Insulin T1DM

Short duration, fast acting 

insulin lispro, insulin aspart, insulin gluosine 

insulin lispro nursing considerations

onset: 15 to 30 minutes

peak: 30 minutes to 3 hours

duration: 3 to 5 hours

short duration, slow acting

regular insulin

regular insulin nursing considerations

onset: 20 minutes to 1 hr

peak: 1 to 5 hours

duration: 6 to 10 hours

intermediate duration, slow acting 

NPH insulin 

NPH insulin nursing considerations 

onset: 1 to 2 hours 

peak: 4 to 14 hours

duration: 14 to 24 hours

long duration, slowest acting

insulin glargine, insulin detemir

insulin glargine nursing considerations

onset: 1 to 4 hours

peak: none

Duration 24 hours 

ultra long basal insulin

degludec

degludec nursing considerations

duration: > 24 hours

nursing considerations for T1DM insulin therapy

monitor for hypoglycemia (< 70 mg/dL)

diaphoresis, tachycardia, shakiness, palpitations 

concious patients: administer 15 g CHO snack 

not fully concious patients: IV, subcutaneous or IM injection 

basal/bolus therapy

most common. check blood glucose FIRST, then administer rapid acting insulin (before meals and before bedtime) - Glargine, NPH

Glargine (long acting) + lispro/ aspart (rapid acting)

less injections (4) but more expensive

NPH (intermediate) + lispro/ aspart (rapid acting)

more injections (5) but more affordable

NPH and regular insulin can be combined by pharmacy or patient themselves. What do you have to do though?

make sure regular insulin (clean) is drawn first, then NPH (cloudy) to avoid contamination