insulin

Management of Type 2 Diabetes

  • Initial Treatment Strategy

    • Start with oral medications such as metformin or another oral glycemic agent.

    • Avoid immediate insulin administration; insulin is a last resort if oral medications are ineffective.

    • Example:

    • Patient may receive metformin first, and if glycemic control is inadequate, insulin may be added to the regimen.

Nephrotoxicity of Metformin

  • Risks of Metformin:

    • Nephrotoxic, requires careful management concerning kidney health.

    • Pre-scan Protocol: Stop metformin 24 to 48 hours prior to any scans requiring IV contrast to protect kidney function.

    • Kidney Injury: IV contrast dye is a primary cause of acute kidney injury, necessitating this precaution.

Risk Factors for Diabetes

  • Distinction between modifiable and non-modifiable risk factors:

    • Non-modifiable risk factors:

    • Sex

    • Age

    • Race

    • Family history (e.g., history of diabetes in relatives)

    • Modifiable risk factors:

    • Diet

    • Exercise regimen

    • Lifestyle changes

Insulin Administration

  • Onset and Administration Timing:

    • Rule of thumb: Onset time is equal to the time of eating (E time).

    • Insulin types and their administration times:

    • Lispro: Administer 15 minutes before meals.

    • Regular insulin: Administer 30 minutes before meals.

    • NPH: Administer 1 hour before meals.

    • Long-acting: Administer 70 minutes before meals.

    • Clinical Guidance: Always administer insulin prior to meal times.

Insulin Types and Identification

  • Memorization Aid:

    • Regular insulin is indicated by an R on the vial.

    • NPH insulin is indicated by an N on the vial.

    • Long-acting insulins (e.g., Lantus, Lispro) are indicated by an L.

Mixing Insulin

  • Practical Skills: In nursing practice, mixing insulin occurs primarily with regular insulin and NPH.

    • Process for Mixing:

    • Prepare 30 units of air for the total insulin dosage (20 units NPH, 10 units regular).

    • Inject air into the cloudy (NPH) vial first to avoid contamination.

    • Inject air into the clear (regular) vial next, and then draw up the correct dosage of regular insulin.

    • Finally, draw up NPH insulin.

    • Visual Comparison:

    • Regular insulin: Clear

    • NPH insulin: Cloudy (think dirty vs. clean water).

Peak Times for Insulins

  • Important to be aware of peak action times for patient education regarding snacks:

    • NPH: Peak time is 6 to 14 hours post-administration; thus, snack should be given at the midpoint (8 hours post-administration, e.g., 3 PM for a 7 AM administration).

Insulin Syringes and Storage

  • Insulin Measurement:

    • Insulin is prescribed in units, not milliliters; typical syringes come in 100 units, 50 units, or 30 units.

    • Storage Requirements: Insulin should be kept at room temperature for up to one month once opened, and it should not be stored in the refrigerator.

Subcutaneous Injection Techniques

  • Standard angle for subcutaneous injections is 90 degrees. However, use 30 degrees in malnourished patients with little body fat.

  • Needle vs. Needleless methods:

    • Needle often leads to slower absorption; alternative technologies (like jet injectors, which do not require a needle) are more costly and less common.

Diabetes Patient Assessment

  • Key Assessment Areas:

    • Weight: Monitor for significant changes (usually defined as 10 pounds in a short period).

    • Vital Signs: Check for orthostatic BP changes.

    • Blood Glucose levels before meals and at bedtime.

    • Urinary Assessment for ketones, especially in cases of Diabetic Ketoacidosis (DKA).

    • Skin and Feet Condition: Look for sores and signs of infection, a common complication in diabetics.

    • Neuropathy Symptoms: Tingling, burning, or numbness in extremities.

    • Regular Eye Checkups: To monitor for diabetic retinopathy; recommended annually for comprehensive eye exams.

Nutritional Management in Diabetes

  • Diet and weight management are crucial for diabetic control, specifically for modifiable risk factors like dietary choices and physical activity.

    • Individuals with Type 1 diabetes are typically not candidates for pancreas transplants since the underlying insulin production issue persists even with a transplanted organ.