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Chapter 18 | Endocrine Disorders 445

TABLE 183 Types of Insulin Used to Treat Diabetes Mellitus—cont’d

INSULIN TYPE

ONSET

PEAK

DURATION AVAILABILITY DOSE

ROUTE CONSIDERATIONS

Insulin Mixtures

0.5–1.0 unit/ kg/day

SQ

Only administered SQ

15–30 minutes 2.8 hours

24 hours

100 units/mL in 10-mL vials, 3-mL disposable delivery devices

Insulin lispro protamine suspension/ insulin lispro solution mixtures, rDNA origin (Humalog 75/25, Humalog Mix 50/50) Insulin aspart protamine suspension/ insulin aspart solution mixtures, rDNA origin (NovoLog Mix 70/30) NPH/regular insulin

0.5–1.0 unit/ kg/day

SQ

Only administered SQ

15 minutes

1–4 hours 18–24 hours 100 units/mL in 10-mL vials,

3-mL disposable delivery devices

0.5–1.0 unit/ kg/day

SQ

Only administered SQ

30 minutes

4–8 hours 24 hours

100 units/mL in 10-mL vials, 3-mL disposable delivery devices

mixtures (Humulin 70/30, Novolin 70/30)

SQ, Subcutaneously.

● Monitor body weight daily, because weight loss or gain will indicate a possible increase or decrease in insulin dose. ● If a sliding-scale insulin regimen is ordered, the nurse must be diligent with obtaining blood glucose levels before meals and at bedtime to adjust the insulin dose. Sliding scales are individualized per patient. ● Diet and nutrition education ● Once the diagnosis of T1DM has been made, the nurse needs to take a thorough dietary history of the patient’s eating hab- its. The patient and parents should have a dietary consult so that the patient can be placed on a diabetic diet or be taught to count carbohydrate exchanges and adjust insulin require- ments based on dietary intake. ● Education regarding physical exercise ● Assessment of the child’s exercise ability and regimen should be considered to determine the possibility for hypoglycemia during exercise and the need for preexercise snacks. ● The child should eat an extra complex carbohydrate and protein serving at least 30 minutes to 1 hour before engag- ing in exercise or sports.

● Education regarding differences between hypoglycemia and hyperglycemia ● Stress management or “sick day rules” should be established and taught to the patient, parents, family members, and teachers to have basic guidelines for how to manage diabe- tes in times of stress such as sickness, emotional stress, minor accidents, surgery, or dehydration ● Blood glucose and urine ketone monitoring ● Monitor blood glucose every 4 to 6 hours or as ordered by the physician. ● Test urine for the presence of ketones using urine ketosticks. ● On follow-up clinic visits to the endocrinologist, it is important to evaluate the patient’s blood sugar log for daily blood sugar trends, doses of insulin, the presence of ketones in the urine, and the presence of hypoglycemia. ● Many blood glucose monitors now have the capability to download blood sugar data into software at the endocri- nologist’s office so that trends in data can be evaluated and the health-care provider can use the data to adjust insulin or other medications.

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