Categories Of InsulinTime Course

Rapid Acting

Agent

Lispro HumalogAspart Novolog

Onset

10-15 min10-15 min

Peak

1 hour

40-50 min

Duration

3h

4-6 hours

Indications

Used for rapid reduction of glucose level, to treat postprandial hyperglycemia, and / to prevent nocturnal hypoglycemia

Short Acting Regular(Humalog R, Novolin R)

½ hour – 1h

2-3 h 4-6 h Usually administered 20-30 mins before a meal; may be taken alone or in combination w/ longer action insulin

Categories Of InsulinTime Course

Intermediate Insulin

Agent

NPH - Neutral protamine HagedornHumulin N, Iletin II Lente,Ileten II NPH,Novolin I(lente)Novolin N (NPH)

Onset

2-4h

3-4h

Peak

6-12h

6-12

Duration

16-20h

16-20

Indications

Usually taken after food intake

Long Acting

Very Long- Acting

Ultra Lente

Glargine (Lantus)

6-8h

1h

12-16h

Continuous(no peak)

20-30h

24h

Used primarily to control fasting glucose levelUsed for basal dose

Preparing Insulin InjectionsPreparing Insulin Injections

Equipment :Equipment :

• Insulin(s)

• 100-unit or 50-unit insulin syringe with needle

• alcohol wipes

• medication card

ProcedureProcedure

1. Check medication orders. Gather equipment.1. Check medication orders. Gather equipment. Wash your hands.Wash your hands. (Insulin does not need to be refrigerated)(Insulin does not need to be refrigerated)

2. Rotate intermediate or long-acting insulin bottle2. Rotate intermediate or long-acting insulin bottle between hands.between hands. (Rationale: This brings cloudy insulin solution(Rationale: This brings cloudy insulin solution into suspension. into suspension. RegularRegular insulininsulin (rapid acting) (rapid acting) is is clear clear and requires and requires NO rotationNO rotation.).)

For One Insulin Solution

3. Wipe top of insulin bottle with alcohol swab. Take off needle guard and place on tray.

4. Pull plunger of syringe down to desired amount of medication (e.g.,30 units). Inject amount of air into air space, not solution. (Rationale: Injecting air directly into insulin solution causes bubbles. Bubbles can confuse drug amount withdrawn).

5. Draw up ordered amount of insulin into syringe.

6. Remove needle from vial, and expel air from syringe.

7. Replace needle guard. Take medication to client’s room.

8. Follow protocol for administration of medications by subcutaneous injections.

For Two Insulin Solutions1. Check medication orders & injection site. Wash hands. Gather equipment. Insulin does not need to be refrigerated.

2. Rotate intermediate or long-acting insulin bottle between hands. (Rationale: This brings cloudy solution into suspension for insulins other than regular).

3. Wipe top of insulin bottles with alcohol. Take needle guard off and place on tray.

4. Pull plunger of syringe down to desired units of intermediate or long-acting insulin.

5. Bottle N : Insert needle and inject prescribed amount of air into intermediate-acting or long-acting bottle. Do not touch insulin with the needle. (Rationale: This method prevents contamination of the second bottle (R).

6. Bottle R (regular insulin) : Inject air into insulin, invert bottle, and withdraw medication. (Rationale : Withdrawing regular insulin first prevents inadvertent injection of intermediate-acting insulin into the regular insulin bottle, which would inactivate its rapid action).

7. Withdraw needle from bottle and expel all air bubbles.

8. Invert bottle N and insert needle. Take care not to push any regular insulin into bottle. This can be avoided by holding steady pressure on plunger with you small finger when inserting needle into bottle.

9. Pull back on plunger to obtain exact prescribed amount of intermediate or long-acting insulin. The total insulin dose now includes both the regular insulin (previously drawn up into syringe), and the intermediate or long-acting insulin you have just drawn up. (Do not rotate syringe to mix insulins).

10. Expel air from syringe. Replace needle guard. Follow protocol for administration of medications by subcutaneous injections.

Complications of Insulin Therapy1. Local allergic reactions - redness, swelling, tenderness, induration or a 2 to 4 cm wheal) may appear at injection site 1 to 2 hrs. after insulin administration.

2. Systemic allergic reactions – rare; immediate local skin reaction that gradually spreads into generalized urticaria.

3. Insulin Lipodystrophy – localized reaction occuring at the site of the insulin injections.

• Lipoatrophy – loss of sub Q fats and appears as slight dimpling of sub Q fats.• Lipohypertrophy – dev’t. of fibrofatty masses at the injection site.

4. Insulin Resistance – defined as a daily insulin requireme of 200 units or more (due to obesity). Immune bodies develop and bind the insulin, decreasing the insulin available for use.

5. Morning Hyperglycemia - elevated bld. Glucose upon arising in the morning may be due to :

-Dawn Phenomenon – characterized by normal bld. Glucose level until 3 a.m., when blood Glucose levels begin to rise.-Somogyi effect - nocturnal hypoglycemia followed by rebound hyperglycemia.-Insulin waning – progressive increase in bld. Glucose from bedtime to morning.

Nursing Considerations• Rotating injection areas is not recommended due to variation in insulin absorption and action. A body area should be used consistently. Give injections consecu- tively at points 1 to 8, then move to another site.

• The injection site should be 1 inch from the previous injection site. Absorption is most predictable in the abdomen.

• Avoid injection into area to be actively used because absorption is enhanced.

• Wait for 30 seconds after slowly injecting insulin before withdrawing needle to prevent insulin leakage. Hold alcohol wipe over injection site for several seconds. This hastens absorption and drug action.

• Aspirating before and massaging after injecting the insulin are NOT recommended due to potential for tissue damage.

• Insulin type and brand should remain consistent for an individual client.

Nasal Spray Insulin

• Intranasal insulin may soon replace regular insulin boluses for mealtimes. A single puff of 30 units replaces 8 units sub Q.

• Advantages : It has rapid physiologic action and can be be either before or after meals.

• Disadvantages : It requires higher doses and thus be more expensive. A potential side effect might be nasal irritation.

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