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Insulin

Terms in this set (24)

Insulin
Indications: Type 1 (100%), Type 2 (40%)
Preparations: expressed in Units. 1 ml = 100 USP Units. (U-500 for syringe prototype only)
Sources: synthetic
Administered: SubQ or IV.. bolus for immediate effect, correction (for longer period of time)
Storage: room temp for 1 month, avoid sun and extreme heat, refrigerate unopened vials
ONLY insulin specific syringes
Insulin Chart: Rapid (Type)
Brand: Humalog, Novolog, Apridra
Color: Clear
Onset: <15 minutes
Peak: 30-90 minutes
Duration: 3-5 hours

Can be mixed with NPH
IV ADMIN
Insulin Chart: Short (Type) or Regular
Brand: Regular Insulin, Humulin R, Novolin R
Color: Clear
Onset: 30-60 minutes
Peak: 2-3 hours
Duration: 5-8 hours

Can be mixed with NPH
IV ADMIN
Insulin Chart: Intermediate (Type)
Brand: NPH insulin, Humulin N, Novolin N
Color: Cloudy
Onset: 1-3 hours
Peak: 4-12 hours
Duration: 12-16 hours

Usually given twice a day
Insulin Chart: Combination (Type)
Brand: Humulin 70/30, Novolin 70/30
Color: Cloudy
Onset: 30-60 min
Peak: 2-12 hours
Duration: <24 hours
Insulin Chart: Long Acting (Type)
Brand: Insulin Glargine (Lantus), Insulin Detemir (Levemir)
Color: Clear
Onset: 1-2 hours
Peak: NO PEAK
Duration: 20-24 hours (given once a day SC at daytime)
NEVER MIX WITH ANY INSULIN!!
(small amounts released over extended time period)

NEVER IV ADMIN
Rapid Acting Insulin (Humalog, Novolog, Apidra)
-must be administered immediately before eating or very shortly after
-should be combined with longer acting insulin
-need breakfast to get metabolized
-used for sliding scale
-SC, IV
-Can be mixed with NPH
Insulin (Afrezza)
-rapid acting inhalation powder
-for type 1 and type 2 diabetes
-given at mealtime
-warning side effect: acute bronchospasm in asthma and COPD patients
-no smoking, check lung function.
Insulin routes
SC - Long acting, Rapid and Regular Insulin
IV - Regular Insulin, Rapid Insulin
Insulin Pump
Insulin Pen
No oral
Nursing Implications of Insulin
1. monitor blood glucose as ordered and PRN
2. rotation of sites to decrease scarring
3. abdomen are most rapidly absorbed, arm is second
4. technique for mixing insulin.
5. carry emergency glucose at all times
Technique for Mixing Insulin
Air in NPH, Air in Regular, Needle first in Rapid Acting or Regular, Needle then in NPH
Insulin Pumps
Cartridge of rapid acting insulin, mimics function of pancreas to release insulin. Inserted into SubQ, changed at least 3 days. Administered at a basal rate and a bolus dose prior to each meal.
Pen injectors (Insulin)
-Should never be used on more than one patient
-Prime the pen: first pen (prime with 10 units), repeated use pen (prime with 2 units)
-Continue to press on the skin and slowly count to 10
What and When of HYPOglycemia
-Blood glucose < 50 mg/dL
-Too much insulin given
-Meals are missed or delayed
-Excessive exercise (utilized glucose in skeletal muscle decrease blood glucose)
-Vomiting or diarrhea
-Drinking excessive alcohol (alcohol being processed, cannot make glucose)
What and When of HYPERglycemia
-Not enough insulin used
-Eat large amounts of CHO
-Fever, illness, infection
-Stress
Symptoms of Hypoglycemia
-Headache, cold sweats, clammy, pale, cool skin, anxiety, irritability, confusion, blurred vision (cold & clammy need some candy)
Symptoms of Hyperglycemia
Classic Triad: increased thirst, increased hunger, increased urination

Red/dry skin, dry mouth, fruity breath odor, weight loss
Treatment for Hypoglycemia:
15:15 Rule. Take 15 grams of CHO if no improvement in sxs in 15 minutes, take another 15 grams.

Hospital usually uses OJ, skim milk, glucose tablets, glucose gel
Treatment for Hyperglycemia:
Administer Insulin
Nursing Implications for All Oral hypoglycemic agents
-encourage diet and exercise
-weigh once a week
-test bloog glucose regularly
-assess DM complications (skin for poor healing, vision, renal function)
-monitor for hypoglycemia and hyperglycemia
-dont use alcohol, anti-coagulants or beta blockers
-liver function
-carry glucose source at all times
The 5 M's of Diabetes Self Management (ADA)
1. Meter (monitor BG)
2. Meds
3. Meals
4. Move
5. Problem solve special situations
Insulin Resistance
unbound hormone cannot activate a drop in BG --> elevated BG results --> ore insulin released in response, islet cell failure
Glucagon
-for severe hypoglycemia
-insulin overdose: to restore consciousness
-IM, SC, IV glucose preferred before use of glucagon
-onset: 20 minutes
-nursing implications: monitor BG, document VS and LOV
KNOW HOW TO DO CASE STUDY IN PACKET
KNOW HOW TO DO CASE STUDY IN PACKET
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