5. Insulin acts in the liver, muscle, and
adipose tissue by attaching to
receptors on cellular membranes and
facilitating the passage of glucose,
potassium and magnesium.
6. INDICATION
•Clients with type 1 DM and Type 2
DM
•Clients with uncontrolled blood
glucose levels with oral hypoglycemic
agents
12. a. The main areas of injections are –
Abdomen – absorbed more rapidly and
evently
Arms (posterior surface)
Thighs (anterior surface)
Hips
13. •Systemic rotation
with in one
anatomical area –
prevents
lipidodyastrophy
•Injections should be
1½ inches apart with in
the anatomical area.
14.
15.
16. CLIENT INSTRUCTION
Not to use one site more than once in
2-3 weeks period
Heat application
Massage
Exercise
Increase absorption rate
May result in
hypoglycemia
19. •No to extreme temperature , no to
freezing , no direct sunlight
•Keep in room temperature before
administering
•Use vial with in 1 month if it is kept at
room temperature
•Otherwise keep it refrigerated
25. Prevent dosage Errors
Be certain that there is a match
between
•Insulin concentration noted on the vial
And
•Calibration of units on the insulin syringe
•Usual concentration – U 100 (100Units/ml)
27. Before use -
Swirl vial gently or rotate – between
palms
Don’t shake it vigorously – may cause
bubbles
28. Procedure
1. Inject air into the insulin bottle – vacuum makes it difficult
to draw up the insulin
2. Insulin Mixing
• When mixing insulin draw up the regular insulin (shorter
acting ) first
• Regular insulin may be mixed with NPH or Lente insulin
• Lispro insulin may be mixed with Humulin N or Humulin –
U
• Insulin aspart protamine may be mixed with NPH insulin
only.
• Insulin zinc suspensions may be mixed only with each
other and regular insulin, not with other types of insulin.
29. •Administer to a mixed dose of insulin within 5 -15 minutes of
preparation ; after this time, the regular insulin binds with the
NPH insulin and its action is reduced.
•Aspiration generally is not recommended with self injection
of insulin
•Administer insulin with 45 to 90 degree angle in clients with
normal subcutaneous mass
• 45-60 degree angle in thin persons or those with a
decreased amount of subcutaneous mass.
30. Steps
•Wash hands
•Gently rotate NPH insulin bottle
•Wipe off tops of insulin vials with
alcohol sponge
•Draw back amount of air into the
syringe that equals total dose
•Inject air equal to NPH dose into
NPH vial
•Remove syringe from the vial
31. Inject air equal to regular dose into a
regular vial
Invert regular insulin vial and withdraw
the dose
33. I/V infusion of insulin
•Use regular insulin
•Usually 5-10 units
prescribed before
continuous infusion starts
•Mix in 0.9% to 0.45% NS
•Flush the insulin solution
through the infusion set
•Discard first 50 – 100 ml
•Place with an IV infusion
controller
34. Monitor –
•Vitals, potassium, glucose, urinary out
put, signs of fluid overload, signs of
increased ICP
•If potassium falls, IV administration of
potassium
35. Insulin pump
•Needle or teflon catheter is changed
at every 2-3 days
•Client delivers bolus of insulin before
each meal
• rapid and regular acting insulin are
used
42. •Diluted insulin for infants
•Glycosylated hemoglobin – every
3months
•With held in illness, stress, infection
•If not receiving any thing by mouth
verify with the physician
•Instruct for the –I/M inj glucagon – if
hypoglycemic reaction occurs
44. •Insulin after a surgery in a diabetic
client may be reduced-
Because clients nutritional intake is
increased
• Need increased when – stress
response and I/V administrations of
glucose solutions
47. Fasting blood glucose
Glucose levels measured after food
has been with held for at least 8 hours
Norm- <100mg?dl
Significant- 100-125mg/dl
Diabetes – 125mg/dl or more
48. •Instruct the client to fast for 8-12
hours before the test
•Instruct a client with DM to with hold
morning insulin or oral hypoglycemic
medication until after the blood is
drawn.
49. Glucose tolerance test
If glucose levels peak at higher than
normal at 1 -2 hours after injection or
ingestion of glucose and are slower
than normal to return to fasting levels,
then DM is confirmed.
50. Nursing considerations
•Instruct client to eat a high CHO (200-300g)
diet for 3 days before the test
•Instruct the client to avoid alcohol, coffee and
smoking before 36 hours before the test
•Keep a fast for 10 to 16 hours
•With hold insulin and hypoglycemic agents
•Avoid strenuous exercise for 8hrs before and
after the test.
51. Instruct the client that the test may
take 3 to 5 hours requires I/V or oral
administration of glucose, and multiple
blood samples.
60. Glycosylated hemoglobin
Average blood glucose levels for a
period of time (2-3 months)
How longer glucose attaches to RBC’s
– and remain an above normal glucose
level
Normal values – 4%- 6%
63. Insulin lipodystrophy
Lipoatrophy –
Loss of subcutaneous fat-
Prevention – use of human insulin
Lipohypertrophy – fibrous fatty masses
at the injection site
Prevention - Avoid repeated use of
same site
67. Dawn phenomenon
Reduced tissue sensitivity to insulin
Usually develops at 5-8 am ( prebreak
fast hyper glycemia- may be because
of nocturnal release of growth
hormone)
Treatment
Evening dose of intermediate acting
insulin
68. Somogyi effect
Normal / elevated blood glucose levels at
bed time
A decrease at 2-3 AM
And a subsequent increase
( action of counter regulatory hormones)
Treatment –
Predinner or bed time dose of
intermediate acting insulin or increase
bed time snack
70. 1
Function of insulin pump
1. Programmed doses delivered
2. Continuous infusion with self monitoring
3. Surgical attachment to pancreas
4. Small dose of regular insulin subcutaneously
with self administration of additional dose before
each meal
71. Ans
Small dose of regular insulin
subcutaneously with self
administration of additional dose
before each meal
72. 2
A client with DM1 – diarrhea, vomiting
Nothing had by mouth for 24hrs, which
statement shows need of additional
teaching?
1. I need to stop insulin
2. I need to increase fluid intake
3. Monitor glucose every4 hrly
4. Call physician
73. Ans
I need to stop insulin
Do not stop insulin
Have plenty of water, notify physician
look for ketonurea