| High Alert |
|
insulin glargine Classification |
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Subcut | within 1 hr | 5 hr | 24 hr |
Assess 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) 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. Recovery from hypoglycemia may be delayed due to the prolonged effect of subcut insulin glargine.
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.
When transferring from once-daily NPH human insulin or ultralente insulin to insulin glargine, the dose usually remains unchanged. When transferring from twice-daily NPH human insulin to insulin glargine, the initial dose of insulin glargine is usually reduced by 20%.Do not mix insulin glargine with any other insulin or solution, or use syringes containing any other medicinal product or residue. Solution should be clear and colorless with no particulate matter.Use only insulin syringes to draw up dose. Insulin syringe or OptiPen One can be used for administration. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake.Store unopened vials and cartridges in the refirgerator; do not freeze. If unable to refrigerate, the 10- ml vial can be kept in a cool place unrefrigerated for up to 28 days, and the 5-ml vial, up to 14 days. Once the cartridge is placed in an OptiPen One, do not refrigerate.Subcut: Administer subcut once daily at any time during the day, but at the same time each day. 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 selection and rotation of injection sites, and compliance with therapeutic regimen.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 on 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.