INSULIN

ADMINISTRATION
 OVERVIEW:
DIABETES
01
MELLITUS 02

TYPE 1 TYPE 2

The body's immune system attacks and The body does not produce enough
destroys the cells that produce insulin. insulin, or the body's cells do not react to
Formerly called insulin-dependent insulin.
diabetes mellitus (IDDM). Formerly called non-insulin dependent
diabetes mellitus (NIDDM).
 WHAT IS INSULIN
A hormone produced by beta cells of the pancreatic
islets.
Considered to be the main anabolic hormone of the
body.
 PURPOSE OF INSULIN
1.Regulates the metabolism of carbohydrates,
fats and protein.
2.Causes the cells in the liver, muscle, and fat
tissue to take up glucose from blood and
convert it to glycogen that can be stored in
the liver and muscles.
 WHEN TO ADMINISTER

GENERALLY:
1.Before meals or snacks
2.For blood glucose levels significantly above
target range
3.For moderate, large, or increasing ketones as
per DMMP
 INSULIN DOSING
Insulin dose varies depending upon:
1.Blood glucose readings
2.Food availability/ preference
3.Physical activity level
4.Age/ body weight.

Follow prescribed guideline in DMMP.

 INSULIN TYPES
1.Rapid-acting (e.g. Humalog, Novolog)
2.Short-acting
3.Intermediate (e.g. Lente, NPH)
4.Long-acting (e.g. Ultralente, Glargine)
 STORAGE
1.Refrigeration or store at temperature
less than 86 degrees as specified by
DMMP.
2.Refrigerate unopened vials and insulin
pens.
 WHERE TO INJECT
• Should be injected in the subcutaneous tissue
• Proper techniques should be learned so as not to
inject too close to the outer skin or too deep
into the muscle
 INJECTION SITES

Any four quadrants of

the abdomen, always at
least an inch away from
the umbilicus
 INJECTION SITES

Front or outer
aspects of both
thighs
 INJECTION SITES

Upper outer area of

buttocks
 INJECTION SITES

Outer and rear

surfaces of upper
arms
INSULIN
DELIVERY
DEVICES

Insulin Insulin pen Insulin

syringe pump
ROUTES OF DELIVERY
01 02 03

Injection Infusion Inhalation

 INSULIN
PREPARATION
Getting ready:

● Know the name and dose of each

medicine to give. The type of insulin
should match the type of syringe (e.g.,
U-100).
Filling the Syringe - one Type of
Insulin
● Wash your hands with soap and
water. Dry them well.
● Check the insulin bottle label.
● The insulin should not have
any clumps on the sides of the
bottle.
 Filling the Syringe - one Type of
Insulin
● Intermediate-acting insulin
(N or NPH) is cloudy, and
must be rolled between
your hands to mix it. DO
NOT shake the bottle. This
can make the insulin clump.
Filling the Syringe - one Type of
Insulin
● If the insulin vial has a
plastic cover, take it
off. Wipe the top of
the bottle with an
alcohol wipe. Let it
dry. DO NOT blow on
it.
 Filling the Syringe - one Type of
Insulin
● Take the cap off the needle, being careful not
to touch the needle to keep it sterile. Pull back
the plunger of the syringe to put as much air
in the syringe as the dose of medicine you
want.
Filling the Syringe - one Type of
Insulin
● Put the needle into
and through the
rubber top of the
insulin bottle. Push
the plunger so the air
goes into the bottle.
Filling the Syringe - one Type of
Insulin
● Keep the needle in the
bottle and turn the
bottle upside down.
Filling the Syringe - one Type of
Insulin
● With the tip of the needle in
the liquid, pull back on the
plunger to get the right dose
of insulin into the syringe.
● Check the syringe for air
bubbles.
Filling the Syringe - Two Types of
Insulin
● Pull air into the
syringe equal to
the first dose of
insulin.
Filling the Syringe - Two Types of
Insulin
● Place the syringe
into the first
insulin bottle and
release the air.
Filling the Syringe - Two Types of
Insulin
● Repeat the first 2
steps with the
second bottle of
insulin.
Filling the Syringe - Two Types of
Insulin
● Draw up the clear
insulin first.
Filling the Syringe - Two Types of
Insulin
● Draw up the
cloudy insulin
second.
● Check the syringe
for air bubbles.
INJECTION
TECHNIQUE
 INSULIN
ADMINISTRATION
PROCEDURE
1. Pinching the skin.
2. Insert the needle into the skin.
3. Inject the insulin.
4. Removing the needle and holding
cotton ball over the site.
5. Discard the syringe into a hard
plastic container.
COMPLICATIONS OF INSULIN
THERAPY
Local Insulin
allergic lypodystrophy
reaction

Systemic Insulin
allergic resistance
reaction
Other:

Morning hyperglycemia Elevated blood

glucose upon arising in the morning may be
due to:
a.Dawn phenomenon: characterized by
normal blood glucose level until 3 am
Other:
b. Somogyi effect: nocturnal
hypoglycemia followed by rebound
hyperglycemia
c. Insulin waning: progressive increase in
blood glucose from bedtime to morning
Nursing Considerations
● Assess for contraindications or cautions
(e.g. history of allergy, pregnancy, etc.)
● Perform a physical assessment to establish a
baseline before beginning therapy.
● Assess skin lesions; orientation and
reflexes; blood pressure, pulse, respiration
and adventitious breath sounds which could
indicate a response to high or low glucose
levels and potential risk factors in giving
insulin.
● Inspect skin areas that will be used for
injection; note any areas that are bruised,
thickened, or scarred.
● Obtain blood glucose levels as ordered to
monitor response to insulin.
● Ensure uniform dispersion of insulin
suspensions by rolling the vial gently
between hands; avoid vigorous shaking.
● Give maintenance doses subcutaneously,
rotating injection sites regularly to decrease
incidence of lipodystrophy; give regular
insulin IV or IM in severe ketoacidosis or
diabetic coma.
● Do not give insulin injection concentrated
IV; severe anaphylactic reactions can occur.
● Use caution when mixing two types of insulin.
● WARNING: Double-check, or have a colleague
check, the dosage drawn up for pediatric patients,
for patients receiving concentrated insulin
injection, or patients receiving very small doses;
even small errors in dosage can cause serious
problems.
● Carefully monitor patients being switched
from one type of insulin to another; dosage
adjustments are often needed.
● Store insulin in a cool place away from
direct sunlight. Refrigeration is preferred.
Do not freeze insulin.
● Monitor urine or serum glucose levels
frequently to determine effectiveness of
drug and dosage.
● Monitor insulin needs during times of
trauma or severe stress; dosage adjustments
may be needed.
THANK YOU!
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