insulins

• discovered in Toronto Canada in 1921
• restores diabetic patients ability to:

  • metabolize carbohydrates, fats, and proteins
  • store glucose in the liver
  • covert glycogen fat stores
• Rapid/short-acting insulins: work within minutes, lasts a few hours, function as bolus insulin
• Intermediate/long-acting insulins: work within 1-2 hours, last over a longer time, basal insulin
• Rapid-acting insulins: Novarapid, starts working 10-15 minutes, peak at 1-2 hours, lats 3-5 hours
• Rapid-acting insulins: given SQ and continuous SQ pump but not IV
• rapid acting insulin: patient must eat meal after injection, not yet approved for use in children less than 18 yrs of age
• Short-acting insulins: insulin regular, humbling R, novolin, Clare appearance, used SQ, IV bolus, IV infusion
• Short-acting insulins:

  onset: 30 minutes

  peak: 2-3 hours

  duration: 6.5 hours
• Short-acting insulins: considerations

  • give 15-30 minutes before meals
  • in hospital ensure there will be a meal tray available
  • Insulins bind to tubing, needs to be flushed through first before initiation infusion
• intermediate-active insulins: insulin isopahane suspension
• intermediate-active insulins:

  onset: 1-3 hours

  peak: 5-8 hours

  duration: up to 18 hours
• intermediate-active insulins:

  • needs to be mixed prior to administration, should be milked-white consistency
  • often started once at bedtime
  • not given at any time specific to meals
• Long-acting insulins: provides a more constant level of insulin in the body, insulin detemir(Levemir)
• intermediate-active insulins: 1-2 times daily
• intermediate-active insulins:

  onset: 90 minutes

  peak: none

  duration: 16-24 hours
• intermediate-active insulins: considerations

  • usually started at bedtime, may br given up to BID if required for glycemic control
• physical activity enhances absorption from the insulin injection site particularly from exercising arms and legs
• Abdomen is best site for insulin administration and absorption is more predictable
• Nursing implications:

  • check BG level before giving insulin
  • mix suspension
  • ensure correct storage
  • only use insulin syringes
  • ensure correct timing of insulin dose with meals
• Monitor therapeutic response

  • measure HbA1c to measure long term compliance
  • monitor for hypoglycemia and hyperglycemia