Indication:
Insulins
To treat high blood sugar for clients:
- with diabetes mellitus
- taking steroids
Generic names:
Rapid-acting insulin
Lispro, Aspart, Glulisine
(LAG)
Onset, Peak, Duration:
Rapid-acting insulin
Onset: 5 - 30 minutes (closer to 15 minutes)
Peak: 1 - 2 hours
Duration: 3 - 5 hours
The peak is when hypoglycemic reactions can occur.
Generic names:
Short-acting insulin
Regular insulin
Brand name: Humulin R
Onset, Peak, Duration:
Short-acting insulin: Regular subcutaneous
Onset: within 30 minutes
Peak: 2 - 4 hours
Duration: 8 hours
Onset, Peak, Duration:
Short-acting insulin: Regular IV infusion or IV push
Onset: 10 - 15 minutes
Peak: unknown
Duration: 4 hours
Why is it important to teach the client when insulin peaks?
The peak action time of insulin is when hypoglycemic reactions can occur. If the blood sugar gets too low, coma can occur.
Which insulin can be given IV infusion or IV push?
ONLY regular insulin is given IV.
What types of insulins should a meal be readily available before administration?
Rapid-acting and short-acting insulin.
This type of insulin works very quickly and can cause hypoglycemia if food is not consumed shortly after administration.
Indication:
Regular IV insulin
To treat diabetic ketone acidosis.
(DKA)
What electrolyte should be checked while the client is receiving IV insulin?
Potassium level.
Insulin lowers the potassium level.
Generic names:
Intermediate insulin
NPH and isophane
Brand name: Humulin N
Onset, Peak, Duration:
Intermediate insulin
Onset: 1 - 2 hours
Peak: 4 - 12 hours
Duration: up to 24 hours
Generic names:
Long-acting insulin
glargine, detemir
Can be given at bedtime.
Onset, Peak, Duration:
Long-acting insulin
Onset: 3 - 6 hours
Peak: none
Duration: up to 24 hours
What types of insulins can be mixed and drawn up into the same syringe?
It’s fine to mix intermediate insulin with rapid or short-acting.
What insulin is drawn up first and what insulin is drawn up second when drawing up the insulins that can be mixed?
- draw up rapid-acting or short-acting first, which is clear
- draw up intermediate-acting second, which is cloudy
“Clear before cloudy”
Sick day rules for insulin:
- check blood sugar every 4 hours - still give insulin if indicated
- drink fluids every hour - to prevent dehydration
- assess for signs of hyperglycemia - ketones in urine, fruity breath, deep and rapid respirations
Where are insulin bottles stored?
In the refrigerator until ready to be opened.
After opening, bottles can be stored in refrigerator or at room temperature for 28 days.
How is subcutaneous insulin administered?
Guidelines:
- clean skin with alcohol before injection
- choose one area on the body to keep absorption rate the same
- use 25-30 gauge needle at 45-90 degree angle and typically in abdomen or upper arm
- rotate around that site to prevent lipodystrophy
- move at least 1.5” (4 cm) away from previous injection site
What is lipodystrophy?
Fibrous fatty areas of the skin caused by repeated use of injections.
Avoid these areas for subcutaneous shots.
Most common adverse reactions:
metformin (oral antidiabetic)
- lactic acidosis
- nausea/vomiting/diarrhea
This is due to toxicity and kidneys unable to get rid of acid build-up.
What are the signs and symptoms of lactic acidosis?
- dyspnea; deep and rapid respirations - to blow off extra CO2 gas
- dizziness, headache, lethargy, coma - acidosis affects the brain
- muscle weakness - due to increased potassium with acidosis
How long should metformin be held if the client is to receive IV contrast?
Hold metformin before and up to 48 hours afterwards for a client getting IV contrast for tests that end in -gram or -graphy.
Taking both together can cause kidney failure.
