Parenteral Insulin Administration Flashcards
What is the primary treatment for Type 1 diabetes?
Insulin
What is the preferred treatment for Type 2 diabetes?
Lifestyle changes and oral drug therapy. Insulin will be perscribed if the above no longer provide adequate glycemic control.
Insulin come from ______ and _________?
domesticated animals and labratories
What is the most pressing adverse effect of insulin?
Hypoglycemia resulting from overdose. Can lead to shock and death.
What are some drugs that interact with insulin?
Beta-blockers, corticosteroids, epinephrine, furosemide, throid hormones can all increase blood levels and decrease insulin effects. Alcohol, ACE inhibitors, propranolol acan increase insulin’s hyporglcemic effects.
What are the four types of insulin?
Rapid, Short, Intermediate, Long-acting.
What insulins appear cloudy?
NPH insulins (Humulin N, Novolin ge NPH). Intermediate-acting insulins.
What insulins appear clear, colourless
Regular insulin, insulin glulisine (Apidra), insulin lispro (Humalog), and insulin glargine (Lantus).
What are two special patient populations that require careful attention?
Children and Pregnant Women
How are insulin dosages measured for children/pregnany women?
Weight: 0.5-1.0 units/kg/day.
Rapid-acting insulin lispro is approved for children over ___ years old?
3
Humalog 25 (75% lispro protamine/25% insulin lispro) is NOT approved for children under ___ years old?
18
What percentage of Aboriginal pregnancies report gestational diabetes? The rest of the population?
Aboriginal population is 18%, Non-Aboriginal population is 3. 5%
What is the percentage risk of developing diabetes later in life, if the individual has had gestational diabetes?
30% - 60%
Does insulin cross the placenta?
No.
Is insulin exreted into human milk?
Yes.
Why is effective glycemic control essential in pregnant women?
Infants born to women with getational diabetes have a 2 - 3 fold greater risk of congenital anomalies.
What are the names of some rapid-acting insulins? What are some important characteristics of rapid insulins?
Lispro (HumaLOG), aspart (NovoRapid), glulisine (Apidra) Give immediately before meals. May be mixed with NPH.
What is short-acting insulin? What is the brand name? What are some important characteristics?
Short-acting insulin is regular insulin and the ONLY classified as short acting. It is the ONLY insulin that can be administered IV. (HumuLIN R).
What are the names of some intermediate-acting insulins? What are some important considerations?
NPH (HumuLIN N, Novolin ge NPH). Do NOT give IV. May be mixed with rapid or regular insulin.
What are the names of some long-acting insulin? What are some important considerations?
glargine (Lantus), detemir (Levemir). Do NOT give IV. Do NOT mix with other insulins. Different brands are not interchangable.
What are premixed insulins? Name several brands. What are some important considerations?
Premixed insulins are combinations of rapid or short-acting and intermediate-acting insulin which work together to optimize glycemic control. The come in ratios: 30/70, 40/60, 50/50. They help to maintain constant blood glucose levels. Usually given once or twice a day. HumuLIN 30/70 is an example. Do NOT give IV. Do NOT mix with other insulins.
What should be done with insulin before it is opened?
Refridgerate it
What should be done with insulin once opened?
Store at room tempurature. Aviod extrmem temps, and avoid exposure to sunlight.
Where should insulin be stored in high temperature environments?
Refridgerator
If insulin currently in use is stored in the fridge, what are two important considerations to make in its administration?
Never administer cold insulin. If insulin is stored in prefilled syringes (can be, for one week), ensure they are kept needle up to avoid clogging within the hub of the needle.
How should insuline be administered in a non-emergency state? (tissue which it is delivered into).
Subcutaneously
How long can insulin be stored at room tempurature? How long in the fridge?
1 month (28 days) at room tempurature, 3 months in the fridge
What is one thing the nurse should always do when starting a new insulin vial?
Write the expiry date on it.
What should you do before drawing up insulin? What insulin does not need this?
Roll insulin between hands. Regular insulin does not require rolling.
How quickly after drawing up insulin should it be administered to the patient?
With-in 5 minutes.
What should be present before administering insulin?
The meal tray. Yum.
Angle of needle during administration of insulin?
90 degress, unless patient is emaciated. If so, 45 degress.
What is the ideal location for insulin injections?
Abdomen provides the most sonsisten and rapid site for injection.
Do you know the best technique for site rotation?
Its on Pg. 611 of pharmacology text book.
Onset, Peak, Duration of rapid-acting insulin?
Onset: 10-15 min. Peak: 60-90 min. Duration: 3-5 hrs. HumaLOG, NovoRapid, Apidra
Onset, Peak, Duration of regular insulin?
HumuLIN R - Onset: 30-60 min. Peak: 2 - 4 hrs. Duration: 5 - 8 hrs.
Onset, Peak, Duration of intermediate-acting insulin?
NPH (HumuLIN N) - Onset: 1 - 3 hrs. Peak: 5 - 8 hours. Duration: 12 - 18 hrs.
Onset, Peak, Duration of long-acting insulin?
glargine (Lantus) - Onset: 90 mins. Peak: None. Duration: 24 hrs
Onset, Peak, Duration of premixed insulin?
HumuLIN 30/70 - Onset: 30 - 60 min. Peak: 4.4 hours. Duration: 16 - 18 hours.
What two things must be checked in a patient’s chart before insulin administration?
Doctor’s order (ensure it is the most recent). Insulin Order (the sheet that tells what should be administed, and the sliding scale, if there is one).
Where is daily glucose recorded?
On the diabetic record.
Is insulin a high risk medication? If so, what is required before administration?
Yes. Insulin always requires a second independent check from another RN.
What are the appropriate steps in drawing up multiple insulin types?
