UNIT 9 Insulin CHAPTER 50

Question 1

What is Diabetes? What are the signs and symptoms

Answer 1

Chronic disease of deficient glucose
metabolism
 Insufficient insulin secretion from beta
cells
 Impaired insulin use
 Major symptoms: polyuria, polydipsia,
polyphagia

Question 2

How many types of Diabetes are there, and what does it represent?

Answer 2

Types
 Type 1
 Insulin-dependent DM
 Type 2
 Insulin resistant
 Secondary
 Due to medications (glucocorticoids, thiazide
diuretics, epinephrine)
 Gestational
 Due to hormonal changes

Question 3

What is the action of insulin?

Answer 3

Action
Promote use of glucose by body cells, store
glucose as glycogen in muscles
 Use
Reduce blood glucose in diabetes
INSULIN

Question 4

What are the side effects of of Insulin

Answer 4

Hypoglycemia
Headache, dizziness, confusion, slurred speech,
hunger, weakness
Nervousness, anxiety, agitation
Tremors, sweating
Flushing, lethargy
Redness, irritation or swelling at injection site

Question 5

What are the Adverse Effects

Answer 5

Adverse Reactions
Tachycardia, palpitations, hypoglycemic reaction
Shock, anaphylaxis, ketoacidosis(fruity odor of breathe)
INSULIN SIDE EFFECTS
ADVERSE REACTIONS

Question 6

Should you take insulin with beta blockers?

Answer 6

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

Question 7

What are the 5 types of Insulin?

Answer 7

 Rapid-acting
 Short-acting
 Intermediate-acting
 Long-acting
 Combinations NPH 70/30 REGULAR

Question 8

RAPID ACTING INSULIN

Answer 8

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

Question 9

SHORT ACTING INSULIN

Answer 9

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

Question 10

INTERMEDIATE ACTING INSULIN

Answer 10

Intermediate-acting (cloudy)
 NPH Insulin
 Onset of action (1 to 2 hours)
 Peak (4 to 12 hours)
 Duration (14 to 24 hours)

Question 11

LONG ACTING INSULIN

Answer 11

Long-acting
Insulin glargine
* Onset of action (1 to 1.5 hours)
* Duration (24 hours)
* Administered at bedtime
INSULIN TYPES

Question 12

COMBINATION INSULIN

Answer 12

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

Question 13

What is the most important instruction for a pt using an insulin pen?

Answer 13

prime the insulin pen needle first before use

Question 14

Should you only use the abdomen when administrating insulin

Answer 14

NO

rotate sites to prevent lipodystrophy (causes damage to adipose tissue, which prevents proper fat storage. )

Question 15

What is Sliding Scale Insulin used for?

Answer 15

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

Question 16

Should you keep unopened Insulin in the sun or fridge?
A. Sun
B. fridge

Answer 16

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.

Question 17

Should you administer Insulin before or after checking the glucose level?

A. Before
B. After

Answer 17

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

Question 18

Nursing Intervention for insulin

Answer 18

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

Question 19

What life-threatening complication can insulin cause?

A. Thrombocytopenia
B. Agranulocyte
C. Hypoglycemia
D. Uticartia

Answer 19

C. Hypoglycemia

Question 20

What are some S/S of Hypoglycemia

Answer 20

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.

Question 21

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 21

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

Question 22

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 22

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.

Question 23

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 23

Answer: B
Rationale: Lispro should be given 5 minutes before eating because the onset of action is 5 to 15 minutes.

Question 24

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.

Answer 24

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.

Question 25

A patient received regular insulin at 7:30 AM.
At 9:30 AM the patient feels slightly hungry
and has a dull headache. The nurse
A. tests the patient’s blood glucose level.
B. ensures that the patient has a meal.
C. provides the patient with 4 ounces of orange
juice.
D. administers the next dose of insulin.

Answer 25

 Answer: A
 Rationale: The peak time for regular insulin is 2 to 4 hours.
It is most important for the nurse to check the patient’s
blood glucose level to prevent a possible hypoglycemic
reaction (insulin shock)

Question 26

A nurse gives a patient NPH insulin at 8:00 AM. At 2:00
PM the nurse finds the patient extremely lethargic but
conscious. The patient is diaphoretic and slightly
combative. The nurse should
A. call the health care provider.
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.

Answer 26

 Answer: C
 Rationale: NPH is an intermediate-acting insulin that peaks
in 6 to 12 hours. Because the patient is conscious, it is
most important for the nurse to provide the orange juice to
prevent a possible hypoglycemic reaction (insulin shock).

Question 27

Which statement by a patient taking glipizide therapy
indicates that more teaching is indicated?
A. “I will use a new needle every time I take the
medication.”
B. “I will take the medication once a day in the
morning.”
C. “I will eat my breakfast very soon after taking my
Glucotrol.”
D. “This medication stimulates my pancreatic cells
to make insulin.”

Answer 27

A. “I will use a new needle every time I take the
medication.”

Answer: A
 Rationale: Glipizide (Glucotrol) is an oral antidiabetic agent.
It is well-absorbed from the GI tract and is highly protein-
bound. Parenteral administration of this medication is not indicated. All other options are correct.