Insulin (BGA)

Drug Classification: Blood Glucose Agent (Insulin)

Drug names/suffixes

Therapeutic Actions-

How does it work in the body?

Indications-

Why do we give it?

Contraindications, Cautions, Interactions

When would we not give it?

Common Adverse Effects

What are we monitoring for?

Nursing Interventions/ Patient Teaching

(Nursing Process-ADPIE)

  • Regular (fast-acting)
  • NPH (long-acting)
  • Inhaled insulin
  • lispro
  • aspart
  • glargine
  • glulisine
  • detemir
  • Treatment of type 1 diabetes mellitus
  • Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents or those experiencing extreme stress

No contraindications except episodes of hypoglycemia

Cations = pregnancy and lactation

Drug-Drug Interactions =

Any drug that decreases glucose levels

Beta blockers (can mask s/s of hypoglycemia)

Thiazide diuretics

Glucocorticoids

  • Hypoglycemia and ketoacidosis
  • Local site infection
  • Decreased blood potassium levels

Assessment:

  • Assess for contraindications or cautions
  • Assess for skin lesions; orientation and reflexes; baseline pulse and blood pressure; respiratory status (inhaled)
  • Assess body systems for changes suggesting possible complications associated with poor blood glucose control
  • Investigate nutritional intake
  • Assess activity level, including amount and degree of exercise
  • Obtain blood glucose levels as ordered; monitor Hgb A1C, urinalysis, and BMP

Diagnosis

  • Glucose and electrolyte imbalance risk related to the use of insulin and underlying disease processes
  • Malnutrition risk related to changes in glucose transport
  • Altered sensory perception (kinesthetic, visual, auditory, and tactile) related to glucose levels
  • Infection risk related to injections and disease processes
  • Injury risk related to potential hyperglycemia or hypoglycemia and injection technique
  • Coping impairment related to diagnosis and the need for injection therapy
  • Knowledge deficit risk regarding drug therapy

Planning:

– want the patient to take the drug correctly

– want the drug to work correctly

– want the patient to have minimal side effects

Implementation

  • Ensure that the patient is following a dietary and exercise regimen and is using good hygiene practices
  • Gently rotate the vial containing the agent and avoid vigorous shaking
  • Select a site that is free of bruising and scarring
  • Give maintenance doses by the subcutaneous or inhaled routes only; rotate injection sites regularly
  • Monitor response carefully
  • Monitor the patient for signs and symptoms of hypoglycemia, especially during peak insulin times
  • Always verify the name of the insulin being given
  • Use caution when mixing types of insulin
  • Store insulin in a cool place away from direct sunlight
  • Monitor the patient during times of trauma or severe stress
  • Monitor the patient's food intake; ensure that the patient eats when using insulin
  • Monitor the patient's exercise and activities
  • Protect the patient from infection, including good skin care and foot care
  • Monitor the patient sensory losses
  • Help the patient to deal with necessary lifestyle changes
  • Instruct patients who are also receiving beta blockers about ways to monitor glucose levels and signs and symptoms of glucose abnormalities
  • Provide thorough patient teaching

Evaluation

  • Monitor patient response to the drug (stabilization of blood glucose levels)
  • Monitor for adverse effects (hypoglycemia, ketoacidosis, lung function decline with inhaled insulin, and injection site irritation)
  • Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and proper administration technique)
  • Monitor compliance with the regimen