Diabetes & Introduction to Parenteral Medications Teresa Stone, 2004

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Diabetes Introduction to Parenteral Medications
Teresa Stone, 2004

• Diabetes
• Blood Glucose Monitoring
• Insulin

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Diabetes Type I Type II

• Most common metabolic disorder
• Currently no cure
• Either pancreas produces no insulin or very
  little
• Also body may be insulin resistant (loss of
  sensitivity of receptor sites)

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Hyperglycemia

• High blood sugar gt 10.0 mmol/L
• Usual gradual onset
• Fruity breath with ketosis
• Slow sluggish

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Signs Symptoms

• Fatigue Lethargy- unable to use glucose
• Polyuria kidneys
• Irritable pruritis
• Glycosuria as unable to reabsorb
• Polyphagia (hunger) - sense of starvation
• Polydipsia (thirst) - blood tonicity fluid loss
• Ketosis fat metabolism

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Hypoglycemia

• Below 4.0 mmol/L
• S S related to parasympathetic stimulation
  sympathetic response
• Hunger, nausea, sweating, weakness, headache,
  confusion, shaking, irritability
• Can be sudden onset appear drunk

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Blood Glucose Monitoring

• Before meals or 2 hrs after meals
• Normal range 3.9 6.1 mmol/L ac
• lt 7.8 mmol/L 1-2 hr pc
• Capillary sample
• Quick easy
• Monitors progress of treatment

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Specimen Collection

• Wash site with soap water
• Warm hand and dangle arm
• Lance side of finger or heel
• Stroke finger from base to tip
• Choose a new site

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Documentation

• Date time of blood specimen
• Results of Blood glucose reading
• On diabetic record with insulin

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BGM Care Standards

• For all clients with diagnosis of diabetes
• Values 2.2 or lt , and 19.4 or gt contact lab for
  stat serum glucose
• Compare values
• Assess, report to physician
• Treat hypoglycemia!

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Hypoglycemia Treatment Protocol

• Mild to moderate 2.8-3.9 treat (3).
• Retest in 15 min. Retreat (1) if lt 4.0
• Severe conscious lt 2.8 treat (4) and retest as
  before. Retreat (1) if lt4.0.
• Severe unconscious lt 2.8 Need IV glucose
• Assess possible cause discuss with Dr.

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Insulin What is it Why do we need it?

• A hormone to promote storage of glucose
• Replacement insulin required by those with
  diabetes mellitus
• Must be given by injection
• Various available with differing
• onsets, peaks durations

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Types of Insulin
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Methods of Administration - How?

• Subcutaneous injection
• Insulin jet injector
• Insulin Pen
• Insulin pump
• Long acting insulin
• Transdermal (coming)
• Inhalant (coming)
• IV

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What are Parenteral Medications?

• Injection of a medication into body tissues
• Invasive procedure
• Must use aseptic technique
• Variety of syringes needles

• Methods
• Subcutaneous
• Intramuscular
• Intravenous
• Intradermal

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Safe Practice with Injections

• Do not recap used needle (or one hand method)
• Take sharps disposal receptacle to bedside
• Aseptic technique
• Never force a needle into a full receptacle
• Use of clean gloves

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Syringes Needles

• Syringe
• Barrel with tip
• Plunger
• .5 50 ml
• 2-3 ml usual for SQ

• Needles
• Hub, Shaft Bevel
• Gauge 29 19
• Depends upon viscosity of fluid
• Vary in length
• 3/8-5/8 for SQ

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Insulin Syringes

• Needle gauge- 27-29
• Unique as in units
• U -100 100 units/1 ml
• U 100 strength insulin

• May have luer lok or attached needle
• Needle length - ½ depth of skin fold

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Insulin facts

• Good for 28 days after opening
• Store in refrigerator
• Room temp for administration
• Temp extremes Loss of potency
• Dose adjusted according to BG
• Lantus not to be mixed with other insulins

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Typical Orders

• Routine BID, QID, ac or with meal
• Regular plus sliding scale
• Sliding Scale
• Short acting according to BG result

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Sliding scale

• Monitor BG QID
• Humulin R or Toronto
• Low, normal high scale
• Example of part of high scale

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Drawing up your dose

• Select correct syringe
• Cleanse stopper
• Inject air same volume
• as medication
• Withdraw correct volume
• Always double check dose with RN college policy

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Mixing Insulin

• Examine vials R should be clear, N will be cloudy
  but not clumpy.
• Gently rotate vials
• Should be at room temperature
• Always mix clear to cloudy
• Clear air from syringe before injection
• Have accurate number of units of each insulin

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Mixing Insulin
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Injection Sites

• Absorption best in abdomen, arm thigh
• Site rotation
• To aspirate or not to aspirate?
• Inject slowly
• Do not massage area after injection

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Injecting

• Inject dart like for best insertion
• Pinch up tissue or pull flat
• 45 or 90 degree angle

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Subcutaneous injection

• 45 degrees if needle gt than ½ inch
• 90 degrees if lt ½
• Between muscle- skin
• Into fat connective tissue
• Avoid inflammation, edema, lesions, irritations,
  marks, impaired coagulation

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The fold/hold of skin

• Pick up skin
• Dont take
• muscle
• Keep hold until finished injecting
• Heparin dont move needle

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Insulin Pens Jet Injectors

• Easy to use and less discomfort
• Decrease risk of error in dose
• Must roll pen with intermediate acting insulin
• Just dial dose inject!

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Insulin Pumps

• Can deliver basal bolus
• Mimics natural release of insulin
• Better control for some
• Flexible for lifestyle
• Still must monitor BG

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Documentation

• June 30/04 Mrs. Sweet Thang
• 0740 - CBG 5.8mmol/L - TS RN
• 0745 -Humulin N 23 units with Humulin R 10 units
  s/c R upper arm - TS RN
• Utilize documentation record.