|
insulin glulisine (rDNA origin) 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 | within 15 min | 1 hr | 2 hr |
Assess patient for signs and symptoms of hypoglycemia (anxiety; irritability; restlessness; personality changes, mood changes; abnormal behavior; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; trouble concentrating; dizziness; drowsiness; nightmares or trouble sleeping; blurred vision; slurred speech; excessive hunger; headache; irritability; nausea; nervousness; rapid pulse; shakiness; unusual tiredness; weakness; unsteady gait) and hyperglycemia (confusion; drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing; frequent urination; loss of appetite; nausea; vomiting; tiredness; unusual thirst; stomach pain; rapid heart rate) periodically throughout therapy.Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.Assess patient for signs of allergic reactions (rash, shortness of breath, wheezing, rapid pulse, sweating, low blood pressure) during therapy.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 of therapy.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. Early signs of hypoglycemia may be less pronounced by long duration of diabetes, diabetic nerve disease, and use of beta blockers; may result in loss of consciousness prior to patient's awareness of hypoglycemia.Due to the short duration of action, insulin glulisine must be used with a longer acting insulin or insulin infusion pump therapy
Use only U-100 insulin syringes to draw up dose.When mixing insulins, draw insulin glulisine into syringe first to avoid contamination of insulin glulisine vial. Mix only with NPH insulin. Administer immediately after mixing. Solution should be clear and colorless with no particulate matter.Store unopened vials of insulin glulisine in refrigerator. Keep open vials refrigerated or as cool as possible. Use within 28 days. Do not use vials past expiration date.Subcut: When used as meal time insulin, administer 15 min before or within 20 min after starting a meal. Administer into abdominal wall, thigh, or upper arm subcutaneously. Pinch skin, inject insulin, leave needle in skin for 10 seconds and remove. Gently press on spot injected for several seconds; do not rub area. Rotate sites with each injection
For administration via infusion pump, as a subcut infusion into abdominal wall. Solution is stable for 48 hr and at temperatures not higher than 98.6°F. Discard infusion sets (reservoirs, tubing, catheters) after no more than 48 hr. Infusion sites that are erythematous, pruritic or thickened should be reported to health care professional and a new site selected; continued infusion may increase skin reaction and alter absorption of insulin glulisine.Syringe Incompatibility: When used via infusion pump, do not dilute or mix with any other insulin.Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, 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. Caution patient not to make any changes in type of insulin or dose without consulting health care professional. Advise patient to read the Patient Information prior to use and each time prescription is refilled.Demonstrate technique for mixing insulins by drawing up insulin glulisine 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.Advise patient not to share insulin glulisine with another person, even if they also have diabetes; may cause harm.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, vitamins 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 or if breast feeding or planning to breast feed.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 in diabetic patients.