Glucose-Elevating Agents Nursing Pharmacology and Study Guide

Glucose-elevating agents raise blood level of glucose when severe hypoglycemia occurs at <40 mg/dL. Two agents are used to elevate glucose: diazoxide and glucagon.

Table of Common Drugs and Generic Names


Here is a table of commonly encountered glucose-elevating agents, their generic names, and brand names:

ClassificationGeneric NameBrand Name
Glucose-elevating agentsdiazoxideProglycem, Hyperstat
glucagonGlucaGen

Therapeutic Action


The desired and beneficial action of glucose-elevating agents:

  • Increasing blood glucose by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose.

Indications


Glucose-elevating agents are indicated for the following medical conditions:

  • Diazoxide is an oral management of hypoglycemia; intravenous use for management of severe hypertension.
  • Glucagon is used to counteract severe hypoglycemic reactions.

Pharmacokinetics


Here are the characteristic interactions of glucose-elevating agents and the body in terms of absorption, distribution, metabolism, and excretion:

RouteOnsetPeakDuration
IV1 min15 min9-20 min
T1/2: 3-10 min
Metabolism: liver
Excretion: bile, urine

Contraindications and Cautions


The following are contraindications and cautions for the use of glucose-elevating agents:

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  • Diazoxide is contraindicated with known allergies to sulfonamides or thiazides.
  • Pregnancy and lactation. Associated with adverse effects to fetus and baby.
  • There are no adequate studies on glucagon and pregnancy, so use should be reserved for those situations in which the benefits to the mother outweigh any potential risks to the fetus.
  • Caution should be used in patients with renal or hepatic dysfunction or cardiovascular disease.

Adverse Effects


Use of glucose-elevating agents may result to these adverse effects:

  • Glucagon is associated with GI upset, nausea, and vomiting.
  • Diazoxide is associated with vascular effects, including hypotension, headache, cerebral ischemia, weakness, heart failure, and arrhythmias. This is because diazoxide has the ability to relax arteriolar smooth muscle.

Interactions


The following are drug-drug interactions involved in the use of glucose-elevating agents:

  • Diazoxide with thiazide diuretics can increase risk of toxicity because these two are structurally the same.
  • Glucagon with oral anticoagulants will increase anticoagulation effects.

Nursing Considerations


Here are important nursing considerations when administering glucose-elevating agents:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for contraindications and cautions: history of allergy, renal and hepatic dysfunction, pregnancy to avoid adverse effects.
  • Perform a complete physical assessment to establish a baseline before beginning therapy, monitor effectiveness of therapy, and evaluate for any potential adverse effects during therapy.
  • Assess orientation and reflexes and baseline pulse, blood pressure, and adventitious sounds to monitor the effects of altered glucose levels, and abdominal sounds and function, which could be altered by these drugs.
  • Monitor blood glucose levels as ordered to assess the effectiveness of the drug and patient response to treatment.
  • Monitor the results of laboratory tests, including urinalysis, to evaluate for glucosuria, serum glucose to evaluate response to therapy, and renal and liver function tests to determine the need for possible dose adjustment or identify possible toxic effects.

Nursing Diagnoses and Care Planning

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

  • Risk for unstable blood glucose related to ineffective dosing of the drug
  • Imbalanced nutrition: more than body requirements related to metabolic effects

Nursing Implementation with Rationale

These are vital nursing interventions done in patients who are taking glucose-elevating agents:

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  • Monitor blood glucose levels to evaluate the effectiveness of the drug.
  • Have insulin on standby during emergency use to treat severe hyperglycemia if it occurs as a result of overdose.
  • Monitor nutritional status to provide nutritional consultation as needed.
  • Monitor patients receiving diazoxide for potential cardiovascular effects, including blood pressure, heart rhythm and output, and weight changes, to avert serious adverse reactions.
  • Provide comfort measures to help patient cope with drug effects.
  • Provide patient education about drug effects and warning signs to report to enhance patient knowledge and to promote compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (stabilization of blood glucose levels).
  • Monitor for adverse effects (hyperglycemia and GI distress).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy.

Practice Quiz: Glucose-Elevating Agents


Here are some practice questions for this study guide:

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1. Severe hypoglycemia is set to occur and would need a dose of glucose-elevating agents at which blood glucose level?

A. 30 mg/dL
B. 65 mg/dL
C. 50 mg/dL
D. 75 mg/dL

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1. Answer: A. 30 mg/dL

Glucose-elevating agents raise blood level of glucose when severe hypoglycemia occurs at <40 mg/dL.

2. Glucose-elevating agents exert their actions by:

A. Delaying the excretion of glucose
B. Decreasing insulin release
C. Delaying the breakdown of glycogen in the liver to release more glucose
D. Transforming into synthetic glucose molecules that the body can use in times of severe stress

2. Answer: B. Decreasing insulin release

The desired and beneficial action of glucose-elevating agents is increasing blood glucose by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose.

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3. Glucagon is commonly associated with which adverse effects?

A. GI upset
B. Arrhythmia
C. Skin rashes
D. Hypokalemia

3. Answer: A. GI upset

Glucagon is associated with GI upset, nausea, and vomiting.

4. Diazoxide is commonly associated with which adverse effects?

A. Hypotension and headache
B. Myalgia and arthralgia
C. Jaundice
D. Oliguria

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4. Answer: A. Hypotension and headache

Diazoxide is associated with vascular effects, including hypotension, headache, cerebral ischemia, weakness, heart failure, and arrhythmias. This is because diazoxide has the ability to relax arteriolar smooth muscle.

5. Which of the following drugs is to be avoided in patients taking diazoxide to prevent toxicity?

A. ACE inhibitors
B. Thiazide diuretics
C. Phenothiazines
D. Antacids

5. Answer: B. Thiazide diuretics

Diazoxide with thiazide diuretics can increase risk of toxicity because these two are structurally the same.

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