Glucose-Elevating Agents

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

Glucose-Elevating Agents: Generic and Brand Names
Therapeutic Action
Indications
Pharmacokinetics
Contraindications and Cautions
Adverse Effects
Interactions
Nursing Considerations
Recommended Resources
See Also
References and Sources

Glucose-Elevating Agents: Generic and Brand Names

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

Glucose-elevating agents
- diazoxide (Proglycem, Hyperstat)
- glucagon (GlucaGen)

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:

Route	Onset	Peak	Duration
IV	1 min	15 min	9-20 min

Half-life (T1/2)	Metabolism	Excretion
3-10 min	Liver	Bile, urine

Contraindications and Cautions

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

Diazoxide is contraindicated with known allergies to sulfonamides or thiazides.
Pregnancy and lactation. Associated with adverse effects on 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 in 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:

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.

Recommended Resources

Our recommended nursing pharmacology resources and books:

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Pharm Phlash! Pharmacology Flash Cards ^{#1 BEST SELLER!}
Test-yourself review cards put critical clinical information for nearly 400 of the top generic medications at your fingertips. And, you can count on them for accuracy, because each card is based on content from Davis’s Drug Guide for Nurses. Increase your test scores in pharmacology class.

Focus on Pharmacology (8th Edition)
Focus on Nursing Pharmacology makes challenging concepts more approachable. Engaging learning features cultivate your clinical application, critical thinking and patient education capabilities. This updated 8th edition builds on your knowledge of physiology, chemistry and nursing fundamentals to help you conceptualize need-to-know information about each group of drugs.

Pharmacology Made Incredibly Easy (Incredibly Easy! Series®)
Nursing pharmacology guide offers step-by-step guidance so you can grasp the fundamentals in enjoyable Incredibly Easy style. This is the perfect supplement to class materials, offering solid preparation for NCLEX® as well as a handy refresher for experienced nurses. Colorfully illustrated chapters offer clear, concise descriptions of crucial nursing pharmacology concepts and procedures.

Lehne’s Pharmacology for Nursing Care (11th Edition)
The Eleventh Edition of Lehne’s Pharmacology for Nursing Care provides a thorough understanding of key drugs and their implications for nursing care. This text, written by renowned nursing educators, helps you comprehend and apply pharmacology principles. A clear and engaging writing style simplifies complex concepts, making even the most challenging pharmacology content enjoyable. We recommend this book if you want a comprehensive nursing pharmacology guide.

Nursing Drug Handbook
Nursing2023 Drug Handbook delivers evidence-based, nursing-focused drug monographs for nearly 3700 generic, brand-name, and combination drugs. With a tabbed, alphabetical organization and a “New Drugs” section, NDH2023 makes it easy to check drug facts on the spot.

Pharmacology and the Nursing Process
The 10th edition of Pharmacology and the Nursing Process offers practical, user-friendly pharmacology information. The photo atlas contains over 100 unique illustrations and photographs depicting drug administration techniques. Updated drug content reflects the most recent FDA drug approvals, withdrawals, and therapeutic uses.

Mosby’s Pharmacology Memory NoteCards: Visual, Mnemonic, and Memory Aids for Nurses
The 6th edition of Mosby’s Pharmacology Memory NoteCards: Visual, Mnemonic, & Memory Aids for Nurses incorporates illustrations and humor to make studying easier and more enjoyable. This unique pharmacology review can be utilized as a spiral-bound notebook or as individual flashcards, making it ideal for mobile study.

References and Sources

References and sources for this pharmacology guide for Glucose-Elevating Agents:

Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link]
Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing care.
Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: JB Lippincott.

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