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What Insulin Can Be Given Intravenously?

Optimal Dose And Method Of Administration Of Intravenous Insulin In The Management Of Emergency Hyperkalemia: A Systematic Review.

Optimal Dose And Method Of Administration Of Intravenous Insulin In The Management Of Emergency Hyperkalemia: A Systematic Review.

Abstract BACKGROUND AND OBJECTIVES: Hyperkalemia is a common electrolyte disorder that can result in fatal cardiac arrhythmias. Despite the importance of insulin as a lifesaving intervention in the treatment of hyperkalemia in an emergency setting, there is no consensus on the dose or the method (bolus or infusion) of its administration. Our aim was to review data in the literature to determine the optimal dose and route of administration of insulin in the management of emergency hyperkalemia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched several databases from their date of inception through February 2015 for eligible articles published in any language. We included any study that reported on the use of insulin in the management of hyperkalemia. RESULTS: We identified eleven studies. In seven studies, 10 units of regular insulin was administered (bolus in five studies, infusion in two studies), in one study 12 units of regular insulin was infused over 30 minutes, and in three studies 20 units of regular insulin was infused over 60 minutes. The majority of included studies were biased. There was no statistically significant difference in mean decrease in serum potassium (K+) concentration at 60 minutes between studies in which insulin was administered as an infusion of 20 units over 60 minutes and studies in which 10 units of insulin was administered as a bolus (0.79±0.25 mmol/L versus 0.78±0.25 mmol/L, P = 0.98) or studies in which 10 units of insulin was administered as an infusion (0.79±0.25 mmol/L versus 0.39±0.09 mmol/L, P = 0.1). Almost one fifth of the study population experienced an episode of hypoglycemia. CONCLUSION: The limited data available in the literature shows no statistically significant difference between the different regimens of insu Continue reading >>

Regular Insulin Only Insulin Given Iv

Regular Insulin Only Insulin Given Iv

New here, LPN of 29 years and about to finish a 4 year BSN program. Work in a level 1 trauma ER. My question is why is regular insulin the only insulin that is given IV? New here, LPN of 29 years and about to finish a 4 year BSN program. Work in a level 1 trauma ER. My question is why is regular insulin the only insulin that is given IV? Why are you giving insulin IV vs. any other route? IV is for fast-action to lower blood sugar. So why would you need a longer acting insulin IV? Occupation: MedLeg Consul/Educator/WHNP-FNPSpecialty:35 year(s) of experienceinEducation, FP, LNC, Forensics, ED, OB;From:US;Joined: Jun '05; Posts: 108,694; Likes: 28,183 new here, lpn of 29 years and about to finish a 4 year bsn program. work in a level 1 trauma er. my question is why is regular insulin the only insulin that is given iv? hello, cinnyb1018 and welcome to allnurses.com rationale for regular insulin iv: regular insulin lacks the additives that prolong action. please come back and post as you can. enjoy the site.:melody: Occupation: Diabetes EducatorSpecialty:15 year(s) of experienceinDiabetes ED, (CDE), CCU, Pulmonary/HIV;Joined: Jan '07; Posts: 528; Likes: 76 Actually, Humalog and Novalog can be given IV, but they cost more, & offer no advantage over regular insulin. Just remember that IV insulin has a very short half-life. There's no point in giving an IV bolus of insulin unless you are going to start a drip within 30 minutes. The ER docs are famous for doing this and all it does is lower the pt's BG for a few minutes. In fact, to quote a well respected UofMiami endocrinologist, "the only place for regular insulin in a hospital is in an insulin drip." We're still trying to abolish use of the "regular insulin sliding scale" (RISS) Like I tell all of my students and new RN's LO Continue reading >>

Insulin (medication)

Insulin (medication)

"Insulin therapy" redirects here. For the psychiatric treatment, see Insulin shock therapy. Insulin is used as a medication to treat high blood sugar.[3] This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Insulin can be made from the pancreas of pigs or cows.[5] Human versions can be made either by modifying pig versions or recombinant technology.[5] It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).[5] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.[8][9] In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS 7.48 pounds, while this amount of insulin glargine costs 30.68 pounds.[5] Medical uses[edit] Giving insulin with an insulin pen. Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacid Continue reading >>

Insulin Therapy - Cueflash - Learn By Studying Flashcards

Insulin Therapy - Cueflash - Learn By Studying Flashcards

When are short acting insulins given? how many minutes before a meal? 30 minutes before a meal to control post prandial hyperglycemia What is very necessary with the administration of short acting insulins as far as meals are concerned? a rigid meal schedule is necessary...the patient must estimate a meal will occur within 45 minutes of the injection. What is the only insulin that can be given IV? What is the normal dose and how is it administered? Regular 0.1 unit/kg/hr per continuous infusion What are the 2 main types of intermediate acting insulins? What are the 2 types of Lente insulins? What is the insulin suspended in? What type of suspension are the NPH insulins in? What purpose is intermediate acting (NPH) insulin given? to control blood glucose levels when patient is not eating. What substance is added to insluin to form a suspension that is more slowly absorbed with different time/action profile? What causes the cloudy appearance of NPH? What special thing should you do before drawing up NPH? What 2 other insulin classes can NPH be mixed with? what should you NOT mix with short acting insulin unless the patient already controlled on this mixture? should not mix lente plus short acting (not reccommended) Long acting insulins: (name the most commonly used now, and the 4 other not common) can lantus be mixed with any other insulin? it can unpredictably alter the onset of actoin and time of peak effect. DUH. 3 weird lente insulins not used much any more...what are they used for. what should you be careful of when using both lantus and lente? DON'T CONFUSE THE MOTHERFUCKERS. lantus is different than lente. should you mix levemir (insulin detemir) with any other insulin? What is the normal ph range of blood in an ABG? What is the normal PCO2 range of blood in an AB Continue reading >>

Regular Insulin - An Overview | Sciencedirect Topics

Regular Insulin - An Overview | Sciencedirect Topics

Regular insulin is a crystalline zinc insulin preparation, the effect of which appears within 30 minutes of subcutaneous injection. Mark A. Atkinson*, in Williams Textbook of Endocrinology (Thirteenth Edition) , 2016 Regular insulin consists of zinc-insulin crystals dissolved in a clear fluid. After subcutaneous injection, regular insulin tends to dissociate from its normal hexameric form, first into dimers and then into monomers; only the monomeric and dimeric forms can pass through the endothelium into the circulation to any appreciable degree.309 This feature determines the pharmacokinetic profile of regular insulin. The resulting relative delay in onset and duration of action of regular insulin limits its effectiveness in controlling postprandial glucose and results in dose-dependent pharmacokinetics, with a prolonged onset, peak, and duration of action with higher doses. Mark A. Sperling MD, ... Moshe Phillip MD, in Pediatric Endocrinology (Fourth Edition) , 2014 Human regular insulin was a mainstay of insulin management of youth with T1D until the early 2000s when the advent of rapid-acting insulin analogs virtually eliminated its use in children and adolescents, except for intravenous administration. The delayed absorption and prolonged duration of action of the large premeal bolus doses of regular insulin that are required by adolescents with T1D to overcome the insulin resistance of puberty contributed to problems with hyper- and hypoglycemia in this age group.142 Regular insulin remains the insulin of choice for intravenous infusion in the treatment of diabetic ketoacidosis. A special U-500 (500 units/mL) formulation of regular insulin as is available for use in patients with severe insulin resistance who require very large daily doses of insulin. Syed Khalid Continue reading >>

Types Of Insulin

Types Of Insulin

Insulin analogs are now replacing human insulin in the US. Insulins are categorized by differences in onset, peak, duration, concentration, and route of delivery. Human Insulin and Insulin Analogs are available for insulin replacement therapy. Insulins also are classified by the timing of their action in your body – specifically, how quickly they start to act, when they have a maximal effect and how long they act.Insulin analogs have been developed because human insulins have limitations when injected under the skin. In high concentrations, such as in a vial or cartridge, human (and also animal insulin) clumps together. This clumping causes slow and unpredictable absorption from the subcutaneous tissue and a dose-dependent duration of action (i.e. the larger dose, the longer the effect or duration). In contrast, insulin analogs have a more predictable duration of action. The rapid acting insulin analogs work more quickly, and the long acting insulin analogs last longer and have a more even, “peakless” effect. Background Insulin has been available since 1925. It was initially extracted from beef and pork pancreases. In the early 1980’s, technology became available to produce human insulin synthetically. Synthetic human insulin has replaced beef and pork insulin in the US. And now, insulin analogs are replacing human insulin. Characteristics of Insulin Insulins are categorized by differences in: Onset (how quickly they act) Peak (how long it takes to achieve maximum impact) Duration (how long they last before they wear off) Concentration (Insulins sold in the U.S. have a concentration of 100 units per ml or U100. In other countries, additional concentrations are available. Note: If you purchase insulin abroad, be sure it is U100.) Route of delivery (whether they a Continue reading >>

Insulin

Insulin

Sort Mixing Compatibilities •NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30) •NPH 70% and regular insulin 30% (Humulin 70/30, Novolin 70/30) •insulin aspart protamine suspension 75% and insulin aspart 25% (NovoLog Mix 75/25) •insulin lispro protamine suspension 75% and insulin lispro 25% (Humalog Mix 75/25) •Premixed; do not mix with other insulins Rapid-acting o Insulin lispro (Humalog) o Insulin aspart (NovoLog) o Insulin glulisine (Apidra) •Given SC or continuous SC pump (not IV) •Most rapid onset (5-15 min) •Shorter duration •Pt must eat meal after injection oMust eat within 15min of dosage Intermediate-acting oIsophane insulin suspension oAKA NPH - Novolin •Cloudy or opaque in appearance •NPH insulin is often combined with regular insulin to reduce the number of insulin injections per day. •Slower in onset than endogenous insulin •More prolonged in duration than endogenous insulin obut not as long as those of the long-acting insulins Put the following insulins in order from shortest to longest time of onset oInsulin glargine (Lantus) oInsulin isophane suspension (NPH) oInsulin Lispro (Humalog) oRegular insulin (Humulin or Novolin R) oRegular insulin (Humulin or Novolin R) 1 oInsulin Lispro (Humalog) 2 oInsulin glargine (Lantus) 3 oInsulin isophane suspension (NPH) 4 Continue reading >>

Nclex Study Pharmacology Insulin

Nclex Study Pharmacology Insulin

Sort Can intermediate acting insulin be mixed with regular or rapid acting insulin? Isophane suspension: NPH Humulin N Novolin N YES What is the technique for mixing intermediate insulin with rapid or regular insulin? Isophane suspension: NPH Humulin N Novolin N CLEAR TO CLOUDY Draw up clear (regular or rapid acting) then draw up cloudy (NPH) Continue reading >>

Intravenous Glargine And Regular Insulin Have Similar Effects On Endogenous Glucose Output And Peripheral Activation/deactivation Kinetic Profiles.

Intravenous Glargine And Regular Insulin Have Similar Effects On Endogenous Glucose Output And Peripheral Activation/deactivation Kinetic Profiles.

Abstract OBJECTIVE: To compare the effects of intravenously administered long-acting insulin analog glargine and regular human insulin on activation and deactivation of endogenous glucose output (EGO) and peripheral glucose uptake. RESEARCH DESIGN AND METHODS: In this single-center, randomized, double-blind, crossover euglycemic glucose clamp study, 15 healthy male volunteers (aged 27 +/- 4 years, BMI 24.2 +/- 0.7 kg/m(2) [mean +/- SE]) received a primed continuous intravenous infusion of 40 mU/m(2) of insulin glargine or regular human insulin on 2 different study days in a randomized order. Euglycemia was maintained at 90 mg/dl using a simultaneous variable intravenous infusion of 20% dextrose containing D-[3-(3)H]glucose. EGO and peripheral glucose disposal kinetics were determined during a 4-h insulin infusion activation period and a 3-h deactivation period. RESULTS: The results demonstrated no significant difference in activation or deactivation kinetics with respect to EGO and peripheral glucose disposal between insulin glargine and regular human insulin when given intravenously. The mean +/- SE time required for 50% suppression of EGO after insulin infusion was 73 +/- 23 min for regular insulin and 57 +/- 20 min for insulin glargine (NS). The mean maximum rate of glucose disposal was 10.10 +/- 0.77 and 9.90 +/- 0.85 mg. kg(-1). min(-1) for regular insulin and insulin glargine, respectively (NS). The mean time required for 50% suppression of incremental glucose disposal rate (GDR), defined as the time required for activation from the basal glucose disappearance rate (R(d)) to half-maximum insulin-stimulated R(d), was 32 +/- 5 and 42 +/- 10 min for regular insulin and insulin glargine, respectively (NS). The time required for deactivation from maximum insulin-stimul Continue reading >>

Insulin Administration

Insulin Administration

Insulin is a protein formed by two cross-linked peptide chains. Insulin is secreted in pulses by the pancreas and reaches the liver via the portal circulation. Some 80% of the insulin reaching the liver is cleared from the circulation, which means that insulin attains much higher concentrations in the liver than in the peripheral circulation. Insulin has a short plasma half-life (3-4 minutes), and choice of the route and timing of insulin administration is a major determinant of metabolic control. Conventional insulin injections are given into the thigh, abdomen or outer side of the buttock. Standard needles range from 0.8 - 1.6 cm in length, are used with a syringe or pen device and deliver insulin into the subcutaneous fat. Too long a needle or poor injection technique can result in injection into a muscle, which is painful and results in more rapid absorption of insulin. Many alternative routes of administration have been tested, but none can match direct injection or infusion. Subcutaneous insulin injection or infusion share the disadvantages of delivery into the systemic rather than portal circulation, and rates of appearance in the blood stream which are delayed and rendered somewhat erratic by the process of absorption from subcutaneous tissues. Characteristics of an ideal insulin administration system Nature has placed the pancreatic beta cell inside a digestive gland and astride an arterial supply that continuously samples the rate of nutrient absorption from the gut. It responds instantaneously to these blood-borne signals by releasing insulin in synchronised pulses, a pattern of secretion that maximises its effect on liver cells. Furthermore, it matches this insulin secretion with reciprocal suppression or release of its partner hormone pancreatic glucagon, t Continue reading >>

Insulin Lispro (intravenous Route, Subcutaneous Route)

Insulin Lispro (intravenous Route, Subcutaneous Route)

Description and Brand Names Drug information provided by: Micromedex US Brand Name Humalog Lispro-PFC Descriptions Insulin lispro is a fast-acting type of insulin. Insulin is one of many hormones that help the body turn the food we eat into energy. This is done by using the glucose (sugar) in the blood as quick energy. Also, insulin helps us store energy that we can use later. When you have diabetes mellitus, your body cannot make enough or does not use insulin properly. So, you must take additional insulin to regulate your blood sugar and keep your body healthy. This is very important as too much sugar in your blood can be harmful to your health. Insulin lispro starts to work faster than some other types of insulin, and its effects do not last as long. It should act more like the insulin your body would normally produce. Because the effects of insulin lispro are short-acting, your doctor may also prescribe a longer-acting insulin for you to use. This medicine is available only with your doctor's prescription. This product is available in the following dosage forms: Suspension Copyright © 2017 Truven Health Analytics Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Continue reading >>

Intravenous Insulin Therapy

Intravenous Insulin Therapy

Patients with hyperglycemia in the ICU have increased morbidity and mortality. Hyperglycemia is associated with immune dysfunction, increased systemic inflammation, and vascular insufficiency. Elevated blood glucose levels have been shown to worsen outcomes in medical patients who are in the ICU for more than 3 days. Hyperglycemia may result from stress, infection, steroid therapy, decreased physical activity, discontinuation of outpatient regimens, and nutrition. [ 1 ] Improved control of hyperglycemia improves patient outcomes, but clinical confirmation of this thesis has proven elusive. Significant interest was generated by initial single-center results that have not been replicated in multisite studies. In 2001, a randomized controlled study in a surgical ICU demonstrated a decrease in mortality from 8% to 4.6% in patients with intensive continuous intravenous insulin therapy. [ 2 ] The author repeated the protocol in a study of 1200 patients in a medical ICU. [ 3 ] The conventional treatment group was treated to maintain a blood glucose level between 180-200 mg/dL, whereas the intensive treatment group was treated to maintain a blood glucose level between 80-110 mg/dL. Mortality was not significantly reduced by intensive insulin therapy and was actually higher in patients in the intensive treatment group who were in the ICU for less than 3 days. In patients who were in the ICU for longer than 3 days, the intensive treatment group did demonstrate reduced morbidityfrom decreased kidney injury, earlier weaning from mechanical ventilation, and earlier discharge from the medical ICU and hospital. Hypoglycemia occurred more often in the intensive treatment group than the conventional treatment group. In addition, an experienced physician was actively involved in adminis Continue reading >>

Should I Inject Insulin Into A Vein?

Should I Inject Insulin Into A Vein?

I am 20 years old and have type 1 diabetes. When I am off the insulin pump, my blood sugar gets unstable and can take more than 48 hours to go down. Two friends told me that to handle this, they just inject a very small amount of insulin directly into the bloodstream. I know it sounds crazy, but this would save me time and money. Is it safe? Continue reading >>

Types Of Insulin For Diabetes Treatment

Types Of Insulin For Diabetes Treatment

Many forms of insulin treat diabetes. They're grouped by how fast they start to work and how long their effects last. The types of insulin include: Rapid-acting Short-acting Intermediate-acting Long-acting Pre-mixed What Type of Insulin Is Best for My Diabetes? Your doctor will work with you to prescribe the type of insulin that's best for you and your diabetes. Making that choice will depend on many things, including: How you respond to insulin. (How long it takes the body to absorb it and how long it remains active varies from person to person.) Lifestyle choices. The type of food you eat, how much alcohol you drink, or how much exercise you get will all affect how your body uses insulin. Your willingness to give yourself multiple injections per day Your age Your goals for managing your blood sugar Afrezza, a rapid-acting inhaled insulin, is FDA-approved for use before meals for both type 1 and type 2 diabetes. The drug peaks in your blood in about 15-20 minutes and it clears your body in 2-3 hours. It must be used along with long-acting insulin in people with type 1 diabetes. The chart below lists the types of injectable insulin with details about onset (the length of time before insulin reaches the bloodstream and begins to lower blood sugar), peak (the time period when it best lowers blood sugar) and duration (how long insulin continues to work). These three things may vary. The final column offers some insight into the "coverage" provided by the different insulin types in relation to mealtime. Type of Insulin & Brand Names Onset Peak Duration Role in Blood Sugar Management Rapid-Acting Lispro (Humalog) 15-30 min. 30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with Continue reading >>

A Nurse's Guide To Administering Iv Insulin

A Nurse's Guide To Administering Iv Insulin

You have a patient that comes up to your unit with a blood sugar of 952. The labs are sent off and the patient is found to be in severe diabetic ketoacidosis (DKA). The doctor puts in the orders for serial lab work, fluid boluses, electrolyte replacements, and an insulin drip. As a newer nurse, you are familiar with labs, boluses, your replacement protocols, but have never administered insulin through an IV. What nursing interventions do you need to perform to safely care for this patient? How Does Insulin Work? Insulin is a hormone created by the pancreas. It allows your body to use glucose to provide the body's cells with the necessary energy they need. Insulin production from the pancreas is based off of your blood sugar levels. If you are getting hyperglycemic, the pancreas is signaled and insulin is released into the bloodstream. Insulin then signals different cells to absorb the glucose and use it as energy or store it for later use. When insulin facilitates glucose being pulled into a cell, a potassium cation is also pulled from extracellular fluid (meaning the bloodstream) into the intracellular fluid. How does this affect our patients? Initially, patients in DKA have an increased extracellular potassium level due to the hyperglycemia and acidosis they are experiencing. This potassium level is quickly decreased as blood glucose is pulled into the cells. Administration As with all critical care medications, be sure to check your hospital's policy for administration. I have seen two main situations in which IV insulin (meaning regular insulin, not Lantus, Aspart, etc.) is given. Treatment of DKA: It seems like each hospital has a different protocol they use to manage DKA patients with. Commonly patients are treated with a bolus of regular insulin IV and then place Continue reading >>

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