Insulin + Care

Short duration

Regular

Intermediate

Long duration

types of insulin

LAG

lispro (Humalog)

aspart (NovoLog)

glusiline (Apidra)

Rapid Short duration: drugs

Onset: 15 - 30 mins

Duration: 3 - 6 hr

SQ or via insulin pump

faster than reg insulin but shorter duration

5 - 10 min B4 meals

Rapid Short Duration: Dose + Route

Humulin R

Novolin R

Reg duration: drugs

Check BG b4 admin @ 8, 12, 9

can be mixed w/ NPH

NR 2 RN

ONLY one given as IV

Reg insulin Implications

SQ, IM, & Oral inhalation (not currently used)

Onset: 30 - 60 min

Peak: 1 - 5 hr

Duration: up to 10 hr

clear solution

Reg duration: dose + route

Injected 2 - 3X DAILY & btwn meals and during night

ONLY one that can be mixed w/ short acting

Allergic Rxs possible

Cloudy

SQ only

NPH insulin Considerations

glargine (Lantus)

detemir (Levemir)

Onset: 1.5 hr

Peak: Peakless

Duration: up to 24 hr

Long duration: Drugs

refrigeration

Unopened vials should be stored under

frozen

insulin SHOULD not be

the expiration date if kept in the fridge

insulin can be used until

1 month w/out losing effectiveness

how long can insulin be kept up to?

direct sunlight and extreme heat

Insulin needs to avoid?

Mixtures of insulin in vials are stable for 1 month at room temp, and for 3 months under refrigeration

mixtures in prefilled syringes should be stored in a refrigerator for at least 1 week; they should be stored vertically w/ the needle pointing up

how long can mixed insulins be effective?

Required by all pts w/ T1DM and many pts w/ T2DM

IV insulin for DKA

Gestational diabetes

Hyperkalemia

aids in the diagnosis of growth hormone (GH) deficiency

Indications of insulin

• Hypoglycemia: BG < 70 mg/dL

• D/I: rapid Tx mandatory

  Conscious Pts: fast acting oral sugar (eg, glucose tablets, OJ, sugar cubes, non-diet soda).

  Unconscious: swallowing/gag reflex is suppressed: NPO, give IV glucose or parenteral glucagon for TX

• Hypokalemia

complications of Insulin

where fat tissue builds up under the skin at insulin injection sites, causing lumps or bumps.

Prevention: rotate injection sites

Lipohypertrophy

DKA

Hyperosmolar hyperglycemic state (HHS)

both are life-threatening

Acute complications of Poor glycemic control

Hyperglycemia is more severe than HHS

ketoacidosis characteristic of DKA absent in HHS

Which acute complication is more severe

severe sx’s of insulin deficiency

sx’s evolve quickly w/in hrs or days

most common complication in peds pts and leading cause of death

hyperglycemia, ketoacids, hemoconcentration, acidosis, coma

DKA sx’s

insulin replacement

BIcarbonate for acidosis

Water & sodium replacement

K replacement

Normalization of glucose levels

DKA TX

• can evolve slowly: changes w/in a month or 2 b4 s’s & sx’s become apparent

• large amount of glucose excreted in urine

• results in dehydration and loss of blood volume

• occurs frequently w/ T2DM w/ acute infx, acute illness, or some other stress

HHS

• No sweet or acetone-like smell to urine or breath

• blood “thickens” and becomes sluggish

• little or no change in ketoacid levels and pH

• If left untreated, it can lead to coma, seizures, and death

Characteristics of HHS

correct hyperglycemia and dehydration w/ IV insulin, fluids, and electrolytes

HHS Tx

• Preferred Tx is IV glucose

• Glucagon immediately raises BG levels

• Can be used if BG is not available

• Delayed elevation of BG

• CANNOT correct hypoglycemia Resulting starvation bc there is nothing for glucagon to break down in the liver

• Promotes glycogen breakdown and the malnourished have little glycogen left

Glucagon Tx of Sev Hypoglycemia