- 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
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