Insulin Jja

8/3/2019 Insulin Jja

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1.Blood sugar monitoring

> to know if blood sugar have reached abnormal

levels.> take actions: administer units of insulin asordered, hold pre-meals diabetes medications,REFER!.. Etc..

> to avoid any such complications / outcomesthat could pose a serious health hazard.

Duties as a NURSEDuties as a NURSE



REMINDER!!!

ALWAYS CHECK YOUR CBG MACHINE

Calibrate!!!





ONSET the activity when the insulin starts towork.

PEAK the activity when the insulin has itsstrongest effect.

DURATION the activity that shows how longthe insulin may work

Time of activity of artificial human insulin



TYPES OF INSULINTYPES OF INSULIN

ONSET PEAK DURATION

> SHORT- ACTING

30 mins. 1hr

2-4 hrs. 6-8 hrs.

>INTERMEDIATE ACTING

1-2 hrs. 4-12 hrs. 18-24 hrs.

> LONG ACTING2- 4 hrs. ----- Up to 24 hrs.

* RAPID ACTING

15 30mins.

30- 90mins.

3-5 hrs.

* PRE-MIXED 30 mins- 1 2-12 hrs. 18-24 hrs.



Timing of injectionTiming of injection

Regular Insulin 30-45 min before meals

Rapid Insulin immediately before meals

NPH 15 min before meals or atbedtime

Peakless ( Lantus)before meals or at

bedtime same time everyday

Novomix30 immediately before meals

HumalogMix25 immediately before meals







RAPID ACTING INSULINS

g

A



PRE-MIXED INSULINS

BIPHASIC RAPID ACTING MIXES







Pre-filled pens

CartridgeKWIK

PEN



Byetta is an incretinmimetic. This means that

it mimics the actions of the incretin hormones inthe body. As an incretinmimetic, Byetta increasesinsulin production inresponse to meals and

decreases the amount of glucose (sugar) that theliver produces. Byetta alsoslows the emptying of food from the stomach,which decreases the

amount of food thatpeople eat.(http://diabetes.emedtv.com)





PEN NEEDLESPEN NEEDLES((novofinenovofine / / microfinemicrofine))



SINGLE DOSE AND MIXINGSINGLE DOSE AND MIXINGINSULINS..INSULINS..



12.7 mm

8 mm

5 mm

Insulin SyringeInsulin Syringe

Ultra Fine Insulin Syringe



WHERE?WHERE?







Injection Sites

Deltoid Thigh Abdomen



R otation of Sites



> Build up of fat below the surface of the skin,causing lumps due to repeated injections of insulin

on the same spot. nhttp://www.diabetes.co.uk/glossary/l.htm

Prevention?

Rotation of injection sites with each injection

Using large injection zone

Non-reuse of needles.

Lipohypertrophy





STORAGE AND HANDLINGREMINDERS!!!

*LABEL the vial/pen (pts name and dateopened).

*DO NOT store pens with needles.*DO NOT expose to extreme temperatures( freeze/ direct sunlight)

* DO NOT inject COLD insulins ROLLbetween your palms..



Needle Length Key points:

The is a clear movement towards use of smaller gauge and shorter-length needles.

There is no medical rationale for using needles longer than 5 or 6mm in children or adolescents or in adult.

An 8 mm needle is the shortest needle for syringes.

A 5 mm needles is the shortest needle for insulin pens.

Skin thickness indicates 4 and 5 mm needles will deliver insulinreliably into the SC tissue and minimizes risk of IM injection.

³Getting Under the Skin´



Needle length for children and adolescent

Children and adolescent should use a 4 , 5 or 6 mm needle.

Slim individuals and those injecting into a limb may need to lift inskin fold, especially whenusing a 5 or 6 mm needle.

An angled injection with the 6 mm needle may be used instead of askin fold.

If the available needle is 8mm , A2, should lift a skin fold or inject ata 45 degree angle.

Arms should be used only if a skin fold is lifted, which requiresinjection by a party (A3)




Needle length in adult

A 4,5 and 6 mm needle may be used by any adult patient

including obese ones and do no genereally require the lifting of a skin fold.

Injection with a shorter needles (4,5 and 6) should be given inadult at 90 degree to the skin surface.

However using a skin fold or injecting at 45 degree maybeconsidered for injecting into limbs or thin abdomen.




Insulin ShrinkageInsulin Shrinkage

Even if you prime the pen before injecting, youmay not be able to get all of the air out.

Carrying an insulin pen from a warm place to acold place (for example, from the warmth of outdoors to an air-conditioned building in thesummer, or from a warm house to a cold car in thewinter) causes the insulin in the cartridge toshrink.

When you carry the pen with needle attached, airgoes into the cartridge through the needle, intothe space where the insulin had been before (andthis will happen even if the needle is capped).

When you inject, the air in the cartridge interfereswith the function of the pen and results in anunder-dose. You could lose as much as twothirds of your dose



Insulin ExpansionInsulin Expansion

When you carry an insulin pen from a cold place toa warm place (for instance, from an air-conditioned room to the outdoors in thesummer, or from the cold outdoors to a warmhouse in the winter), the insulin in the cartridgewill expand.

If you carry the pen with the needle attached, theexpanding liquid leaks from the pen. If you use acloudy insulin or premix, the insulin particles mayhave settled in the bottom of the pen; if so, theliquid that leaks out of the needle contains few - if any - particles

The insulin that remains in the pen cartridge(and that you will inject later) becomes moreconcentrated than it should be, and it maynot have the desired effect on your bloodsugar.



Situations:Situations:

Doctor¶s order: 10:25pm

Monitor CBG pre-meals and HS withthe following HR scale:

150mg/dl = no insulin

151-200mg\dl = 2 units

201-250 mg/dl = 4 units

251-300 mg/dl = 6 units

301-350 mg/dl = 7 units

351-400 mg/dl = 8 units

> 400mg/dl = refer to MROD

For FBS and Lipid profile in am

CBG 11:30 pm = 150mg/dl

CBG 5:30 am = 259 mg/dl

Doctor¶s order: 3:30am

Monitor CBG pre-meals and HS

Give HN 15 units in am and 17 unitsin pm.

Give HR 4 units pre-meals except inpm.

CBG <70 mg/dl no insulin give half

dose D5050 and refer

CBG 5:30 am = 150mg/dl

CBG 11:30am = 259 mg/dl

CBG 5:30 pm = 120 mg/dl

CBG 11:30 pm = 330mg/dl



Admitting orders: 1:00pm

Monitor CBG pre-meals with the following APIDRA scale:

150-175 = 4 u * Schedule patient for whole abdominal

176-200 = 5 u ultrasound in am.

201-250 = 6 u

251-300 = 7 u CBG results: 5:30pm = 125mg/dl

301-350 = 8 u 5:30am = 169mg/dl

351-400 = 9 u

401 = refer



Doctors order:

Do blood sugar monitoring pre-meals & hs with the following HR scale:

<100 = no insulin101- 180 = 8 u CBG results:

181- 249 = 10 u : 5:30am = 123mg/dl

250- 299 = 12 u 11:30am = 205 mg/dl

300- 349 = 14 u 5:30pm = 199mg/dl

350 = refer 11:30pm = 266 mg/dl

*Inject HN 30 u pre-breakfast and 14 u pre-supper.



Ano Ano dawdaw!?!?!?!?!?!?

DAY 1 order: Monitor CBG pre-meals with the following apidrascale:

150-175 = 4 u

176-200 = 5 u

201-250 = 6 u

251-300 = 7 u

301-350 = 8 u

351-400 = 9 u

401 = refer

DAY 3: increase HR scale to 1 unit.

Doctor¶s order:

Inject 16 units of

Lantus (flexpen)once a day at9pm.



Doctor¶s order: 2:30pm

Start insulin regimen with HumalogMix, 20 units in am and 22 units inpm.

CBG pre-meals and hs follow previousrescue dose of HR

20-0-22

Situations:Situations:

Doctor¶s order:

Revise insulin doses:

Give Humulin N 10 units ½ hr beforebreakfast

Rescue: Humulin R 6 units subq ½hr before lunch and supper if CBG > 160 mg/dl



THANK YOU FOR YOUR

ATTENTION!

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Insulin Jja