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Insulin Administration
Insulin Administration
I – DEFINITION
Considered in light of the normal eating and activity pattern and the response to
therapy:
1. Time of onset
2. Peak action
3. Duration
Regular insulin may be used to bring blood glucose into the control by using it as
a supplement with long-acting or intermediate-acting insulins. This is termed the
“sliding scale” or “rainbow” method. Sliding scale insulin is usually taken before
meals and at bedtime. By this method the client selects a proper regular insulin
dose based on a blood glucose level at that time. The physician has previously
prescribed units of insulin to be given for various ranges in blood glucose or for
results of the glucosuria test. The client measures the blood glucose with
capillary blood and the DEXTRO System (or tests the urine with the glocosuria
test).
An allergic reaction at the injection site is not unusual when insulin is first
administered. Itching, redness, and induration develop at the injection site. This
process is self-limiting and subsides spontaneously after 1-2 weeks of therapy.
Impurities in the alcohol used in skin leansing or giving the insulin intradermally
can cause these symptoms. The former is easily relieved by switching skin
preparation to povidone iodine (betadine) solution. The client’s injection
technique should also be evaluated and reteaching instituted as appropriate.
Somogyl Effect This phenomenon is the body’s attempt to correct a low blood
glucose caused by administering too much insulin. It is suspected when the client
has wide swings in blood glucose over a short time interval. The hypoglycemia
may not cause any symptoms, and therefore the phenomenon may be
overlooked as the basis for the unregulated blood glucose. The underlying
mechanism is that hypoglycemia activates counter regulation with release of
epinephrine, glucocorticoids, and growth hormone. This stimulates
gluconeogenesis, and the blood glucose climbs.
Insulin reactions develop more slowly with the long and intermediate-acting
insulin’s so that the premonitory sins may go unheeded.
Diabetic control during surgery When the diabetic client undergoes surgery,
special care is needed to avert serious metabolic complications. The
management scheme throughout the operative experience depends largely upon
whether insulin is a usual part of the daily therapy. For non- insulin-dependent
client the possibilities range from being permitted to take the oral antidiabetic
agent on the morning of surgery to receiving intravenous fluids. Undermost
circumstances, insulin is not given to the client controlled by diet alone. If the
therapeutic plan is a combination o diet and an oral agent, an intravenous
infusion is started. Whether the oral agent is taken or insulin is given as
replacement for it depends upon the extent of the procedure. Fluids are
administered intravenously, and insulin is given in low dose by slow continuous
infusion.
Management and monitoring are similar to those for the person in ketosis. The
blood volume is restored, and the osmolarity of the blood reduced. Hypotonic
intravenous fluids are used, and insulin is given sparingly.
Potential for Injury Several factors contribute to the diabetic’s potential for
injury. Neuropathic changes can diminish sensation, making the client less aware
of injury. Vascular changes can decreased the arterial blood supply, thereby
decreasing the body’s ability to heal.
Differents Tests:
Glycosylated Hemoglubin
The advantages of urine glucose testing are that it is less expensive than SMBG
and it is not invasive. The general procedure involves applying urine to a reagent
strip or tablet and matching colors on the strip with a color chart at the end of a
specified period.
• The renal threshold for glucose is 180 to 200 mg/dl (9.9 to 11.1 mmol/L),
far above target blood glucose levels.
• Patients may have a false sense of being in good control when results are
always negative.
• In elderly patients and patients with kidney disease, the renal threshold is
raised; thus, false-negative readings may occur at dangerously elevated
glucose levels.
Ketones (or ketone bodies) in the urine signal that control of type 1 diabetes is
deteriorating, and the risk of DKA is high. When there is almost no effective
insulin available, the body starts o break down stored fat for energy. Ketone
bodies are byproducts of this fat breakdown, and they accumulate in the blood
and urine.
Urine testing is most common method used for self-testing of ketone bodies by
patients. A meter that enables testing of blood for ketones is available but not
widely used.
Urine ketone testing should be performed whenever patients with type 1 diabetes
have glucosuria or persistently elevated blood glucose levels (more than 240
mg/dL or 13.2 mmol/L for two testing periods in a row) and during illness, in
pregnancy with pre-existing diabetes, and in gestational diabetes.
PHARMACOLOGIC THERAPY
Insulin is secreted by the beta cells of the islet of Langerhans and works to lower
the blood glucose level after meals by facilitating the uptake utilization of glucose
by muscle, fat, and liver cells.
Because the body loses the ability to produce insulin in type 1 diabetes,
exogenous insulin must be administered for life.
A number of insulin preparation are available. They vary according to three main
characteristics: time course of action, species (source), and manufacturer
II – PURPOSES:
III – PROCEDURE
1. Storing Insulin
Cloudy insulin’s should be thoroughly mixed by gently inverting the vial or
rolling it between the hands before drawing the solutions into a syringe or
a pen.
Whether insulin is the short- or long-acting preparation, the vials not in use
should be refrigerated and extremes of temperature should be avoided;
insulin should not be allowed to freeze and should not be kept in direct
sunlight or in a hot car. The insulin vial in use should be kept at room
temperature to reduce local irritation at the injection site, which may occur
when cold insulin is injected. If a vial of insulin will be used up in 1 month,
it may be kept at room temperature. Patients should be instructed to
always have a spare vial of the type or types of insulin they use. Spare
vials should be refrigerated.
2. Selecting syringes
Syringes must be matched with the insulin concentration. Currently, 3
sizes of U-100 insulin syringes are available:
Most insulin syringes have a disposable 27-to 29- gauge needle that is
approximately 0.5 inch long. The 1 ml syringes are marked in 2-unit
increments. A small disposable insulin needle (29- to 30- gauge, 8 mm
long) is available for very thin patients and children.
For patients who have difficulty mixing insulin’s, two options are available
they may use a premixed insulin, or they may have prefilled syringes
prepared.
4. Withdrawing Insulin
Most (if not all) of the printed materials available on insulin dose
preparation instruct patients to inject air into the bottle of insulin equivalent
to the number of units of insulin’s to be withdrawn. The rationale for this is
to prevent the formation of a vacuum inside the bottle, which would make
it difficult to withdraw that proper amount of insulin.
The four main areas for injection are the abdomen, arms (posterior
surface), thighs (anterior surface), and hips. Insulin is absorbed faster in
some areas of the body than others. The speed of absorption is greatest
in the abdomen and decreases progressively in the arm, thigh, and hip.
IV – NURSING CONSIDERATION
7. Insulin preparation and Injection. Experts once thought that insulin vials
should be rolled between the hands to resuspend the insulin without
creating air bubbles.
9. Site Selection and Rotation. Insulin absorption varies from side to side.
To avoid possibly dramatic changes in daily insulin absorption, instruct the
client to give injections in one area, about an inch apart, until the whole
area has been used, before changing to another site.