Insulin Flashcards
Insulin
Categorized according to their strength, onset of action, duration, and species source
Insulin strength
Most patients use U-100 (U-40 and U-500 are available). The numeral following the “U” indicates the number of units of insulin per milliliter
Source of Insulin
All insulins currently on market are “semi-synthetic” or “human” insulin (using recombinant DNA technology ) Some products are referred to as human insulin identical to insulin produced in pancreas (Humulin R, Humulin N, Humulin 70/30); Other products, referred to as human insulin analogs, are modified forms of human insulin (Humalog, insulin lispro):
Rapid Acting***
Trade Name: Humalog (insulin lispro) Onset: 15-30 min. Peak: 0.5-2.5 hrs. Duration: 3-6.5 hrs.
Short Acting
Trade Name: Humulin R Regular Onset: 30-60 min. Peak: 1-5 hrs. Duration: 6-10 hrs.
Intermediate Acting
Trade Name: Humulin N Levemir Onset: 60-120 mins Peak: 6-14 hrs. Duration: 16-24 hrs.
Levemir
Onset: 6-8 hrs. Peak: 12-24 hours
Long Acting
Trade Name: Lantus Onset: 70 min. Peak: NONE Duration: 24 hrs.
what insulin is given now
humlin or humalog
effects of rapid acting
immediate effects so blood glucose will drop fast so pt need to eat. don’t want pt blood glucose to bottom out
how many units of insulin depends on
blood glucose level
patients can be on both
rapid acting and intermediate acting
Humalog (insulin lispro)
rapid acting; Can be injected immediately before eating instead of 30 minutes before meals
Humalog (insulin lispro) eliminated
more quickly than regular
Humalog (insulin lispro) effects
begin 15-30 minutes
Humalog (insulin lispro) has a closer
approximation to physiologic insulin release
which insulin has less nocturnal episodes of hypoglycemia than regular insulin
Humalog (insulin lispro)
Which insulin can you administer close to meal times
Humalog (insulin lispro); Closer administration to meal times within 5-10 minutes; even shortly after the meal if necessary
Humulin R/Regular
short acting
Humulin R/Regular administered
subQ and can be given IV for hyperglycemia emergencies
Humulin R/Regular is for
routine treatment, given subQ before meals to control postprandial hyperglycemia
Humulin R/Regular effects
begin in 30-60 minutes, peaks 1-5 hours and persists up to 10 hours
Humulin N (Neutral Protamine Hagedorn) prepared
by conjugating regular insulin with protamine; the protamine decreases the solubility of NPH insulin and prolongs absorption (intermediate acting)
Humulin N (Neutral Protamine Hagedorn) onset of action
is delayed and duration of action extended
Humulin N (Neutral Protamine Hagedorn) given
twice daily to provide glycemic control between meals and during night
Humulin N (Neutral Protamine Hagedorn) can be mixed with
with regular insulin (draw up regular first in syringe)
Humulin N (Neutral Protamine Hagedorn) onset
60-120 min. Peaks: 6-14 hrs. Lasts 16-24 hrs
Humulin N (Neutral Protamine Hagedorn) supplied
as a cloudy suspension
if mixing humulin N with regular then draw up
regular (clear) insulin first then humlin N (cloudy)
Lantus (insulin glargine)
long acting
Lantus (insulin glargine) ia a
modified human insulin with a prolonged duration of action (at least 24 hours)
Lantus (insulin glargine) given
once-daily subQ, recommended at night
Lantus (insulin glargine) allows for
Allows for once-daily dosing; most like patient’s basal insulin release Lantus
after injection of Lantus (insulin glargine) the
the acidic solution is neutralized, leading to formation of microprecipitates from which small amounts of insulin are slowly released; • Result is a relatively constant concentration over 24 hours with no pronounced peak
Can you mix other types of insulin with Lantus?
no
Does Lantus “look” funny?
YES, compared to NPH, it’s clear
pt on lantus would also most likely been on what for meal time
rapid acting insulin
when administering insulin you should know
your onset, peak, & duration times
pts must _______ when receiving insulin
EAT
Consider holding or lowering insulin dose if patient
is NPO…Consult physician
when administering insulin look for
signs & symptoms of hypoglycemia
signs & symptoms of hypoglycemia **
headache, light headedness; nervousness, apprehension, tremors; excess perspiration, cold, clammy skin; tachycardia, slurred speech, confusion
signs of hypoglycemia appear when blood sugar level
is < 60 mg/dl (the more it drops the more pronounced the symptoms are
pts must _______ when receiving insulin
EAT
Consider holding or lowering insulin dose if patient
is NPO…Consult physician
when administering insulin look for
signs & symptoms of hypoglycemia
signs & symptoms of hypoglycemia **
headache, light headedness; nervousness, apprehension, tremors; excess perspiration, cold, clammy skin; tachycardia, slurred speech, confusion
signs of hypoglycemia appear when blood sugar level
is < 60 mg/dl (the more it drops the more pronounced the symptoms are
insulin keep at
room temperature but only for 1 month after opening (date). Keep Unopened bottles in refrigerator
for injections absorption is
fastest in abdomen, then deltoid, thigh, and buttocks
for injections rotating sites prevent
lipohypertrophy (increased swelling of fat tissue in skin) and lipoatrophy (loss of fatty tissue); • Rotation WITHIN on anatomic site is preferred
The equivalency of 10-15 grams of glucose (approximate servings) are:
Four lifesavers ; 4 teaspoons of sugar ; 1/2 can of regular soda or juice (can be used for Treatment of Hypoglycemia)
Once the acute episode of hypoglycemia has been treated,
a healthy, long-acting carbohydrate to maintain blood sugars in the appropriate range should be consumed. Half a sandwich is a reasonable option
What if pt is hypoglycemic and is comatose & cannot take anything by mouth?
then use glucagon
glucagon
causes a rapid release of glucose stores from the liver. It is an injection given intramuscularly to a patient who cannot take glucose by mouth. A response is usually seen in minutes and lasts for about 90 minutes.
If glucagon is not available and the patient is not able to take anything by mouth,
emergency services (for example 911) should be called immediately. An intravenous route of glucose (Dextrose 50%) should be administered immediately.
