Chapter 18 | Endocrine Disorders 443
● When using insulin pen devices, replace the pen needle with each dose and store the insulin pen in the refrigerator. Some insulin may be stored at room temperature for up to 28 days after opening. Always check the manufacturer’s rec- ommendations in the prescribing information that comes with the insulin vial or pen cartridge. ● Only regular insulin may be used IV during management of diabetic ketoacidosis (DKA). ● Verify the dose with a second RN, and document the dose of insulin administration in the chart. ● Rotate insulin injection sites with each dose (abdomen, arms, legs, buttocks). ● Assess for injection-site reactions.
Nursing Interventions Nursing interventions should focus on the following major areas: ● Physical assessment ● Administration of insulin (Table 18-3) ● Always double-check insulin orders to make sure they are clear and concise. When drawing up insulin, another regis- tered nurse (RN) must verify that the correct dosage is drawn up in the syringe. ● Make sure that the correct strength of insulin has been ordered because multiple strengths and types are available. ● Only use insulin syringes to draw up insulin doses.
TABLE 183 Types of Insulin Used to Treat Diabetes Mellitus
INSULIN TYPE
ONSET
PEAK
DURATION AVAILABILITY DOSE
ROUTE CONSIDERATIONS
Short-Acting Insulin
SQ
Regular U-100 insulin May be given IV to
SQ doses indi- vidualized per patient IV; loading; doses 0.1 units/kg Maintenance 0.05–
30–60 minutes 2–4 hours 5–7 hours
Humulin R, Humulin R U-500, Novolin R
100 units/mL in 10-mL vials, 3-mL disposable delivery devices, 500 units/mL in 20-mL vials
treat diabetic ketoaci- dosis (DKA) U-500 insulin is 5 times more concentrated than U-100 insulin, they are not interchangeable.
U-500 insulin not
0.2 units/ kg titrate
given IV. U-500 insulin should be given via pen or if using vial
per medical order start at 0.5–1.0 unit/ kg/day
with specifically designed U-500 syringes. U-500 is absorbed slower than U-100 insulin
Intermediate-Acting Insulin
NPH Insulin, Humulin N, Novolin NPH, Novolin N
SQ
Only given SQ
Total insulin dose 0.5–1 unit/kg/day
2–4 hours
4–10 hours 10–16 hours 100 units/mL in 10-mL vials,
3-mL disposable delivery devices
Rapid-Acting Insulin
SQ
May be given SQ via syringe, pen, or insulin pump
Initial dose pa- tient specific SQ doses given as mealtime bolus Insulin pump
Within 15 minutes
1–2 hours 3–4 hours
100 units/mL in 10-mL vials and
Insulin Aspart (Novolog) Insulin Glulisine (Apidra) Insulin Lispro (Humalog)
3-mL pens Lispro also
200 u/mL pens
doses given as basal and mealtime boluses
Continued
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