Insulin

   Patients with Type I Diabetes (formerly called juvenile diabetes) require insulin to
control their blood sugar levels.  Some patients with Type II Diabetes (Adult onset)
may also require insulin when other methods of controlling glucose have failed.  Also
for Type II Diabetics who are experiencing elevated glucose levels due to stress
(emotional or physical).  Insulin is also given when oral anti-diabetic medication is
contraindicated such as in pregnancy or hypersensitivity.

Most of the time insulin is given subcutaneously (SQ).  Nurses must remember that
absorption of the insulin will vary depending on the injection site, the blood flow to
the area and how much hypertrophy of the tissue exists in at the injection site.

Insulin can be given IV (Only Regular Insulin can be given IV) by a RN or by

dialysate fluid into the peritoneal cavity in patients that are receiving peritoneal
dialysis therapy.

Insulin is also used to treat several other conditions other then diabetes.  It is used to
treat Diabetic Ketoacidosis which is more common in patients with Type I diabetes,
Hyperosmolar hyperglycemic nonketotic syndrome which is more common in patient
with type II diabetes.  Insulin is also used to treat severe hyperkalemia because it
potassium moves with glucose from the bloodstream into the cell thereby lowering the
level of potassium in the blood.

Insulin Injections (Insulin by Category)

Course Agent Onset Peak Duration
Humalog
Rapid 30-60 min 3-4 hours
(Lispro)
Rapid Acting
Reg (R) 30-60 min 2-4 hours 5-7 hours
Reg IV 10-30 min 15-30 min 30-60 min
NPH/reg
Fast Acting 30 min 4-8 hr 24 hours
(70/30)
Intermediate Lente (L) 1-3 hours 8-12 hours 18-28 hours
Acting NPH 1-4 hours 6-12 hours 18-28 hours
Ultra-lente
Long Acting 4-6 hours 18-24 hours 36 hours
(UL)

 
 Mixing Insulin

1. Obtain appropriate size insulin syringe and draw up enough air equal to
combined volume of both insulin.  (So if you are giving 5 of Regular and 10 of
NPH then you need to draw up 15 of air)
2. Inject the NPH vial with amount of air equal to amount of NPH to be mixed
without dipping needle into NPH solution (Inject 10 units of air into the vial)
3. Inject remaining air into regular insulin vial and draw up the regular insulin to
be mixed. (Inject the 5 units of air into the vial then draw up the 5 units of
regular insulin)
4. Remove any air bubbles from the syringe after drawing up the regular insulin.
5. Mix:  Roll (do not shake) NPH vial between hands.
6. Reinsert needle into pressurized NPH and withdraw the ordered amount.

   Remember that Regular Insulin is clear and that NPH is cloudy.  You always
draw up regular before NPH.  Clear to Cloudy or RN.