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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 183 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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