Also Read: Insulin Therapy Insulin is produced and secreted by the pancreas, which allows for intracellular transportation of glucose. Without insulin, glucose fails to enter the body’s cells, and hyperglycemia occurs. As such, administration of insulin lowers blood glucose.
Insulin Types
- Rapid-Acting
- Short-Acting: given 30 minutes before a meal.
- Intermediate-Acting: usually NPH, given post-prandial
- Long-Acting: usually Glargine and Detemir (Levenin)
| Insulin | Onset | Peak | Duration |
|---|---|---|---|
| Rapid Acting (Clear): Lispro (Humalog), Aspart (Novalog) | 5 mins | 30 to 60 mins | 2 to 4 hours |
| Short Acting (Clear): Regular (Humulin R, Novolin R, Iletin II regular) | 30 to 60 mins | 2 to 4 hours | 6 to 8 hours |
| Intermediate (Cloudy): NPH | 1 to 2 hours | 6 to 12 hours | 18 to 24 hours |
| Intermediate (Cloudy): Humulin N Lente | 1 to 2 hours | 8 to 12 hours | 18 to 24 hours |
| Intermediate (Cloudy): Humulin L | 1 to 2 hours | 8 to 12 hours | 18 to 28 hours |
| Long Acting: Ultralente Glargine (Lantus) | 5 to 8 hours | 14 to 20 hours | 30 to 36 hours |
Complications
- Local Allergic Reaction: 1-2 hours after insulin. Mild, localized, and may disappear with continued use. Antihistamine may be given prior to insulin administration as ordered.
- Systemic Allergic Reaction: characterized by generalized urticaria (hives), treated with desensitization (tapered dosage with a kit)
- Insulin Lipodystrophy: decrease in or hardening of fatty tissues (fibrofatty masses) at the injection site, caused by the repeated use of an injection site.
- Rotation of the sites is required to avoid this complication.
- Insulin Lipohypertrophy: development of fatty tissues
- Morning Hyperglycemia
- Insulin Waning, a progressive rise in blood glucose from bedtime to morning.
- Increase evening dose of intermediate-acting or long-acting insulin.
- Dawn Phenomenon, where at about 3:00 AM, blood glucose levels start to rise.
- Delay or change the time of administration of intermediate acting insulin from dinner to h.s.
- Somogyi Effect, an elevation of blood glucose at bedtime, then hypoglycemia at 2:00 to 3:00 AM due to the release of counterregulatory hormones (GH, Cortisol, Catecholamines)
- Decrease evening dose of intermediate acting insulin or increase bedtime snacks.
- Insulin Waning, a progressive rise in blood glucose from bedtime to morning.
Aspiration and Administration of Insulin
Two types may be added into one insulin syringe (orange hub).
- Clear (regular): aspirated first to prevent contamination. Contamination of regular with intermediate results in changes in duration, while contamination of intermediate of regular results in changes in onset.
- Onset: fast-acting; 30 minutes - 60 minutes
- Peak: 2 to 4 hours
- Duration: 5 to 8 hours; short-acting
- Cloudy (intermediate)
- Onset: slow-acting 1 to 2 hours (average 2 hours)
- Peak: 6 hours
- Duration: 12 to 18 hours; intermediate-lasting
- Self-administration topics:
- (most important) Asepsis
- Sites of administration: subcutaneous; upper arm, abdomen, front/lateral thigh, buttocks in 9 or 12 sites two finger breadths (1”) away from the umbilicus. avoid injection of insulin in the same site due to lipodystrophy.
- Thigh: ease of access, slower absorption
- Abdomen: faster absorption, less affected by muscle activity.
- Buttocks: UOQ, may be used in small children
- Lateral arm: rarely used for children with little SC.
- Never inject within 2” of the umbilicus, and 1” from moles and scars.
Normal Blood Glucose Levels
| Time | Without DM | With DM |
|---|---|---|
| Fasting | 70-99 mg/dL | 80-130 mg/dL |
| 1-2 Hours after Meals | <140 mg/dL | <180 mg/dL |
| A1C Test | <5.7% | <7% |
Capillary Blood Glucose Measurement
Done in various times (fasting, after meals, and at bed time) to check the blood sugar for if the individual
- Verify the doctor’s orders
- Wash hands
- Gather the materials and identify the patient.
- Glucometer
- Test Strips
- Lancing Device
- Lancet (Needle)
- Control Solution (for checking glucometer accuracy)
- Alcohol Swab
- Gloves
- Greet and explain the procedure
- Position the patient comfortable and provide privacy.
- Check and test if the glucometer if necessary
- Advise the patient to wash their hands. Assist if necessary to avoid sample contamination.
- Decontaminate hands prior to procedure
- Apply a single-use disposable apron.
- Apply a single-use disposable non-sterile gloves
- Prepare single-use disposable lancing device
- Prepare test strip and ensure calibration
- Obtain blood sample
- Sites should be rotated, avoiding the thumb and index finger.
- Blood sample should be of adequate size. Milking may be required.
- Hold the edge of the strip to the blood; do not place blood on the strip. Ensure full filling of the test pad. If inadequate, additional blood may be added within 15 seconds. Otherwise, repeat the test.
- Dispose of used lancets (sharps) and materials. Remove the test strip and PPE in compliance with waste management policies.
- Decontaminate hands and equipment to avoid cross-contamination.
- Explain results and potential outcomes of the result (changes in plans, diet, etc.) to the patient.
- Document the procedure.
(from the video)
- Open the test strip and place it within the glucometer. Test the glucometer with a control solution. Ensure that the result is within the reference range for calibration.
- Prepare the lancing device: open and insert the lancet, remove the protective cap from the lancet and close the device. Adjust the skin thickness setting as appropriate.
- Handwashing, prepare the glucometer, decontaminate the site.
- Let a large drop of blood pool, remove the first drop, and use the blood from the second sample.