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Pharmacologic class: Amino acid derivative
Therapeutic class: Hypoglycemic
Pregnancy risk category C
Decreases blood glucose level by stimulating insulin secretion from pancreatic beta cells; interacts with calcium and potassium channels in pancreas
Tablets: 60 mg, 120 mg
Indications and dosages
➣ To decrease glucose levels in type 2 (non-insulin-dependent) diabetes mellitus not adequately controlled by diet and exercise
Adults: 120 mg P.O. t.i.d. up to 30 minutes before meals, or 60 mg P.O. t.i.d. if patient is near glycosylated hemoglobin (HbA1c) goal
• Hypersensitivity to drug or its components
• Diabetic ketoacidosis
• Type 1 (insulin-dependent) diabetes mellitus
Use cautiously in:
• renal or hepatic impairment, adrenal or pituitary insufficiency
• elderly or malnourished patients
• pregnant or breastfeeding patients.
• Give 30 minutes before meals. If meal is missed, don't give dose.
• Know that drug may be given alone or with metformin.
Musculoskeletal: back pain, joint pain
Respiratory: upper respiratory tract infection, bronchitis, coughing
Other: flulike symptoms, trauma
Drug-drug. Beta-adrenergic blockers, MAO inhibitors, nonsteroidal antiinflammatory drugs, salicylates: increased hypoglycemic effect
Corticosteroids, sympathomimetics, thiazides, thyroid products: reduced hypoglycemic effect
Drug-diagnostic tests. Glucose: decreased level
• Monitor blood glucose and HbA1c levels.
• Assess pulmonary status for bronchitis, upper respiratory infection, and flulike signs and symptoms.
• Monitor musculoskeletal status. Check for back pain and arthropathy.
• Note GI complaints, and identify nutritional deficiencies.
• Instruct patient to take dose up to 30 minutes before each main meal.
• Advise patient not to skip a meal. If he does, tell him to also skip accompanying nateglinide dose, to prevent hypoglycemia.
• Teach patient how to monitor blood and urine for glucose and ketones, as prescribed.
• Instruct patient to report adverse CNS effects and signs and symptoms of respiratory infection.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects sensation and balance.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Time/action profile (effect on blood glucose)
|PO||within 20 min||1 hr||4 hr|
Adverse Reactions/Side Effects
Central nervous system
- upper respiratory infection
- hypoglycemia (life-threatening)
- back pain
- flu symptoms
Drug-Drug interactionConcurrent use with beta blockers may mask hypoglycemia.Alcohol, combination with other antidiabetics, NSAIDs, MAO inhibitors, nonselective beta blockers, amiodarone, fluconazole, miconazole, or oxandrolone may ↑ the risk of hypoglycemia.Hypoglycemic effects may be ↓ by thiazide diuretics, corticosteroids, thyroid supplements, sympathomimetic (adrenergic) agents, somatropin, rifampin, or phenytoin.Blood levels and effects are significantly ↓ when administered prior to a liquid meal.
Availability (generic available)
- Observe for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety).
- Lab Test Considerations: Monitor serum glucose and HbA1c periodically during therapy to evaluate effectiveness.
Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated with administration of oral glucose. Severe hypoglycemia should be treated with IV D50W followed by continuous IV infusion of more dilute dextrose solution at a rate sufficient to keep serum glucose at approximately 100 mg/dL.
- May cause ↑ uric acid levels.
Potential Nursing DiagnosesImbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)
- Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
- Oral: Administer 1–30 min prior to meals.
- May be administered concurrently with metformin, pioglitazone, or rosiglitazole.
- Instruct patient to take medication at same time each day. Take missed doses as soon as remembered unless almost time for next dose. Do not take if unable to eat.
- Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
- Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2–3 tsp of sugar, honey, or corn syrup dissolved in water and notify health care professional.
- Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
- Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified if significant changes occur.
- May occasionally cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially, especially aspirin and alcohol.
- Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
- Insulin is the recommended method of controlling blood glucose during pregnancy. Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional promptly if pregnancy is planned or suspected.
- Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times.
- Emphasize the importance of routine follow-up exams.
- Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.