1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 11 Measuring Insulin Dosages

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Insulin Prior to 1980s, insulin manufactured using animal sources Today, all insulin products produced from DNA

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Most Commonly Used in Health Care Settings Regular insulin Neutral Protamine Hagedorn (NPH) insulin

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Regular Insulin Clear in color Short-acting or fast-acting Must learn onset, peak, and duration times

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Onset, Peak, and Duration of Regular Insulin Onset of 30 minutes Peak at one to five hours –Time most likely to see hypoglycemia Primary and most potentially life-threatening adverse effect of insulin Duration of eight hours

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. NPH Insulin Cloudy white in color Intermediate-acting Must learn onset, peak, and duration times

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Onset, Peak, and Duration of NPH Insulin Onset of one to four hours Peak at four to 12 hours –Time most likely to see hypoglycemia Duration of 14 to 26 hours

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Rapid-Acting Insulin e.g., insulin aspart analog, insulin lispro Must learn onset, peak, and duration times

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Onset, Peak, and Duration of Rapid-Acting Insulin Onset of 10 to 30 minutes Peak at 30 minutes to three hours –Time most likely to see hypoglycemia Duration of three to five hours

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Long-Acting Insulin e.g., insulin detemir, insulin glargine Must learn onset, peak, and duration times

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Onset, Peak, and Duration of Long-Acting “Basal” Insulin Onset of one to two hours Minimal peak due to nature of long-acting insulin Duration of 24 hours

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Administration Time Administration of short- and rapid-acting insulins must be followed immediately by a meal Administration of intermediate- and long- acting insulins not related to food ingestion

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Labels Diligence in identification of insulin preparations critical Must be read carefully Most vials and labels look similar

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Packaging Insulin pen Pre-filled, self-injection syringes Multiple dose vials –Most common in health care facilities Bags for IV infusion

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Units Measurement for insulin Most insulin vials U-100

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Insulin Syringes U-100 syringes –Contain 100 units/mL –Used for insulin dosages greater than 50 units Low-dose syringes –Contain 50 units/0.5 mL –Contain 30 units/0.3 mL –Used for insulin dosages smaller than 50 units, such as for children

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Calibrations U-100 syringes calibrated for every two units –Difficult to measure odd-numbered units Low-dose syringes calibrated for every unit –More precise whether dosage odd- or even-numbered

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Reading Insulin Syringes Rotate side-to-side to locate necessary calibration and to draw up insulin dosage prescribed

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Combining Insulin Dosages When two insulins combined in same syringe, regular (short-acting) insulin always drawn up first Pressure inside vials must be equalized after insulin withdrawn

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. NPH Insulin Must be gently rotated to mix immediately prior to withdrawal from vial –Never shaken

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Steps for Combining Insulins in Same Syringe for Administration Prescription for 10 units of Regular and 23 units of NPH 1.Locate correct insulin and use alcohol wipe to cleanse tops of both vials 2.Use low-dose syringe since combined dosage equals 33 units

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Steps for Combining Insulins in Same Syringe for Administration 3.Draw up 33 units of replacement air into syringe for NPH and insert needle tip into vial –Be sure needle is above level of insulin in vial 4.Inject air into NPH vial and remove needle

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Steps for Combining Insulins in Same Syringe for Administration 5.Draw up 10 units of replacement air into syringe for Regular and insert needle tip into vial –Be sure needle is above level of insulin in vial 6.Inject air into Regular vial and draw up 10 units of Regular insulin

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Steps for Combining Insulins in Same Syringe for Administration 7.Pick up and gently rotate NPH vial until insulin mixed 8.Insert needle into NPH vial and draw up 33 units

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Steps for Combining Insulins in Same Syringe for Administration 9.Administer insulin immediately because NPH will alter onset, peak, and duration of Regular insulin within 20 minutes after being mixed in syringe

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Insulin Injection Sites Subcutaneous Must be rotated to prevent lipodystrophy

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Insulin Injection Sites Abdomen –Must maintain an inch from umbilicus –Absorbs most rapidly Upper arm –Absorbs second most rapidly Anterior upper thigh

28. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Insulin Injection Sites Site must be documented on MAR –In addition to time and initials of nurse who administered dose

29. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Injection Insulin not an irritating medication Speed of administration can cause pain –Inject slowly to prevent pain