Insulin - Pharm

s/sx of hypoglycemia

dizziness, tachycardia, diaphoresis, poor ability to concentrate, possible syncope

s/sx of hyperglycemia

polyuria, polydipsia, polyphagia, fatigue, dry mouth, vision changes

cloudy insulin

intermediate acting

insulin syringes

ORANGE, ordered in units, always injected, adverse effects include hypoglycemia and insulin shock (losing consciousness from giving too much insulin), PINCH drug

insulin resistance

patients can develop antibodies against exogenous insulin, causing them to need greater amounts

rapid acting

act in less than 15 minutes, peaks in an hour, end in -log

short acting

act in 30 minutes, peaks in 2 hrs, end in -lin, most similar to natural human insulin. Regular or R

intermediate acting

onset in a few hours, duration of action is 12 hours. cloudy. NPH or N, end in -lin. Have protamine added to prolong its action

long acting

basal, administered once a day, delivers a steady amount over 24  hours, is 1st type given to Type II D

what can be mixed?

rapid acting and short acting can be mixed with protamine to last longer, but can’t be mixed with each other. NPH/intermediate can be mixed with rapid. Basal isn’t mixed with anything

Rapid analog insulin

lispro (Humalog), aspart (Novolog). clear, administered subQ, used for sliding scale

Short Acting Insulin (regular)

Humulin R, Novolin R. Can be given SQ,IV - most similar to human insulin. Used for set doses, sliding scale, insulin drips

Intermediate Acting Insulin

Humulin N, Novolin N, NPH. is more likely to cause allergic rxn due to foreign proteins added to prolong its duration

Long Acting (Basal) Insulin

glargine (crystallizes in SQ), degludec (is protein bound). Administered once a day, no peak, never mixed, never used for sliding scale

order to mix insulin

newly registered registered nurse - make sure to double check each time

combination insulin

premixed insulin with fixed ratios: 1st number is % of intermediate acting insulin, 2nd number is % of rapid acting insulin.

insulin pens

never shared between pts, prime it, hold it so they get full dose, never use it as a vial

nursing implications for insulin

check BS before giving, sliding scale, hold if patient is NPO except for basal insulin, follow mixing order, s/sx of hypo/hyperglycemia, hypoglycemia protocol

patient teaching

BS monitoring and target goals, carry fast acting carbs, s/sx of hypoglycemia, wear medical alert, exercise - know it can drop BS, diet (avoid drinking alcohol - can cause a hypoglycemic episode), rotate injection sites to avoid damage to SQ tissue