Insulin Flashcards by noelle wilson

What is insulin?

A hormone that controls the storage & metabolism of carbs, proteins, & fats

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Where does activity of insulin primarily take place in the body?

Liver, in muscle, & adipose tissue

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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

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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

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What is the goal of insulin therapy?

To mimic physiological control of blood glucose levels

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What is basal insulin rate?

Insulin released continuously during periods of fasting

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What is postprandial insulin?

Released after meals to control blood glucose spikes

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What occurs due to the balance between basal insulin rate & postprandial insulin?

Steady state glucose regulation

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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

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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

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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

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What is the best insulin absorption site?

Abdomen

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List 2 other sites that can be used to admin insulin subcutaneously

1) outer thigh
2) upper arm

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Injection timing for insulin Hint: 3

1) before meals (for meal-related insulin)
2) bedtime (for LA)
3) monitoring: 4x daily (before meals & bedtime)

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Effects of lipodystrophy Hint: 2

1) fat hardening/ thickening (dimpling of skin)
2) reduced insulin absorption (leads to poor glucose control)

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List 3 methods of insulin administration

1) insulin pumps
2) insulin pen injectors
3) insulin syringes must be used

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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

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How are insulin syringes/ vials measured?

In units!!!

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What color cap is an insulin syringe?

orange

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Multi-dose vials

Regular insulin → clear
NPH (intermediate) → cloudy

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What population may we see inhaled insulin used in?

Pediatrics

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What are insulin pens?

Pre-filled, disposable cartridges
easier for patients than vials/ syringes

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What is required when using insulin pens?

Priming

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How do you prime an insulin pen?

Turn dial to 1 unit & press button before injecting
ensures no air is injected instead of insulin

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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