Insulin Flashcards
What is insulin?
A hormone that controls the storage & metabolism of carbs, proteins, & fats
Where does activity of insulin primarily take place in the body?
Liver, in muscle, & adipose tissue
List 2 actions of insulin
1) stimulates synthesis of glycogen by liver
2) promotes protein synthesis & helps body store fat by preventing its breakdown for energy
What cells release insulin & what is it in response to?
Released from beta cells of the islet of Langerhans in response to increased blood sugar
What is the goal of insulin therapy?
To mimic physiological control of blood glucose levels
What is basal insulin rate?
Insulin released continuously during periods of fasting
What is postprandial insulin?
Released after meals to control blood glucose spikes
What occurs due to the balance between basal insulin rate & postprandial insulin?
Steady state glucose regulation
What should normal patterns of insulin secretion (based off graph from slide)
Insulin levels will be lower prior to meals & see a spike after meals are consumed… then decreased again over night
List 4 indications for giving insulin & why
1) type 1 DM (always require)
2) type 2 DM → when not able to control w/ lifestyle & oral meds; or have progressive disease
3) Tx severe DKA / diabetic coma
4) Tx hyperkalemia in combo with glucose
5 key points for insulin administration
1) ONLY use insulin syringe
2) Admin SubQ
3) Prevent lipodystrophy by rotating sites
4) keep injections ~ 1.5 in from each other
5) give BID & use both Rt & Lt side
What is the best insulin absorption site?
Abdomen
List 2 other sites that can be used to admin insulin subcutaneously
1) outer thigh
2) upper arm
Injection timing for insulin Hint: 3
1) before meals (for meal-related insulin)
2) bedtime (for LA)
3) monitoring: 4x daily (before meals & bedtime)
Effects of lipodystrophy Hint: 2
1) fat hardening/ thickening (dimpling of skin)
2) reduced insulin absorption (leads to poor glucose control)
List 3 methods of insulin administration
1) insulin pumps
2) insulin pen injectors
3) insulin syringes must be used
4 key points about insulin pumps
1) small subcutaneous device attached to the abd
2) continuously delivers insulin at basal rate
3) can give extra bolus doses when needed (i.e. before meals)
4) changed every 7 days or earlier if leak occurs
How are insulin syringes/ vials measured?
In units!!!
What color cap is an insulin syringe?
orange
Multi-dose vials
Regular insulin → clear
NPH (intermediate) → cloudy
What population may we see inhaled insulin used in?
Pediatrics
What are insulin pens?
Pre-filled, disposable cartridges
easier for patients than vials/ syringes
What is required when using insulin pens?
Priming
How do you prime an insulin pen?
Turn dial to 1 unit & press button before injecting
ensures no air is injected instead of insulin
How long do insulin pen cartridges last before having to replace them?
10 days
List 4 types of insulin
1) rapid-acting
2) short-acting (regular)
3) intermediate
4) long-acting
List 4 drugs considered to be rapid acting insulins
1) Aspart (Novolog)
2) Glulisine
3) Lispro (Humalog)
4) Inhaled insulin
Rapid acting insulins onest of action:
Aspart, Glulisine, Lispro → 5-15 min
Inhaled → within 1 min
Based off table!!
Onset, peak, & duration of Lispro RA insulin
Onset: 15-30 min
Peak: 30-90 min
Duration: 3-5 hrs
Based off table!!!
Usage of Lispro RA insulin
Immediately after meals or acute hyperglycemia
Based off table!!!
Onset, peak, & duration of Aspart RA insulin
Onset: 10-20 min
Peak: 40-50 min
Duration: 3-5 hrs
Based off table!!!
Usage of aspart RA insulin
Often used with other insulins
Rapid acting insulin peak times
Aspart, Glulisine, Lispro → 30-90 min (~1 hr)
Inhaled → 12-15 min
Rapid acting insulins duration of action
~ 3-5 hrs
3 key points to note when giving rapid acting insulins
1) food MUST be present
2) Usually given in conjunction w/ intermediate acting insulin
3) ALWAYS monitor for hypoglycemia
What is the most deadly type of insulin?
Rapid-acting → due to fast action
List 2 examples of SA (regular) insulin
1) Humulin R
2) Novolin R
Onset of SA (regular) insulin
30-60 min
Peak of SA (regular) insulin
2-5 hrs
Duration of SA (regular) insulin
5/6-8 hrs
Based off table!!!
Usage for giving SA insulins
With meals or for acute hypoglycemia
4 key points to note when giving SA (regular) insulin
1) used to cover glucose rise after eating
2) give 30 min before meals. Food MUST be present
3) May be given IV
4) Often given with LA insulin
What should be done if regular insulin vial looks cloudy?
Discard it!!
How do you mix regular insulin with NPH human insulin?
Draw up regular insulin first
Intermediate-acting insulins are referred to as ____ or ____
Isophane or NPH (neutral protamine Hagedorn) insulins
List 2 examples of intermediate insulins
1) Humulin N
2) Novolin N
Onset of intermediate insulin
1-2 hrs
Peak of intermediate insulin
4-12 hrs
Duration of intermediate insulin
12-18 hrs
Intermediate acting insulin provides ____ ____; _____
basal insulin; overnight
How many times a day is intermediate insulin usually given?
Twice a day
Typically split 2/3 in morning & 1/3 in evening
5 key points to note about intermediate insulins
1) pre made in 70/30 mixture of reg/NPH
2) supplied as pen for easy admin
3) Can be at room temp for 10 days
4) Cloudy vial
5) NOT for IV use
List 2 examples of LA insulins
1) Lantus (Glargine)
2) Levemir (Detemir)
Onset of LA insulin
1.5-2 hrs (2-4 hrs)
Duration of action of LA insulins
24+ hrs (no peaks or valleys → even absorption)
Based off table!!!
Usage of LA insulin
Provides basal insulin; full day coverage
4 key points for using LA insulins
1) provides steady glucose control throughout the day
2) does NOT cause hypoglycemia
3) Cannot be mixed w/ other insulins
4) Best given at bedtime
What type of patients is LA insulin used for?
Both type 1 & type 2 DM but frequent use in type 2
LA insulin can cause rare ____ ____
Nocturnal hypoglycemia
List the only 2 insulins that can be given IV
1) rapid-acting
2) short-acting
How is insulin usually dosed?
dosed at 0.6-0.8 u/kg/ day
LA insulin dosing
May see 50% given at evening dose of LA
other 50% will be given in SA before meals
How are combination insulin products dosed?
Use 0.3 u/kg/day of 70/30 & given 2/3 in morning & 1/3 in evening
Example scenario:
If patient recieved regular insulin at 8 AM when would peak occur?
~ 11 AM
Example scenario:
Patient had a small breakfast at 8 AM and feels shaky at 11 AM. What could this indicate & what is the solution?
They are likely hypoglycemic
Solution: eat more breakfast / adjust insulin dose
What is alternative dosing for insulin?
Counting carbs to determine dose
Start with 1 unit of insulin per 15 g of carbs then make adjustments
What is sliding scale insulin used for?
Used to adjust insulin doses based on blood glucose
Example protocol for sliding scale insulins:
150-200 mg/dL → __ units
201-250 mg/dL → __ units
> 400 mg/dL → ______
1) 2 units
2) 4 units
3) call doctor!!
Critical hyperglycemia levels may require what 3 things?
1) doctor consultation
2) confirming levels with lab tests
3) adjusting insulin dosages carefully
Sliding scale insulin is usually reserved for who?
Short term inpatient use
How should unopened vials/ pens of insulin be stored?
In the refrigerator
How should insulin be stored after opening?
1) room temp for 1 mo
2) refrigerator for 3 mos
3) prefilled syringes must be used within 1-2 weeks
What should you always check on insulin vials & change once opened?
Expiration dates!!!
List 8 nursing interventions when giving insulin
1) monitor VS & glucose
2) Instruct pt to report hypo/ hyperglycemia
3) encourage compliance
4) teach how to check blood glucose & how to admin insulin
5) antidote for hypoglycemia: sugar
6) try to schedule procedures in morning
7) even in NPO will need insulin for type 1DM
8) have pt wear medical alert tag
Hypoglycemia Tx (if conscious & unconscious)
Conscious → give fast acting sugar (juice, glucose tabs)
Unconscious → use glucagon injection or IV dextrose
What type of DM may have their insulin held prior to surgery unless doctor orders otherwise?
Type 2 DM
What is the importance/ significance of all diabetics wearing medical alert bracelets/ necklaces?
If unconscious → emergency responders can ID diabetes & provide sugar if needed
