|
insulin detemir Classification |
stimulating glucose uptake in skeletal muscle and fat.inhibiting hepatic glucose production.inhibition of lypolysis and proteolysis.enhanced protein synthesis.| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Subcut | within 2 hr | 3–14 hr | 24 hr |
Assess patient for signs and 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) periodically 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: Insulin-related medication errors have resulted in patient harm and death. Clarify ambiguous orders; do not accept orders using the abbreviation “u” for units, (can be misread as a zero or the numeral 4; has resulted in tenfold overdoses). Insulins are available in different types, 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.Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin’s units/ml. Special syringes for doses <50 units are available. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake
High Alert: Do not mix insulin detemir (Levemir) with any other insulin or solution, or use syringes containing any other medicinal product or residue. If giving with a short acting insulin, use separate syringes and different injection sites. Solution should be clear and colorless with no particulate matter.Do not use if cloudy, discolored, or unusually viscous. Store unopened vials and cartridges of insulin detemir in the refrigerator; do not freeze. After initial use vials of insulin detemir cartridges (PenFill) or a prefilled syringe may be stored in a cool place for 42 days. Do not store in-use cartridges and pre-filled syringes in refrigerator or with needle in place. Keep away from direct heat and sunlight.Subcut: Rotate injection sites
Administer daily insulin detemir with evening meal or at bedtime. Administer twice daily insulin detemir evening dose with evening meal, at bedtime, or 12 hrs after morning dose.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. Patients taking insulin detemir should be given the Patient Information circular for this product.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 glucose 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.