Diabetes Medications: Insulin and Oral Agents
Diabetes is managed with insulin and oral hypoglycaemic agents. Nurses must know insulin types, onset/peak, injection technique, and recognition of hypoglycaemia.
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What you must know about Diabetes Medications
Insulin is classified by onset: rapid, short (regular), intermediate (NPH), and long-acting.
When mixing insulins, draw up the clear (short-acting) before the cloudy (intermediate) — "clear before cloudy".
Insulin is given subcutaneously; rotate injection sites to prevent lipodystrophy.
Signs of hypoglycaemia: sweating, tremor, hunger, confusion, tachycardia.
Treat conscious hypoglycaemia with fast-acting oral glucose; give IV dextrose or glucagon if unconscious.
Metformin is a common oral agent; it does not typically cause hypoglycaemia alone.
NMCN Exam Tips
How this topic appears in the NMCN exam
"Clear before cloudy" is the rule when mixing regular and NPH insulin.
Hypoglycaemia in a conscious patient → give oral fast-acting sugar first.
Insulin is always subcutaneous (except regular insulin, which can be IV).
Rotate injection sites to prevent lipohypertrophy.
Practice Question
Test yourself
When mixing short-acting (regular) and intermediate-acting (NPH) insulin in the same syringe, the nurse should:
Explanation
The rule is "clear before cloudy": draw up the clear regular insulin first, then the cloudy NPH. This prevents contaminating the regular insulin vial with the longer-acting NPH, which could alter its action.
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