Nursing Interventions in Insulin Therapy

• Nursing Interventions in Insulin Therapy

  The main route of insulin injection is subcutaneous. This promotes slower absorption and is less painful.
• Nursing Interventions in Insulin Therapy

  Administer insulin at a 45-degree angle. Obese - 90-degree angle.
• Nursing Interventions in Insulin Therapy

  Do not massage injection site to prevent rapid absorption= hypoglycemia
• Nursing Interventions in Insulin Therapy

  Injections should be 1/2 inch apart within the anatomical area. Finish all sites in one anatomical area before going to another area.
• Nursing Interventions in Insulin Therapy

  Lipodystrophy - hard fatty masses in the subcutaneous layers
• Nursing Interventions in Insulin Therapy

  To prevent Lipodystrophy:

  • systemic rotation of the site of injection; reuse one site after at least 2 weeks
  • administer insulin at room temperature; cold insulin causes lipodystrophy
• Nursing Interventions in Insulin Therapy

  Gently roll vial in between the palms to redistribute insulin particles. Do not shake the vial; bubbles make it difficult to aspirate exact amount.
• Nursing Interventions in Insulin Therapy

  Storing insulin:

  • Prefilled insulin syringes = refrigerator; potent for 1 week
  • Vial will be used up in 30 days = kept at room temperature (otherwise, vial should be refrigerated)
  • Insulin should not be frozen or kept in direct sunlight
• Nursing Interventions in Insulin Therapy

  To mix insulin:

  • Remember: Draw up the regular insulin (clear) first!

  1. Introduce air into the vial of intermediate-acting insulin. Do not aspirate or draw up the insulin yet
  2. Introduce air into the vial of regular insulin, and draw up the insulin.
  3. Draw up the NPH
• Nursing Interventions in Insulin Therapy

  Administer a mixed dose of insulin within 5 to 15 minutes of preparation; after this time the regular insulin binds with the NPH insulin and its action is reduced.
• Complications of Insulin Therapy

  Local allergic reactions

  • redness, swelling, tenderness, and induration or wheal at the site of injection

  Management:

  • avoid alcohol
  • administer antihistamine one hour before injection as prescribed by the physician
• Complications of Insulin Therapy

  Insulin Lipodystrophy

  • Lipoatrophy - loss of subcutaneous fat
  • Lipohypertrophy - development of fibrous fatty masses

  Management:

  • Rotate injection site
• Complications of Insulin Therapy

  Dawn Phenomenon

  • Increased blood glucose level between 5 and 8 AM

  Management:

  • Delay Insulin - administer at 10 PM to control morning hyperglycemia
• Complications of Insulin Therapy

  Somogyi Phenomenon

  • Hypo glycemia occurs at 2-3 AM, which triggers production of counterregulatory hormones
  • By 5-6 AM, in response to the counterregulatory hormones, the blood glucose rebounds to hyper glycemic range

  Management:

  • Decrease evening insulin
  • Give midnight snack
• Complications of Insulin Therapy

  Insulin Waning

  • progressive rise in the blood glucose level from bedtime to morning

  Management:

  • increase evening insulin
• Chronic Complications of Diabetes Mellitus

  Macrovascular - medium to large artery

  • Stroke
  • MI

  Microvascular - small artery

  • Diabetic Retinopathy - eyes
  • Diabetic Neuropathy - nerves
  • Diabetic Nephropathy - kidneys