Insulin Administration

Insulin Administration
Pressentation by: Christie Candelaria, BSN, MA,RN,CCRN


Insulin Administration to Adult Clients

* What is insulin?

Insulin is a hormone used to treat Diabetes

* Why is insulin used?

Insulin is used when there are few or no beta cells in the pancreas secreting insulin

* What factors affect the amount of insulin administered?

Glucometer readings, exercise and nutritional habits, coexisting medical factors and medications

Different types of Insulin

* Six different types of insulin
* Rapid acting
* Regular
* NPH (N)-slower and longer acting
* Lente (L)- slower and longer acting
* Ultralente- slowest and longest acting
* Long acting basal-slowest and longest acting

Route of Administration

Subcutaneous (hypodermic) –into the subcutaneous tissue

* Injected into the adipose tissues beneath the skin, a drug moves into the blood stream more rapidly than if given by mouth.
* Allows slower, more sustained drug administration than IM injection.
* Common sites: outer aspect of the of the upper arm, anterior thigh, loose tissue of the lower abdomen, upper hips, buttocks, and upper back.

Subcutaneous Injections

* Advantages
o Allows slower absorption
o Minimal tissue Risk
o Minimal risk of hitting blood vessel
* Cautions
o Do not give in scarred areas, in moles, inflamed or edematous areas
* Sites
Outer, upper arm,

Anterior Thigh, Lower

abdomen, upper Hips,

buttocks, upper Back.

* Needles
o 25 to 27 G- 5/8” to ½”
* Syringes
o 1 ml = 100 unit of Insulin (U 30 & U 50)
* Position – 45-90 degree angle


Onset, Peak, and Duration of Insulin Types and Therapeutic Actions

* Onset. The length of time before insulin reaches the bloodstream and begins lowering blood glucose.
* Peak time. The time during which insulin is at its maximum strength in terms of lowering blood glucose levels.
* Duration. How long the insulin continues to lower blood glucose.


Insulin Injection Sites


Blood Glucose Monitoring

* Blood glucose levels are often checked q ac (30 minutes before meals), q hs (at bedtime), or prn (as needed)
* Preprandial* (fasting, or before a

meal)—70-130 mg/dl

* Postprandial* (1-2 hours after the start of a meal)—<180 mg/dl
* These ranges may very depending on institution and physician protocols.



Procedure of Withdrawing Insulin from a vial

WASH HANDS!

* Check the med order and make sure the solution in the vial matches the ordered solution. (7 Rights of Medication Administration)
* Obtain an insulin syringe.
* Pick up the vial and verify the type of insulin that is prescribed.
* Check the patient’s most recent blood glucose. If in doubt or assessment changes always recheck and reassess.
* If applicable, verify the blood glucose and use sliding scale insulin administration dosage on the patient’s MAR.
* Wipe the insulin vial with a sterile gauze alcohol pad, if the insulin is cloudy roll between palms of your hands.
* Withdraw the appropriate type and amount of insulin. Remember the order and dosage must be verified by 2 RNs before administration
* Pull back on barrel of syringe to draw in a volume of the ordered medication dose. Holding the vial between your thumb and fingers of the non-dominant hand, insert the needle through the rubber stopper into the air space – not the solution!!!!!!!!!!!!!!!!
* Invert the vial & withdraw the ordered dose of medication by pulling back on the plunger. Make sure the needle is in the solution to be withdrawn.
* Expel air bubbles and adjust dose if necessary.
* Remove needle from vial and cover the needle with guard using one hand or scoop method.
* Take Medication into client’s room and verify 7 rights, administer the SC injection. Remember to never massage the insulin injection site.


Mixing 2 types of Insulins

* Regular insulin can be mixed with all other types
* Semilente insulin (zinc suspension) can not be mixed with NPH insulin
* Remember to always draw up clear or regular/fasting acting insulin FIRST
* Then the cloudy or slower acting insulins i.e. NPH


Hypoglycemia

* Hypoglycemia is the most common adverse effect of insulin.
* Treatment of a blood sugar <70 may be reversed by giving the patient 15 g of glucose which is the equivalent to 4 oz of orange juice, 1 T jelly or 1 T honey.
* Diabetics will always have a standing order for a D50 injection <60, this is administered via IV or IVP.


Education

* Explain that the dose of insulin is adjusted according to their blood glucose level.
* Educate your patient, explain that the lowest blood glucose reading is usually obtained before meals.
* The highest level is obtained 1-2 hours after meals.
* Levels can very depending on the variables listed above.

Goal of Blood Glucose Monitoring and Insulin Administration

* The immediate goal is to obtain Blood Glucose levels between 70-130.
* The ultimate goal is to obtain a HgbA1c of <6.5.
* Overall good control of blood sugar levels in diabetes does correlate with decreased incidence of diabetic complications

Insulin Administration