| High Alert |
|
insulin aspart Classification |
stimulating glucose uptake in skeletal muscle and fat.inhibiting hepatic glucose production.inhibition of lipolysis and proteolysis.enhanced protein synthesis.| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Subcut | rapid | 1–3 hr | 3–5 hr |
Assess patient periodically for symptoms of hypoglycemia (anxiety; restlessness; mood changes; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nausea; nervousness; rapid pulse; shakiness; unusual tiredness or weakness)and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, frequent urination; loss of appetite; tiredness; unusual thirst) during therapy.Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.Lab Test Considerations:
Monitor blood glucose and ketones every 6 hr during therapy, more frequently in ketoacidosis and times of stress. Glycosylated hemoglobin may also be monitored to determine effectiveness.Toxicity and Overdose:
Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.
High Alert: Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation “u” for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths and from different species. Check type, species source, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional.Check type, species source, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional
Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin's units/ml.When mixing insulins, draw insulin aspart into syringe first to avoid contamination of regular insulin vial. Administer immediately after mixing. Do not mix with crystalline zinc insulin preparations.Insulin aspart should be refrigerated, but do not freeze or administer solution if it has been frozen. Cartridges or vials may be kept at room temperature for up to 28 days if kept from excessive heat and sunlight. Do not use if cloudy, discolored, or unusually viscous.Because of short duration of insulin aspart, supplementation with longer-acting insulin is usually necessary to control blood glucose levels.Subcut: Administer insulin aspart subcut in the abdominal wall, thigh, or upper arm within 5–10 min before a meal. Rotate injection sites. Do not administer IV.Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen.Demonstrate technique for mixing insulins by drawing up insulin aspart first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.Advise patient to consult health care professional prior to using alcohol or other Rx, OTC, or herbal products concurrently with insulin.Advise patient to notify health care professional of medication regimen prior to treatment or surgery.Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood sugar levels are not controlled. Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.Advise patient to notify health care professional if pregnancy is planned or suspected.Patients with diabetes mellitus should carry a source of sugar (candy, sugar packets) and identification describing their disease and treatment regimen at all times.Emphasize the importance of regular follow-up, especially during first few weeks of therapy.Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.