insulin

Overview of Diabetic Treatment and Pharmacology

  • Discussion on diabetic treatment includes comprehensive coverage of pharmacology, especially focusing on insulin.
  • Importance of understanding the types of diabetes: Type 1 and Type 2.

Type 1 Diabetes

  • Definition: Characterized by complete lack of insulin due to autoimmune destruction of the pancreas.
  • Insulin Dependence: Patients with Type 1 diabetes are insulin-dependent.

Type 2 Diabetes

  • Definition: Involves insulin resistance primarily due to lifestyle factors (diet, exercise) and some genetic predispositions.
  • Initial Management: Focus on lifestyle modifications such as diet and exercise to improve insulin sensitivity before medication.
  • Pharmacological Treatment: Introduction of oral medications or insulin if lifestyle changes are insufficient.

Seven Rules of Insulin

  • Rule 1: Peaks Equal Plates

    • Overview: Food should be provided during insulin peak times to mitigate the risk of hypoglycemia.
    • Risk Monitoring: Greatest risk for low blood sugar occurs during the insulin peak times, emphasizing the importance of timing in relation to meals.
    • Hypoglycemia Threshold: Blood sugar levels below 70 mg/dL are considered low.

  • Rule 2: Response to Low Sugar

    • Symptoms of Hypoglycemia: Signs include shakiness, pallor, sweating, and clamminess.
    • Immediate Intervention: Administer sugary candy if patient is awake; use sugary fluids (soda, juice, crackers, low-fat milk) for rapid absorption.
    • Consideration for Unresponsive Patients: For those who are unarousable, administer IV dextrose 50% (D50). Assessment must precede treatment.
    • Follow-up: Always reassess blood sugar after 15 minutes post-intervention.

  • Rule 3: Insulin Types

    • Long-Acting Insulin: Characterized by no peaks and should not be mixed with other insulins. Examples include Detremir, Glargine, and Lantus.
    • Memory Trick: "Grumpy old men" representing long-acting insulins as they do not mix well and have no peak effects.

  • Rule 4: IV Use of Insulin

    • Key Fact: Only regular insulin can be administered via IV. Other insulins (NPH, Lispro, Lantus) are not suitable for IV use.
    • Memory Trick: Regular insulin is “ready to go IV” and must be noted as the only form allowed.

  • Rule 5: Mixing Insulin

    • Process: Always draw up clear insulin (regular) before cloudy (NPH) to prevent contamination and ensure proper administration.
    • Visual Reminder: Think of clear days before cloudy ones.

  • Rule 6: Injection Sites

    • Rotation of Sites: It's critical to rotate injection sites every 2-3 weeks to prevent tissue damage.
    • Preferred Location: Injection should be given in the abdomen near the navel.
    • Technique: Never aspirate the syringe during subcutaneous injections to avoid complications.

  • Rule 7: Insulin on Sick Days

    • Management During Illness: Yes, insulin is necessary even if the patient is not eating or nauseous; however, monitor glucose closely.
    • Adjustments: Increase insulin dose during stressful events such as surgery, sepsis, or infections.

Insulin Types Overview

  • Long-Acting Insulin:

    • Types: Detremir ("lasts all year") and Glargine ("large lasting"). No risk of hypoglycemia due to prolonged action.

  • NPH Insulin:

    • Characteristics: Intermediate-acting insulin, mixed with regular insulin for treatment. Peak time varies between 4-12 hours.
    • Risk of Hypoglycemia: Most pronounced between 5-6 hours post-administration.

  • Regular Insulin:

    • Usage: The only insulin allowed for IV push. Peak times are between 2-4 hours.

  • Rapid-Acting Insulin:

    • Types: Includes Lispro, Aspart, and Glulisine, marked by quick onset (15 minutes) and a peak time of 30-90 minutes.
    • Key Usage: Must be administered when the patient is about to consume food, requiring immediate eating.
    • Memory Aids:
    • Aspart: “Move your ass parts.”
    • Lispro: “Less time for onset.”
    • Glulisine: “Moves like a limousine.”

NCLEX Practice Questions

  • Significance of learning peaks: Questions typically focus on peak times and their related food administration requirements.
  • Sample NCLEX Questions:
    • Understanding Timing: e.g., if regular insulin is administered at 12 PM, risk for hypoglycemia peaks between 2 PM and 4 PM.
    • Food Timing for Aspart Insulin: Should be consumed immediately (within 10-15 minutes of administration).
    • Long-Acting Insulins like Glargine: No need for specific eating times due to lack of peaks.
    • NPH Injection Timing: If taken at 7 PM, watch for hypoglycemia around midnight.

Insulin Infusion Pumps (CSII)

  • Purpose and Benefits: Aimed at providing consistent insulin delivery, particularly beneficial for noncompliant Type 1 patients.
  • Management Requirements: Blood sugar checked at least four times daily; insulin bolus given pre-meal.
  • Troubleshooting: Always prioritize patient assessment over machinery issues.

Conclusion

  • Regular practice with these details and concepts is essential for NCLEX success. Printing study guides and active recall methods are recommended for comprehensive learning.