Insulin

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Insulin
July 2006
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Insulin

• Session outline
• Insulin action
• Types
• Administration
• Syringe disposal
• Dosage
• Sliding scale insulin
• Insulin pens

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Insulin action

• The action of insulin is to
• Help movement of glucose into the cells.
• Stimulate cells to take up glucose from the
  blood.
• Increase the storage of glucose, amino acids and
  fatty acids.
• Increase glycogen formation and storage in the
  liver.

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Short acting insulins

• Human analogue Humalog / Novo Rapid
• onset 0.25 - 0.5 hrs
• peak 1 - 3 hrs
• lasts 3 - 5 hrs
• Neutral Actrapid / Humalin R
• onset 0.5 - 1 hr
• peak 2 - 4 hrs
• lasts 5 - 8 hrs

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Intermediate acting insulins

• Isophane Protaphane / Humalin NPH (cloudy)

• onset 1 - 2 hrs
• peak 4 - 12 hrs
• lasts 16 - 24 hrs

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Long acting analogue insulins

• Human analogue
• Glargine
• onset 2 - 4 hrs
• peak nil
• lasts 24 hrs
• Detemir
• onset 1 - 2 hrs
• peak 6 - 12 hrs
• lasts 20 - 24 hrs

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Premixed insulin

• Neutral plus Isophane mix
• Mixtard 20/80, 30/70, 50/50, Humalin 30/70
• human (cloudy)
• mixture of intermediate and short
• Human analogue plus Isophane mix
• NovoMix 30 (30/70 ) Humalog Mix 25 (25/75)
• human (cloudy)
• mixture of intermediate and very short

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Insulin administration

• Nurses responsibilities
• Check medication order
• Check the correct insulin type and dose
• Ensure correct patient and time
• Supervise administration technique
• Consult diabetes nurse as needed
• Documentation

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Insulin administration

• Sites abdomen (preferable) rotate site with
  each injection.
• Timing depends on the type of insulin.
• Storage unopened stored in refrigerator.
  Insulin in use, in cool, dark place lt25º (not in
  fridge).
• Expiry use within 28 days of opening. Discard
  after expiry date.
• Supply prescription only.

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Syringe disposal

• Take care at all times
• Store supplies carefully
• Use a sharps container
• Do not recap your needles / lancets
• For local arrangements about safe disposal of
  containers check council, public hospital or
  community health centre

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Dosage

• Insulin types and doses vary.
• Usual insulin dose should be maintained if person
  is nauseated.
• Dosage may be decreased if hypos occur, or
  decreased food.
• Dosage may be increased during illness,
  inactivity or increased food.

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Sliding scale insulin

• Possible indications
• Major surgery
• Unwell and fasting

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Sliding scale insulin

• Management
• Give at appropriate time and check BGL
  immediately prior to insulin dose.
• If fasting ensure Dextrose IVT insitu.
• No 0200 insulin unless Dextrose IVT insitu.
• Check with MO if 2100 dose is required.
• Recommence 30 phane insulin as soon as possible.

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Insulin devices