Christie Candelaria, BSN, MA,RN,CCRN

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INSULIN ADMINISTRATION

• Christie Candelaria, BSN, MA,RN,CCRN

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Insulin Administration to Adult Clients

• What is insulin?
• Insulin is a hormone used to treat Diabetes
• Why is insulin used?
• Insulin is used when there are few or no beta
  cells in the pancreas secreting insulin
• What factors affect the amount of insulin
  administered?
• Glucometer readings, exercise and nutritional
  habits, coexisting medical factors and
  medications

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Different types of Insulin

• Six different types of insulin
• Rapid acting
• Regular
• NPH (N)-slower and longer acting
• Lente (L)- slower and longer acting
• Ultralente- slowest and longest acting
• Long acting basal-slowest and longest acting

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Route of Administration

• Subcutaneous (hypodermic) into the subcutaneous
  tissue
• Injected into the adipose tissues beneath the
  skin, a drug moves into the blood stream more
  rapidly than if given by mouth.
• Allows slower, more sustained drug administration
  than IM injection.
• Common sites outer aspect of the of the upper
  arm, anterior thigh, loose tissue of the lower
  abdomen, upper hips, buttocks, and upper back.

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Subcutaneous Injections

• Advantages
• Allows slower absorption
• Minimal tissue Risk
• Minimal risk of hitting blood vessel
• Cautions
• Do not give in scarred areas, in moles, inflamed
  or edematous areas

• Sites
• Outer, upper arm,
• Anterior Thigh, Lower
• abdomen, upper Hips,
• buttocks, upper Back.
• Needles
• 25 to 27 G- 5/8 to ½
• Syringes
• 1 ml 100 unit of Insulin (U 30 U 50)
• Position 45-90 degree angle

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Onset, Peak, and Duration of Insulin Types and
Therapeutic Actions

• Onset. The length of time before insulin reaches
  the bloodstream and begins lowering blood
  glucose.
• Peak time. The time during which insulin is at
  its maximum strength in terms of lowering blood
  glucose levels.
• Duration. How long the insulin continues to lower
  blood glucose.
• Refer to page 557.

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Insulin Injection Sites
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Blood Glucose Monitoring

• Blood glucose levels are often checked q ac (30
  minutes before meals), q hs (at bedtime), or prn
  (as needed)
• Preprandial (fasting, or before a
• meal)70-130 mg/dl
• Postprandial (1-2 hours after the start of a
  meal)lt180 mg/dl
• These ranges may very depending on institution
  and physician protocols.

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Procedure of Withdrawing Insulin from a vial

• WASH HANDS!
• Check the med order and make sure the solution
  in the vial matches the ordered solution. (7
  Rights of Medication Administration)
• Obtain an insulin syringe.
• Pick up the vial and verify the type of insulin
  that is prescribed.
• Check the patients most recent blood glucose.
  If in doubt or assessment changes always recheck
  and reassess.
• If applicable, verify the blood glucose and use
  sliding scale insulin administration dosage on
  the patients MAR.
• Wipe the insulin vial with a sterile gauze
  alcohol pad, if the insulin is cloudy roll
  between palms of your hands.
• Withdraw the appropriate type and amount of
  insulin. Remember the order and dosage must be
  verified by 2 RNs before administration

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Procedure of Withdrawing Insulin from a vial

• Pull back on barrel of syringe to draw in a
  volume of the ordered medication dose. Holding
  the vial between your thumb and fingers of the
  non-dominant hand, insert the needle through the
  rubber stopper into the air space not the
  solution!!!!!!!!!!!!!!!!
• Invert the vial withdraw the ordered dose of
  medication by pulling back on the plunger. Make
  sure the needle is in the solution to be
  withdrawn.
• Expel air bubbles and adjust dose if necessary.
• Remove needle from vial and cover the needle with
  guard using one hand or scoop method.
• Take Medication into clients room and verify 7
  rights, administer the SC injection. Remember to
  never massage the insulin injection site.

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Mixing 2 types of Insulins

• Regular insulin can be mixed with all other types
• Semilente insulin (zinc suspension) can not be
  mixed with NPH insulin
• Remember to always draw up clear or
  regular/fasting acting insulin FIRST
• Then the cloudy or slower acting insulins i.e. NPH

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Hypoglycemia

• Hypoglycemia is the most common adverse effect of
  insulin.
• Treatment of a blood sugar lt70 may be reversed by
  giving the patient 15 g of glucose which is the
  equivalent to 4 oz of orange juice, 1 T jelly or
  1 T honey.
• Diabetics will always have a standing order for a
  D50 injection lt60, this is administered via IV or
  IVP.

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Education

• Explain that the dose of insulin is adjusted
  according to their blood glucose level.
• Educate your patient, explain that the lowest
  blood glucose reading is usually obtained before
  meals.
• The highest level is obtained 1-2 hours after
  meals.
• Levels can very depending on the variables listed
  above.

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Goal of Blood Glucose Monitoring and Insulin
Administration

• The immediate goal is to obtain Blood Glucose
  levels between 70-130.
• The ultimate goal is to obtain a HgbA1c of lt6.5.
• Overall good control of blood sugar levels in
  diabetes does correlate with decreased incidence
  of diabetic complications

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