christie candelaria, bsn, ma,rn,ccrn

1. Christie Candelaria, BSN, MA,RN,CCRN

3. Different types of Insulin Six different types of insulin Rapid acting Regular NPH (N)-slower and longer acting Lente (L)- slower and longer acting Ultralente- slowest and longest acting Long acting basal-slowest and longest acting

4. Route of Administration Subcutaneous (hypodermic) �into the subcutaneous tissue Injected into the adipose tissues beneath the skin, a drug moves into the blood stream more rapidly than if given by mouth. Allows slower, more sustained drug administration than IM injection. Common sites: outer aspect of the of the upper arm, anterior thigh, loose tissue of the lower abdomen, upper hips, buttocks, and upper back.

5. Subcutaneous Injections Advantages Allows slower absorption Minimal tissue Risk Minimal risk of hitting blood vessel Cautions Do not give in scarred areas, in moles, inflamed or edematous areas Sites Outer, upper arm, Anterior Thigh, Lower abdomen, upper Hips, buttocks, upper Back. Needles 25 to 27 G- 5/8� to �� Syringes 1 ml = 100 unit of Insulin (U 30 & U 50) Position � 45-90 degree angle

6. Onset, Peak, and Duration of Insulin Types and Therapeutic Actions Onset. The length of time before insulin reaches the bloodstream and begins lowering blood glucose. Peak time. The time during which insulin is at its maximum strength in terms of lowering blood glucose levels. Duration. How long the insulin continues to lower blood glucose. Refer to page 557.

7. Insulin Injection Sites

8. Blood Glucose Monitoring Blood glucose levels are often checked q ac (30 minutes before meals), q hs (at bedtime), or prn (as needed) Preprandial* (fasting, or before a meal)�70-130 mg/dl Postprandial* (1-2 hours after the start of a meal)�<180 mg/dl These ranges may very depending on institution and physician protocols.

9. Procedure of Withdrawing Insulin from a vial WASH HANDS! Check the med order and make sure the solution in the vial matches the ordered solution. (7 Rights of Medication Administration) Obtain an insulin syringe. Pick up the vial and verify the type of insulin that is prescribed. Check the patient�s most recent blood glucose. If in doubt or assessment changes always recheck and reassess. If applicable, verify the blood glucose and use sliding scale insulin administration dosage on the patient�s MAR. Wipe the insulin vial with a sterile gauze alcohol pad, if the insulin is cloudy roll between palms of your hands. Withdraw the appropriate type and amount of insulin. Remember the order and dosage must be verified by 2 RNs before administration

10. Procedure of Withdrawing Insulin from a vial Pull back on barrel of syringe to draw in a volume of the ordered medication dose. Holding the vial between your thumb and fingers of the non-dominant hand, insert the needle through the rubber stopper into the air space � not the solution!!!!!!!!!!!!!!!! Invert the vial & withdraw the ordered dose of medication by pulling back on the plunger. Make sure the needle is in the solution to be withdrawn. Expel air bubbles and adjust dose if necessary. Remove needle from vial and cover the needle with guard using one hand or scoop method. Take Medication into client�s room and verify 7 rights, administer the SC injection. Remember to never massage the insulin injection site.

11. Mixing 2 types of Insulins Regular insulin can be mixed with all other types Semilente insulin (zinc suspension) can not be mixed with NPH insulin Remember to always draw up clear or regular/fasting acting insulin FIRST Then the cloudy or slower acting insulins i.e. NPH

12. Hypoglycemia Hypoglycemia is the most common adverse effect of insulin. Treatment of a blood sugar <70 may be reversed by giving the patient 15 g of glucose which is the equivalent to 4 oz of orange juice, 1 T jelly or 1 T honey. Diabetics will always have a standing order for a D50 injection <60, this is administered via IV or IVP.

13. Education Explain that the dose of insulin is adjusted according to their blood glucose level. Educate your patient, explain that the lowest blood glucose reading is usually obtained before meals. The highest level is obtained 1-2 hours after meals. Levels can very depending on the variables listed above.

14. Goal of Blood Glucose Monitoring and Insulin Administration The immediate goal is to obtain Blood Glucose levels between 70-130. The ultimate goal is to obtain a HgbA1c of <6.5. Overall good control of blood sugar levels in diabetes does correlate with decreased incidence of diabetic complications