UNIT 9 Insulin CHAPTER 50 Flashcards
What is Diabetes? What are the signs and symptoms
Chronic disease of deficient glucose
metabolism
Insufficient insulin secretion from beta
cells
Impaired insulin use
Major symptoms: polyuria, polydipsia,
polyphagia
How many types of Diabetes are there, and what does it represent?
Types
Type 1
Insulin-dependent DM
Type 2
Insulin resistant
Secondary
Due to medications (glucocorticoids, thiazide
diuretics, epinephrine)
Gestational
Due to hormonal changes
What is the action of insulin?
Action
Promote use of glucose by body cells, store
glucose as glycogen in muscles
Use
Reduce blood glucose in diabetes
INSULIN
What are the side effects of of Insulin
Hypoglycemia
Headache, dizziness, confusion, slurred speech,
hunger, weakness
Nervousness, anxiety, agitation
Tremors, sweating
Flushing, lethargy
Redness, irritation or swelling at injection site
What are the Adverse Effects
Adverse Reactions
Tachycardia, palpitations, hypoglycemic reaction
Shock, anaphylaxis, ketoacidosis(fruity odor of breathe)
INSULIN SIDE EFFECTS
ADVERSE REACTIONS
Should you take insulin with beta blockers?
Interactions
Decreased glucose with aspirin, oral anticoagulants,
alcohol, other hypoglycemics, Beta blockers
Increased glucose with thiazides, glucocorticoids,
oral contraceptives, thyroid drugs, smoking
Contraindications
Hypoglycemia
Allergy
What are the 5 types of Insulin?
Rapid-acting
Short-acting
Intermediate-acting
Long-acting
Combinations NPH 70/30 REGULAR
RAPID ACTING INSULIN
Insulin lispro (Humalog)
Onset of action (15-30 minutes)
Peak (30 minutes to 90 minutes)
Duration (3 to 5 hours)
TAKE WITH FOOD , MEAL TRAY
SHORT ACTING INSULIN
Short-acting insulin (clear)
Insulin Regular
Onset of action (30 minutes)
Peak (1.5 to 3.5 hours)
Duration (4 to 12 hours)
INSULIN TYPES
INTERMEDIATE ACTING INSULIN
Intermediate-acting (cloudy)
NPH Insulin
Onset of action (1 to 2 hours)
Peak (4 to 12 hours)
Duration (14 to 24 hours)
LONG ACTING INSULIN
Long-acting
Insulin glargine
* Onset of action (1 to 1.5 hours)
* Duration (24 hours)
* Administered at bedtime
INSULIN TYPES
COMBINATION INSULIN
Combinations
Composed of short- and intermediate-acting or rapid- and intermediate-acting
Humulin or Novolin 70/30 (NPH 70%, insulin regular 30%)
NPH 50%, regular 50%
Can be mixed in other strengths
What is the most important instruction for a pt using an insulin pen?
prime the insulin pen needle first before use
Should you only use the abdomen when administrating insulin
NO
rotate sites to prevent lipodystrophy (causes damage to adipose tissue, which prevents proper fat storage. )
What is Sliding Scale Insulin used for?
Sliding-scale insulin coverage
Adjusted doses dependent on individual blood
glucose
Usually done before eating and at bedtime
Usually uses rapid or short-acting insulin
Example
151-200 2 units insulin lispro
201-250 4 units insulin lispro
251-300 6 units insulin lispro
301-350 8 units insulin lispro
Should you keep unopened Insulin in the sun or fridge?
A. Sun
B. fridge
B. fridge
Storage of insulin
Keep unopened inulin in refrigerator.
Remove from refrigerator 30 minutes before
injection to decrease tissue irritation
May store open insulin at room temperature for 30
days or in the refrigerator for 3 months
Avoid storing insulin in direct sunlight or at high
temperatures.
Should you administer Insulin before or after checking the glucose level?
A. Before
B. After
A. Before
Assessment
Take a medication/medical history
Assess the type of insulin and dosage
Vital signs
Blood glucose reading, A1C lab
Signs and symptoms of hypo/hyperglycemia
Nursing Intervention for insulin
Nursing interventions/Teaching
Monitor vital signs and glucose levels, hBA1c
Instruct patient to report hypoglycemia and
hyperglycemia & that hypoglycemia more likely
during the peak time of insulin( nervousness, irritability, tremors)
Teach how to stop a hypoglycemic event(meat routine meals , small and frequent carb)
Encourage compliance with diet, insulin, exercise.
Advise patient to wear medical alert tag.
Teach patient how to check blood glucose.
Teach patient how to administer insulin and rotate
sites to prevent lipodystrophy
What life-threatening complication can insulin cause?
A. Thrombocytopenia
B. Agranulocyte
C. Hypoglycemia
D. Uticartia
C. Hypoglycemia
What are some S/S of Hypoglycemia
EARLY SIGNS
Peripheral autonomic symptoms,
including sweating,
irritability,
tremors,
anxiety, tachycardia,
and hunger,
cold skin
clammy skin
LATE SIGNS
serve as an early warning system and occur before the symptoms of confusion,
paralysis,
seizure, and
coma occur from brain glucose deprivation.
A patient with type 1 diabetes mellitus is
ordered insulin therapy once daily to be
administered at bedtime. What is the type
of insulin the patient is most likely
receiving?
A. Insulin glargine
B. Lente insulin
C. Lispro insulin
D. Regular insulin
Answer: A
Rationale: Insulin glargine (Lantus) is long-acting insulin
with an onset of 1 hour. It is evenly distributed over a 24-
hour duration of action; thus, it is administered once a day,
usually at bedtime. Intermediate-acting insulins include
neutral-protamine-Hagedorn (NPH), Lente, and Humulin N.
Rapid-acting insulins include insulin lispro. Regular insulin
is short acting
When teaching the patient about the
storage of insulin, which statement will the
nurse include?
A. Keep the insulin in the freezer.
B. Warm the insulin in the microwave before
administration.
C. Do not place insulin in sunlight or a warm
environment.
D. Open insulin vials lose their strength after one
year.
Answer: C
Rationale: Unopened insulin vials are refrigerated until
needed. Once an insulin vial has been opened, it may be
kept (1) at room temperature for 1 month or (2) in the
refrigerator for 3 months. Insulin is less irritating to the
tissues when injected at room temperature. Insulin vials
should not be put in the freezer. In addition, insulin vials
should not be placed in direct sunlight or in a high-
temperature area. Prefilled syringes should be stored in the refrigerator and should be used within 1 to 2 weeks.
Opened insulin vials lose their strength after approximately
3 months.
Which time frame would be most appropriate
for administering sliding-scale lispro insulin?
A. Within 30 minutes of consuming breakfast
B. When the breakfast tray is served and ready to
eat
C. Within 1 hour of obtaining blood glucose
measurement
D. Within 15 minutes of obtaining blood glucose
measurement
Answer: B
Rationale: Lispro should be given 5 minutes before eating because the onset of action is 5 to 15 minutes.
A patient receives lispro insulin. The first
nursing action following administration is
to
A. test the patient’s blood glucose level.
B. ensure that the patient has a meal.
C. provide the patient with 4 ounces of orange
juice.
D. administer the next dose of insulin.
B. ensure that the patient has a meal.
Answer: B
Rationale: Lispro (Humalog) insulin is a rapid-acting insulin. It must not be administered more than 5 minutes before
mealtime.
