diabetes oral antigyperglycemic agents, please help

Student with a question here:rolleyes:

In regards to the oral agents in management of type II diabetes, I have written in my notes that if a pt is NPO for surgery, you should NOT give a meglitinide, as it will cause hypoglycemia. Is this true of all of the oral antihyperglycemic agents? One thing that confused me is that the meglitinides' effects are glucose dependent--effect decreases when blood glucose level decreases--so if this drug must be held for NPO pts, I would assume (but am not sure) that the rest would also need to be held. Basically, would SUs, biguanides (metformin), AGI's, and TZDs also have to be held in NPO patients? Or could you check their blood glucose readings before administering?

someone please help me :)

[AuntieRN]

My understanding is NPO means NPO...nothing is given unless the order reads NPO except for meds. I am a student also sooo...not sure if I am telling you right or not..but thought I would throw it out there and someone could correct us both if we are wrong.

Usually the p o hypoglycemics are long actiong and the pill you give today is really for tomorrow if ya know what I mean. I usually give all necessary po meds if the surgery is scheduled for atleast a few hours away. I hold diruetics unless the pt has a foley and alwasy give the cardiac meds if the pt has been on them regulary. I will hold colace or non essential meds if that is all that they have ordered.

What did the order read NPO well in most cases the medical provider will write what meds the pt. should receive so actually no second guessing and pick up the phone to clarify if you are in doubt.

[lsyorke, RN]

I don't give hypoglycemic, unless specifically ordered. It's much safer to use regular insulin to cover any elevated sugar during surgery.

[Daytonite, BSN, RN]

NPO means NPO and that includes oral medications. If you think the doctor may have forgotten about the patient being diabetic you can always call him and ask if he wants the patient to get the meglitinide the morning of surgery.

Are you talking specifically about Glyset (miglitol)? Glyset, as well as Acarbose (Precose), has no effect on insulin production and does not cause hypoglycemia. It specifically prevents blood glucose from rising after eating by slowing down the breakdown of complex sugars into glucose. The reason it doesn't cause hypoglycemia is because it only acts in the presence of the complex sugars in the system. If it were accidentally given when the patient was NPO there should be minimal to no effect on the patient's blood sugar. I use Precose prn if I am going to be bad and stray from my low carb diet and eat something like ice cream or pasta which I know is going to raise my blood sugar fairly quickly and keep it elevated for awhile.

Remember, this patient is a known diabetic and his blood sugars are going to monitored while in the hospital.

How about antihypertensives.If I check a blood pressure on the day of surgery and it is normal do I go ahead and give the med?

[annatuesday]

An NPO order does not mean the patient gets nothing, no matter what the circumstances are. If a patient goes for a heart cath and is NPO, all the cardiac meds should still be given. If the patient's blood sugar is steadily in the 200s, of course I will give diabetic meds. A patient with blood sugar of 200-300 should not be left at that because he is going into surgery and is NPO. The surgery itself is going to increase his sugar even higher. Now if the patient is 115, I would not give diabetic meds. I don't think there are hard and fast rules. Nursing judgments are always in style.

[classicdame, MSN, EdD]

unless the MD specifies, I would hold all oral anti-diabetics and all insulin EXCEPT the basal insulins (Lantus and Levimir). The practice in our hospital is to check glucose levels before and after the procedure (during, if it is long). The CRNA can always add dextrose to the IV if glucose gets low. If you are the nurse receiving the patient post-op then please check glucose levels. Once for baseline and again per nursing judgment. I have had to explain to some nurses that, although the MD orders check AC/HS that is the minimum, and nurses should be able to use their own skills to assess the patient prn.