Biguanides 

Drug:  metformin (Glucophage) 

Action: Decreases hepatic glucose production and decreases intestinal absorption of glucose 

Use: 1st line treatment for DM Type 2 

Adverse: GI bloating / Nausea / Diarrhea 

Contraindications:renal disease 

Nursing Implications: 

• Take w/ meals to decrease tomach upset 
• discontinue 48 hours before diagnostic tests 
• Monitor blood glucose
• Need for diet/exercise

*Does not cause hypoglycemia 

Sulfonylureas

Drug:  

• glipizide (Glucotrol) - 2nd generation
• glyburide (Diabeta)  

Action: increases insulin secretion from pancreas 

Use:  Type 2 DM

Adverse: hypoglycemia 

Contraindications: renal disease 

Nursing Implications: 

• monitor blood glucose
• take before meals
• teach signs/symptoms of hypoglycemia
• teach diet/exercise

Meglitinides 

Drug:  repaglinide (Prandin) 

Action: Facilitates pancrease to produce more insulin after a meal 

Use:  DM Type 2 

Adverse: hypoglycemia / weight gain / GI disturbances 

Contraindications: CANNOT BE TAKEN WITH SULFONYLUREAS

Nursing implications: 

• Give a dose with each meal; if meal is skipped, do not give
• Give 15-30 minutes before meal
• Monitor blood glucose

Alpha Glucosidase Inhibitors 

Drug:  

•  miglitol (Glycet)
• acarbose (Precose) 

Action: Inhibit enzymes in GI tract, delaying digestion of complex carbohydrates

Use:  diabetes mellitus 

Adverse: GI upset / bloating 

Nursing Implications: 

• must take these with meal 

Incretin Mimetics 

Drug:  exenatide (Byetta) - subQ 

Action: hormones are released by GI tract in response to food; slows gastric emptying, increasing the feeling of satiety 

Use: type 2 DM 

Adverse: GI upset 

DPP-4 Inhibitors 

Drug:  sitagliptin (Januvia) - PO

Action: stimulates insulin release in response to a meal 

Use: Type 2 DM 

Adverse:  Respiratory tract infection 

Contraindications: renal disease 

*Not a first line treatment; only has small area of use nowadays 

Other Agents 

rosiglitazone (Avandia) 

Action: increases effectiveness of circulating insulin

Use:  Limited use for diabetes 

Adverse: fluid retention / edema / worsening of heart failure / heart attack 

pramlintide (Symlin) - subQ 

Action: slows gastric emptying 

Use:  diabetes 

Adverse: hypoglycemia 

Nursing Implications: 

• can be used with insulin, sulfonylureas, or metformin 

Insulin 

Insulin - given IV, SQ, Nasal Spray

U-100 or U-500 

Types: 

• Insulin Lispro (Humalog) - rapid acting (within 15 min) 
• Regular insulin (Humulin) - short, subQ, IV 
• only insulin that can be given IV 
• Insulin isophane (NPH) - intermediate; slower acting
• stays in body much longer (patient must eat consistently) 
• not used in hospital b/c of risk of hypoglycemia
• Insulin glargine or detemir (Lantus, Levimer) - long acting, mimics basal insulin 
• Does NOT cause hypoglycemia 
• treats glucose made by liver 
• this is never mixed with other insulines in syringes
• Insulin human (Afreeza) - inhaled
• usually used along with Lantus or Levimer
• used in caution in people with lung problems 

Action: synthesized pancreatic hormone 

Use:  Type 1 DM / some Type 2 Diabetics 

Adverse: hypoglycemia 

Nursing Interventions: 

• Monitor blood glucose
• Hemoglobin A1c - measures 90 day blood glucose avg
• Emergency situations: glucose less than 70, nurse treats with orange juice (simple sugar)
• Teach Patients:
• how to monitor glucose levels
• to correlate intake of carbs with peak timing of insulin
• to keep 15g of carbs/simple sugar on hand (candy bar)
• to recognize hypoglycemic symptoms (anxiety, sweaty, hunger)
• to recognize hyperglycemic signs (thirst, headache, fatigue, frequent urination)
• to have a "sick day" plan (insulin needs change when a person is ill) 
• drink plenty of water while ill
• infection raises glucose levels so med is necessary

Other: Insulin Types

Mixed combinations: 

• Humulin 70/30 (NPH 70%, Regular 30%)
• Humalog 75/25 (NPH 75%, Rapid 25%)
• Numerous combinations