1. Copyright © 2015 Cengage Learning® Chapter 11 Measuring Insulin Dosages

2. Copyright © 2015 Cengage Learning® Insulin Prior to 1980s, insulin was manufactured using animal sources. Today, all insulin products are produced from recombinant DNA. 11-2

3. Copyright © 2015 Cengage Learning® Safeguards for Insulin The –lin ending of regular and N insulin trade names can be used as an additional safeguard in distinguishing them from several of the analogs, which incorporate –log at the end of their names. 11-3

4. Copyright © 2015 Cengage Learning® Most Commonly Used in Health Care Settings Regular insulin Neutral protamine Hagedorn (NPH) insulin Rapid-acting insulin Long-acting insulin 11-4

5. Copyright © 2015 Cengage Learning® Regular Insulin Clear in color Short acting or fast acting Must learn onset, peak, and duration times 11-5

6. Copyright © 2015 Cengage Learning® 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 11-6

7. Copyright © 2015 Cengage Learning® NPH Insulin Cloudy white in color Intermediate acting Must learn onset, peak, and duration times 11-7

8. Copyright © 2015 Cengage Learning® Onset, Peak, and Duration of NPH Insulin Onset of one to four hours Peak at 4 to 12 hours –Time most likely to see hypoglycemia Duration of 14 to 26 hours 11-8

9. Copyright © 2015 Cengage Learning® Rapid-Acting Insulin For example, insulin as part analog, insulin lispro Must learn onset, peak, and duration times 11-9

10. Copyright © 2015 Cengage Learning® 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 11-10

11. Copyright © 2015 Cengage Learning® Long-Acting Insulin For example, insulin detemir, insulin glargine Must learn onset, peak, and duration times 11-11

12. Copyright © 2015 Cengage Learning® Onset, Peak, and Duration of Long-Acting Insulin Onset of one to two hours Minimal peak due to nature of long-acting insulin Duration of 24 hours 11-12

13. Copyright © 2015 Cengage Learning® Administration Time Administration of short- and rapid-acting insulins must be followed immediately by a meal. Administration of intermediate- and long- acting insulins is not related to food ingestion. 11-13

14. Copyright © 2015 Cengage Learning® Labels Diligence in identification of insulin preparations critical. Must be read carefully. Most vials and labels look similar. 11-14

15. Copyright © 2015 Cengage Learning® Packaging Insulin pen Pre filled self-injection syringes Multiple dose vials –Most common in health care facilities Bags for IV infusion 11-15

16. Copyright © 2015 Cengage Learning® Insulin Pen Prescribed for exclusive use with a single patient. Under no circumstances are insulin pens to be used for other than the patient they are ordered for. Does not require refrigeration. 11-16

17. Copyright © 2015 Cengage Learning® Units 11-17 How insulin measured Most insulin vials are U-100 –Meaning 100 units/mL

18. Copyright © 2015 Cengage Learning® Insulin Syringes 11-18 U-100 –Contain 100 units/mL –Used for insulin dosages greater than 50 units Low-dose or ½ mL syringes –Contain 50 units in ½ milliliter

19. Copyright © 2015 Cengage Learning® Calibrations 11-19 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

20. Copyright © 2015 Cengage Learning® Reading Insulin Syringes Rotate side-to-side to locate necessary calibration and to draw up insulin dosage prescribed. 11-20

21. Copyright © 2015 Cengage Learning® Combining Insulin Dosages When two insulins are combined in same syringe, regular (short-acting) insulin is always drawn up first. Pressure inside vials must be equalized after insulin withdrawn. 11-21

22. Copyright © 2015 Cengage Learning® NPH Insulin NPH insulin must be gently rotated to mix immediately prior to withdrawal from vial. –Never shaken 11-22

23. Copyright © 2015 Cengage Learning® 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. (continues) 11-23

24. Copyright © 2015 Cengage Learning® Steps for Combining Insulins in Same Syringe for Administration (cont’d) 3.Draw up 23 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. (continues) 11-24

25. Copyright © 2015 Cengage Learning® Steps for Combining Insulins in Same Syringe for Administration (cont’d) 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. (continues) 11-25

26. Copyright © 2015 Cengage Learning® Steps for Combining Insulins in Same Syringe for Administration (cont’d) 7.Pick up and gently rotate NPH vial until insulin mixed. 8.Insert needle into NPH vial and draw up 23 units. (continues) 11-26

27. Copyright © 2015 Cengage Learning® Steps for Combining Insulins in Same Syringe for Administration (cont’d) 9.Administer insulin immediately because NPH will alter onset, peak, and duration of Regular insulin within 20 minutes after being mixed in syringe. 11-27

28. Copyright © 2015 Cengage Learning® Insulin Injection Sites Subcutaneous Must be rotated to prevent lipodystrophy (continues) 11-28

29. Copyright © 2015 Cengage Learning® Insulin Injection Sites (cont’d) Abdomen –Must maintain an inch from umbilicus –Absorbs most rapidly Upper arm –Absorbs second most rapidly Anterior upper thigh (continues) 11-29

30. Copyright © 2015 Cengage Learning® Insulin Injection Sites (cont’d) Site must be documented on MAR –In addition to time and initials of nurse who administered dose 11-30

31. Copyright © 2015 Cengage Learning® Injection Insulin not an irritating medication. Speed of administration can cause pain. Inject slowly to prevent pain. 11-31