Insulin Administration

• Insulin is a hormone that lowers the level of glucose in the blood.
• It is made by the beta cells of the pancreas and released into the blood when the glucose level goes up.
• BLOOD GLUCOSE MONITORING = BGM
• HEMO GLUCOSE TEST = HGT
• Methods of insulin delivery: Traditional Subcutaneous Injections, Insulin Pens, Insulin Pumps
• Healthy Blood Sugar levels
• CAPILLARY BLOOD GLUCOSE = CBG
• Insulin helps glucose enter the body's cells for energy or storage.
• The major action of insulin is to lower blood glucose.
• Rapid-acting insulin (e.g. Lispro, Aspart) has an onset of 10-15 minutes, peak at 40-50 minutes, and duration of 2-4 hours.
• Infection at injection sites is uncommon
• Injection sites: Front of thigh/lateral thigh, Abdomen, Buttocks, Lateral aspect of arm
• Type 1 diabetes is autoimmune, Type 2 diabetes is lifestyle-related, and gestational diabetes occurs during pregnancy.
• Recommendation: Children and adolescents should be encouraged to inject consistently within the same site at a particular time in the day, but must avoid injecting repeatedly into the same spot to prevent lipo dystrophy
• Insulin Injection Rotation: Start with the left thigh until all injection spots in that area have been used, then switch to the right thigh
• Cleaning or disinfection of skin is not necessary unless hygiene is a real problem
• Never inject within 2 inches of the belly button
• Short-acting insulin (e.g. Regular) has an onset of 30 minutes, peak at 2-3 hours, and duration of 4-6 hours.
• Intermediate-acting insulin (e.g. NPH) has an onset of 2-4 hours, peak at 4-12 hours, and duration of 16-20 hours.
• Lipodystrophy or lipoatrophy is a recognized complication of insulin injection due to loss of the adipose tissue layer at the sites of injection
• Morning Hyperglycemia: Somogyi effect - Normal or elevated blood glucose at bedtime then a decrease at 2-3 am to hypoglycemic levels and a subsequent increase caused by the production of counterregulatory hormones
• Sliding Scales: Insulin prescriptions generally specify fixed amounts of long-acting insulin to be given routinely, and fixed amounts of short-acting insulin prior to every meal (the 'sliding scale' approach)
• Morning Hyperglycemia: Dawn Phenomenon - Normal blood glucose until about 3am, when the level begins to rise
• Rotation of injection site is important
• Morning Hyperglycemia: Insulin Waning - Progressive rise in blood glucose from bedtime to morning
• Management for Morning Hyperglycemia: Decrease evening dose of intermediate acting insulin or increase bedtime snack
• Long-acting insulin (e.g. Glargine, Detemir) has an onset of 1 hour, continuous action without a peak, and a duration of 24 hours.
• Complications of insulin therapy include local allergic reactions, systematic allergic reactions, and insulin lipodystrophy.
• Management for Morning Hyperglycemia: Delay/Change time of injection of evening intermediate-acting insulin from dinnertime to bedtime
• If insulin is injected into scarred areas, absorption may be delayed
• Management for Morning Hyperglycemia: Increase evening dose of intermediate acting or long-acting insulin or institute a dose of insulin before the evening meal
• How to aspirate and mix regular insulin and NPH insulin in a single syringe: Instill 20 units of air into the NPH vial and withdraw the needle, inject 10 units of air into the regular insulin vial and withdraw 10 units of regular insulin, reinsert the needle into the NPH insulin vial and withdraw 30 units of NPH insulin