GENERIC
THERAPEUTIC
NAME
ACTIONS
Insulin Insulin injection:
Humulin R, Humulin R Regular U-500 (concentrated) , Novolin ge Toronto (CAN), Novolin R, Novolin R PenFill, Regular Iletin II, Velosulin Human BR Regular insulin
– It has an onset of action (begins to reduce blood sugar) within 30 minutes of injection, reaches a peak effect at 1-3 hours, and has effects that last 6-8 hours.
Insulin is a hormone secreted by the beta cells of the pancreas that, by receptormediated effects, promotes the storage of the body's fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids.
INDICATIONS
ADVERSE EFFECTS
NURSING CONSIDERATIO N
INDICATIONS
Intermediate Insulin
– It has an onset of action starting about 2
CONTRA-
Treatment of type 1 (insulindependent) diabetes Treatment of type 2 (non – insulindependent) diabetes that cannot be controlled by diet or oral agents Regular insulin injection: Treatment of severe ketoacid osis or diabetic coma Treatment of hyperkalemia with infusion of glucose to produce a shift of potassium into the cells Highly purified and human insulins promoted for short courses of therapy (surgery, intercu rrent disease), newly diagnosed patients, patients with poor metabolic control, and patients with gestational diabetes Insulin injection concentrated:
Contraindicated with allergy to pork products (varies with preparations; human insulin not contraindicated with pork allergy). Use cautiously with pregnancy (keep patients under close supervision; rigid control is desired; following delivery, requirements may drop for 24 – 72 72 hr, rising to normal levels during next 6 wk); lactation (monitor mother carefully; insulin requirements may decrease during lactation).
Hypersensitivity: R ash, anaphylaxis or angioedema Local: Allergy Local: Allergy— local reactions at injection site — redness, swelling, itching; usually resolves in a few days to a few weeks; a change in type or species source of insulin may be tried; lipodystrophy; pruritus Metabolic: Hypoglyc emia; ketoacidosis
Assessment
History: Allergy History: Allergy to pork products; products; pregnancy; lactation lactation Physical: Skin color, lesions; eyeball turgor; orientation, reflexes, peripheral sensation; P, BP, adventitious sounds; R, adventitious sounds; urinalysis, blood glucose
Interventions
Ensure uniform dispersion of insulin suspensions by rolling the vial gently between hands; avoid vigorous shaking. Give maintenance doses subcutaneously, rotating injection sites regularly to decrease incidence of lipodystrophy; give regular insulin IV or IM in severe ketoacidosis or diabetic coma. Monitor patients receiving insulin IV carefully; plastic IV infusion sets have been reported to remove 20% –80% of the insulin; dosage delivered to the patient will vary. Do not give insulin injection concentrated IV; severe anaphylactic reactions can occur. Use caution when mixing two types of insulin; always draw the regular insulin into the syringe first; if mixing with insulin lispro, draw the lispro first; use mixtures of regular and NPH or regular and Lente insulins within 5 –15 min of combining them; Lantus insulin (insulin glargine) cannot be mixed in solution with any other drug, including other insulins. WARNING: Double-check, or have a colleague check, the dosage drawn up for pediatric patients, for patients receiving concentrated insulin injection, or patients receiving very small doses; even small errors in dosage can cause serious problems. Carefully monitor patients being switched from one type of insulin to another carefully; dosage adjustments are often needed. Human insulins often require smaller doses than beef or pork insulin; monitor cautiously if patients are switched; lispro insulin is given 15 min before a meal. Store insulin in a cool place away from direct sunlight. Refrigeration is preferred. Do not freeze insulin. Insulin prefilled in glass or plastic syringes is stable for 1 wk refrigerated; this is a safe way of ensuring proper dosage for patients with limited vision or who have problems with drawing up insulin. Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage. Patients can learn to adjust insulin dosage on a sliding scale based on test results. Monitor insulin needs during times of trauma or severe stress; dosage adjustments may be needed. WARNING: Keep life support equipment and glucose readily
hours following injection. It has a peak effect 4-12 hours after injection, and a duration of action of 1826 hours.
Drug classes: Antidiabetic Hormone
Pregnancy Category B
Treatment of diabetic patients with marked insulin resistance (requirements of > 200 units/day) Glargine ( Lantus): Treatment of adult patients with type 2 diabetes who require basal insulin control of hyperglycemia Treatment of adults and children > 6 yr who require baseline insulin control
Teaching points
Use the same type and brand of syringe; use the same type and brand of insulin to avoid dosage errors. Do not change the order of mixing insulins. Rotate injection sites regularly (keep a chart) to prevent breakdown at injection sites. Dosage may vary with activities, stress, diet. Monitor blood or urine glucose levels, and consult physician if problems arise. Store drug in the refrigerator or in a cool place out of direct sunlight; do not freeze insulin. If refrigeration is not possible, drug is stable at controlled room temperature and out of direct sunlight for up to 1 month. Monitor your urine or blood for glucose and ketones as prescribed. Wear a medical alert tag stating that you have diabetes and are taking insulin so that emergency medical personnel will take proper care of you. Avoid alcohol; serious reactions can occur. Report fever, sore throat, vomiting, hypoglycemic or hyperglycemic reactions, rash.
