insulin, regular (injection, concentrated)
(in-su-lin)
Classification
Therapeutic: antidiabetics, hormones
Pharmacologic: pancreatics
Pregnancy Category B
See Appendix N for more information concerning insulins
| High Alert |
|
insulin, regular (injection, concentrated) Classification |
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Regular insulin IV | 10–30 min | 15–30 min | 30–60 min |
| Regular insulin subcutaneous | 30–60 min | 2–4 hr | 5–7 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:
May cause ↓ serum potassium levels
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. Do not confuse regular concentrated (U-500) insulin with regular insulin.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
When mixing insulins, draw regular insulin into syringe first to avoid contamination of regular insulin vial.Insulin should be stored in a cool place but does not need to be refrigerated.Subcut: Administer regular insulin within 15-30 min before a meal.IV: Regular insulin is the onlyinsulin that can be administered IV. Do not use if cloudy, discolored, or unusually viscous.
High Alert: Do not administer regular (concentrated) insulin U-500 IV.Direct IV: May be administered IV undiluted directly into vein or through Y-site. Rate: Administer up to 50 units over 1 min.Continuous Infusion: May be diluted in commonly used IV solutions as an infusion; however, insulin potency may be reduced by at least 20–80% by the plastic or glass container or tubing before reaching the venous system. Rate: Rate should be ordered by physician, and infusion placed on an IV pump for accurate administration
Rate of administration should be decreased when serum glucose level reaches 250 mg/100 ml.Y-Site Compatibility: , amiodarone, ampicillin, ampicillin-sulbactam, aztreonam, cefazolin, cefotetan, dobutamine, esmolol, famotadine, gentamicin, heparin, imipenem-cilastatin, indomethacin , magnesium sulfate, meperidine, meropenem, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, oxytocin, potassium chloride, propofol, ritodrine, sodium bicarbonate, tacrolimus, terbutaline, ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin, vitamin B complex with C.Y-Site Incompatibility: , dopamine, nafcillin, norepinephrine, ranitidine.Additive Compatibility: May be added to total parenteral nutrition (TPN) solutions.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. Opened, unused insulin vials should be discarded 1 month after opening.Demonstrate technique for mixing insulins by drawing up regular insulin 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 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.