Give glucagon intramuscularly right away.
- Wait one hour and recheck the blood glucose.
- Give the scheduled insulin dose.
Answer: Give 15 grams of carbohydrates and recheck the blood glucose in 15 minutes.
The 15–15 rule treats hypoglycemia: 15 grams of carbohydrates, then a glucose check 15 minutes later. Glucagon is used when the client cannot eat or drink or is unconscious, and giving insulin or waiting would let the glucose fall further.
A client with diabetes is found unconscious with a very low blood glucose. Which treatment does the nurse anticipate?
- Glucose tablets
- Glucagon by injection
- Orange juice by mouth
- An oral diabetes agent
Answer: Glucagon by injection
Glucagon can be given intravenously, intramuscularly or subcutaneously when the client is unable to eat or drink or is unconscious. Anything by mouth is unsafe in an unconscious client, and oral diabetes agents lower glucose further.
The nurse is assessing a client for hyperglycemia. Which findings are consistent with it? Select all that apply.
- Clammy skin
- Polyphagia
- Polyuria
- Polydipsia
- Shakiness
Answer: Polyphagia, Polyuria, Polydipsia
Hyperglycemia causes frequent urination, increased thirst and increased hunger, along with hot, dry skin. Clammy skin and shakiness are signs of hypoglycemia.
A client's lab results show a HbA1c of 6.0%. How should the nurse interpret this result?
- Diabetes
- Prediabetes
- Hypoglycemia
- Normal
Answer: Prediabetes
A HbA1c between 5.7% and 6.4% represents prediabetes. Below 5.7% is normal, and 6.5% or higher indicates diabetes; A1c does not diagnose hypoglycemia.
A client who had gestational diabetes has delivered, and her blood glucose is back to baseline. What teaching is most important?
- She no longer has any diabetes risk.
- She will need insulin for life.
- She is at higher risk of developing type 2 diabetes as she ages.
- She now has type 1 diabetes.
Answer: She is at higher risk of developing type 2 diabetes as she ages.
Blood glucose usually returns to baseline after delivery, but clients with gestational diabetes are at higher risk of type 2 diabetes as they age. Lifelong insulin describes type 1 diabetes, which gestational diabetes does not become.
A client asks how type 1 and type 2 diabetes differ. Which statements by the nurse are accurate? Select all that apply.
- In type 2 the pancreas stops making any insulin.
- Type 2 symptoms usually come on gradually.
- Type 1 is an autoimmune disorder that destroys the insulin-making beta cells.
- Type 1 can be prevented with diet and exercise.
- Type 1 symptoms often start suddenly.
Answer: Type 2 symptoms usually come on gradually., Type 1 is an autoimmune disorder that destroys the insulin-making beta cells., Type 1 symptoms often start suddenly.
Type 1 is autoimmune destruction of beta cells with often sudden onset, while type 2 comes on gradually. There is no known way to prevent type 1, and in type 2 the beta cells keep some function.
Where every quote comes from
Section 28.1 Introduction to Diabetes of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.