1. What Key Personal Need To Know INSULIN ADMINISTRATION

2. Health and Learning Health & Education Monitoring Blood glucose Hypoglycemia & hyperglycemia Nutrition Insulin administration Following the insulin regimen is critical to treatment success. It is just one piece of a comprehensive management plan.

3. Learning Objectives Patients will learn: Insulin definition Types of insulin Insulin delivery basics Vial and syringe administration Pen device administration Pump basics

4. insulin -Hormone secreted by the pancreas -Regulate the blood glucose, -Artificial insulin is known as human insulin which is the commonly used form. -Used for treatment of type 1 diabetes which usually affects children, some cases of type 2 diabetes and in treatment of gestational diabetes as well.

5. Rapid-acting – Humalog ®, Novolog ® Short-acting - Regular Intermediate - Lente, NPH Long-acting - Ultralente, Insulin Types

6. Rapid acting insulin:- –Action - Its action starts very rapid 5 to 15 minutes. –Effects: - effect lasts for 3 to 5 hours. –Administer:- Should be taken directly before meals. –No need to maintain any period between injections administration and the food.

7. Type of rapid acting insulin Insulin lispro (HUMALOG). Aspart (NOVORAPID).

8. Short acting insulin:- Action: - Its action starts after 30 minutes. Effects: - lasts for 5 to 8 hours.

9. The clear insulin R (HUMULIN) or (ACTRAPID).

10. Inter mediate acting insulin –Action: - Its action starts after 1 to 3 hours. –Effects: - effects last to 18 – 24 hours.

11. Known as the cloudy insulin (NPH). Onset, 1 - 1.5 hours. Peak, 4 - 12 hours. Duration, 24 hours. (INSULTARD). It is an intermediate-acting insulin suspension containing isophane insulin or NPH insulin. Onset: within 1.5 hours Maximum effect: 4-12 hours Duration: 24 hours. Type of Inter mediate acting insulin

12. continued (MONOTARD). Is intermediate-acting insulin containing Lente Insulin, In this cloudy insulin preparation, zinc ions are added to retard absorption therefore prolonging the duration of action. Onset: 2.5 hours Maximum effect: 7- 15 hours Duration: up to 24 hours.

13. Can be found also as mixed type Which is insulin contain 30% clear insulin (R ) & 70% from the cloudy insulin (N). It is usually used for patients who need 1/3 of their dose from the clear insulin and 2/3 of it from the cloudy insulin from the total daily dose. Insulin30/70 or (Mixtard) 30 (HM). It acts about half an hour after intake. Its effect lasts for up to 24 hours.

14. Long acting insulin : (Lantus), time profile over 24 hours with no pronounced peak. This profile allows once-daily dosing as a patient's basal insulin. (HumulinU), Onset, 4-8 hours. Peak, 10- 30 hours. Duration, >36 hours.

15. Delivery Methods Insulin Syringe. Insulin Pen.

16. Insulin Pump. Jet Injector. Delivery Methods

17. When to Give Insulin Before meals. For blood glucose levels significantly above target range. For increased ketones.

18. Dosing For many patients, insulin dose varies, depending upon: –Blood glucose readings –Food availability/preference –Physical activity level –Age/body weight

19. Syringe & Vial: Preparation 1. Get Supplies –Insulin (Verify) –Syringe –Alcohol wipe –Disposable gloves –Sharps container

20. Syringe & Vial: Preparation 1. Wash hands. 2. Apply gloves. 3. Clean the insulin vial.

21. continued 4. Have patients select injection site. 5. Clean the injection site.

22. continued 6. Check the insulin dose. 7. Remove the cap from syringe.

23. continued 8. Pull the plunger down to number of units to be administered. 9. Inject air into bottle.

24. continued 10. Draw out prescribed number of units of insulin. Check Dose

25. continued 11.Pinch up the skin. 12. Push needle into skin at 90 . 13. Release pinch. 14. Push the plunger in. 15. Count to “5”. 16. Remove needle and dispose of syringe.

26. Insulin Pen: Devices Prefilled pens. Reusable (cartridge) pens. Techniques for dose preparation and insulin delivery are similar for both types of pen devices.

27. Insulin Pen: Preparation 1. Gather supplies. Verify insulin type. –pen device (with cartridge) –pen needle –alcohol wipe –sharps container 2. Wash hands. 3. Chose injection site 4. Clean injection site 5. Screw on pen needle

28. Insulin Pen: Dosing 6. Prime: Dial “2” units. 7. Remove air by pressing the plunger. Repeat “Prime” if no insulin shows. 8. Dial number of units to be administered.

29. Insulin Pen: Injecting 9. Pinch up the skin. 10. Push the needle into the skin at 90 . 11. Release pinched skin. 12. Push down on the plunger. 13. Count to “5”. 14. Remove and dispose of pen needle.

30. Insulin Pump Therapy Based on what body does naturally –Small amounts of insulin all the time (basal insulin) –Extra doses to cover each meal or snack – (bolus insulin) Rapid or Short-Acting Insulin Precision, micro-drop insulin delivery Flexibility

31. What is an Insulin Pump? Battery operated device about the size of a pager Reservoir filled with insulin Computer chip with user control of insulin delivery Worn 24 hours per day Delivers one type of insulin

32. Sampling of Pumps

33. After Giving Insulin Check site for leakage Correction doses: – Retest. –Meal/snack doses. –Timeliness. –Supervision of food amount.

34. How to store insulin: Store the unopened insulin’s vial in the fridge, with out freezing it. The used vials can be stored out side the fridge in good conditioning room for one month, or 2 month in the fridge. Protect the insulin from exposure to heat or direct sun light, and don’t leave it in the car especially in summer time. Don’t use the vials if you see any color changes or Crystals formation or if it was frozen.

35. continued Check the expiry date on the vial before using it. Don’t use the expired insulin even though the vial was not opened yet. Keep out of reach of children. Roll the vial gently between your hands and don’t shake it before use.

36. THANK YOU