diabetestalk.net

What Is The Route Of Administration Of Insulin?

Actrapid 100 International Units/ml, Solution For Injection In A Vial

Actrapid 100 International Units/ml, Solution For Injection In A Vial

1 vial contains 10 ml equivalent to 1,000 international units. 1 ml solution contains 100 international units insulin human* (equivalent to 3.5 mg). *Human insulin is produced in Saccharomyces cerevisiae by recombinant DNA technology. Excipient with known effect: Actrapid contains less than 1 mmol sodium (23 mg) per dose, i.e. Actrapid is essentially 'sodium-free'. For the full list of excipients, see section 6.1. Posology The potency of human insulin is expressed in international units. Actrapid dosing is individual and determined in accordance with the needs of the patient. It can be used alone or in combination with intermediate-acting or long-acting insulin before a meal or a snack. The individual insulin requirement is usually between 0.3 and 1.0 international unit/kg/day. Adjustment of dose may be necessary if patients undertake increased physical activity, change their usual diet or during concomitant illness. Special populations Elderly (≥ 65 years old) Actrapid can be used in elderly patients. In elderly patients, glucose monitoring should be intensified and the insulin dose adjusted on an individual basis. Renal and hepatic impairment Renal or hepatic impairment may reduce the patient's insulin requirements. In patients with renal or hepatic impairment, glucose monitoring should be intensified and the human insulin dose adjusted on an individual basis. Paediatric population Actrapid can be used in children and adolescents. Transfer from other insulin medicinal products When transferring from other insulin medicinal products, adjustment of the Actrapid dose and the dose of the basal insulin may be necessary. Close glucose monitoring is recommended during the transfer and in the initial weeks thereafter (see section 4.4). Method of administration Actrapid is a Continue reading >>

How To Give Insulin To A Dog

How To Give Insulin To A Dog

Dogs with diabetes aren't able to make enough insulin, a hormone that allows the body to store energy from food and move glucose into cells. Because this condition has serious and potentially fatal consequences, diabetic dogs are typically treated with insulin injections one or two times each day. Because insulin is not a sturdy substance, it is important to handle it gently and avoid exposing it to extreme temperatures or excessive motion. Store unopened bottles of insulin in your refrigerator. After they have been opened, it is still advisable to keep insulin in the fridge. It can tolerate short periods of time at room temperature in an area where it’s out of direct sunlight. Before attempting to give your dog insulin, it is wise to practice loading the syringe with the appropriate amount of sterile water or saline. You can even use an apple or orange to practice giving insulin injections until you feel you are ready to try it on your dog. Because there are many different kinds of dog insulin syringes, make sure you buy the size and type recommended by your veterinarian. Always use a new syringe and needle every time you give your dog an insulin injection. This will guarantee that your supplies are sterile and minimize risk of infection. Unwrap the syringe and needle, but leave the needle itself capped until you are prepared to load the syringe with insulin. Carefully roll the bottle of insulin in your hands to make sure the hormone is well mixed. Do not shake it. Remove the needle cap. Then, use the pointer finger and thumb of one hand to hold the insulin syringe while drawing back on the plunger with the other hand. Continue to pull back, filling the plunger with air, until you reach the correct marker for the amount of insulin your dog will need. Hold the bottle Continue reading >>

Insulin: From Prescription To Administration

Insulin: From Prescription To Administration

The purpose of this guideline is to support the safe and effective use of insulin at Great Ormond Street Hospital (GOSH). It follows the implementation of the National Patient Safety Agency (NPSA 2010) guidance “Safer Administration of Insulin” and supports best practice throughout the Trust. The aim of this document is to ensure that: The right patient receives the right type and dose of insulin, at the right time by the most appropriate delivery device The most appropriate technique is used to inject insulin with the most commonly used insulin pens The most appropriate insulin syringe is used to prepare insulin for an insulin infusion Insulin therapy in diabetes Diabetes mellitus is a group of metabolic diseases characterised by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Insulin is a polypeptide hormone produced by the beta cells in the pancreas that plays a key role in the regulation of carbohydrate, fat and protein metabolism. Treatment with insulin in patients with diabetes mellitus, is essential not only to optimise glycaemic control, but also to reverse the abnormalities in fat and protein metabolism caused by the deficient action of endogenous insulin on target tissues and to reduce the development of micro and macrovascular complications. Insulin is lifesaving medication when prescribed and administered appropriately but also has the potential to cause significant harm (Diabetes Care, 2011). It is a high-risk medicine (Institute of Safe Medication Practice, 2008; Patient Safety First, 2013). Nationally, incidents related to insulin have been reported at all stages of the medication process, the most common being, wrong dose, omitted or delayed insulin and wrong insulin product (Department of Health (DH) 2012/ Continue reading >>

Route And Rate Of Insulin Administration In Diabetic Ketoacidosis

Route And Rate Of Insulin Administration In Diabetic Ketoacidosis

DOI: This article does not have an abstract to display. Continue reading >>

Handling, Storing & Administering Insulin To Dogs

Handling, Storing & Administering Insulin To Dogs

Insulin is available in concentrations of 40, 100, and 500 units/ml. There are corresponding syringes to use for the measurement of the three concentrations of insulin. If using insulin with 40 U/ml, you must measure and administer it with a U-40 syringe; using a U-100 or U-500 syringe would result in the wrong amount of insulin being given, with perhaps a fatal outcome. There may be several types of U-40 syringes available, manufactured to deliver low or high doses. The measurements marked off on those syringes designed for giving a low dose are often easier to read. Find out from your veterinarian (or pharmacist) what syringes are available for you to use with the concentration of insulin your dog is receiving. How is insulin stored and handled? Insulin comes in a glass vial with a rubber stopper, and must be stored in the refrigerator. Do not use the insulin beyond its expiration date. How is a dose of insulin measured? The concentration of insulin is measured in units. Insulin syringes are marked in units, and may also be marked in milliliters. Be sure to use the unit scale. Also, be sure you are using the appropriate insulin syringe for the concentration of insulin you are using. An insulin syringe has 4 basic parts: the barrel, plunger, needle, and needle guard. Many brands of syringes have the needle permanently attached to the syringe barrel so it cannot be removed. 1. Prior to removing a dose of insulin from the vial, mix and warm the contents by gently rolling the vial between the palms of your hands. DO NOT SHAKE INSULIN as that will cause air bubbles to form, and it will be more difficult to get an accurate measurement. NOTE: We have used a pink solution instead of insulin to better illustrate the steps. 2. Hold the vial stopper-side-down, remove the needle Continue reading >>

The Pharmaceutics And Compounding Laboratory

The Pharmaceutics And Compounding Laboratory

The subcutaneous (SC, SQ) route is one of the most versatile routes of administration in that it can be used for both short term and very long term therapies. The injection of a drug or the implantation of a device beneath the surface of the skin is made in the loose interstitial tissues of the upper arm, the anterior surface of the thigh, or the lower portion of the abdomen. The upper back also can be used as a site of subcutaneous administration. The site of injection is usually rotated when injections are frequently given. The maximum amount of medication that can be subcutaneously injected is about 2 ml. Needles are generally 3/8 to 1 inch in length and 24 to 27 gauge. Absorption of drugs from the subcutaneous tissue is influenced by the same factors that determine the rate of absorption from intramuscular sites (slowly soluble salt forms, suspensions versus solutions, differences in particle size, viscosity of the injection vehicle, etc.); however, the vascularity in the subcutaneous tissue is less than that of muscle tissue, and therefore absorption may be slower than after intramuscular administration. But absorption after subcutaneous administration is generally more rapid and predictable than after oral administration. There are several ways to change the absorption rate: use heat or massage the site to increase the absorption rates of many drugs. co-administer vasodilators or hyaluronidase to increase absorption rates of some drugs. Conversely, epinephrine decreases blood flow which can decrease the absorption rate. Many different solution and suspension formulations are given subcutaneously. Heparin, enoxaparin, and insulin are the most important drugs routinely administered by this route. Drugs that are administered by the route must be soluble and potent in Continue reading >>

Isophane Insulin Injection

Isophane Insulin Injection

Enter brand name, generic name, or approved indication. TABLE OF CONTENTS 1. DESCRIPTION 7. WARNINGS AND PRECAUTIONS 2. INDICATIONS AND USAGE 8. ADVERSE REACTIONS 3. DOSAGE AND ADMINISTRATION 9. OVERDOSAGE 4. CONTRAINDICATIONS 10. DRUG INTERACTIONS 5. MECHANISM OF ACTION 11. PHARMACOKINETICS 6. USE IN SPECIFIC POPULATIONS 12. HOW SUPPLIED/STORAGE AND HANDLING Neutral Protamine Hagedorn (NPH) or isophane insulin is an intermediate-acting insulin that is produced by adding zinc and protamine to regular insulin causing a delay in absorption and a prolongation of the duration of action after subcutaneous administration. Commercially available insulin is prepared using recombinant DNA technology (E. coli bacteria) or enzymatic modification of beef or pork insulin to create a product identical in structure and function to endogenous human insulin. Diabetes mellitus type 1 is caused by insulin deficiency while diabetes mellitus type 2 is caused by a combination of insulin deficiency and resistance. Biosynthetic insulin is used as replacement therapy in patients with diabetes mellitus to temporarily restore their ability to use fats, carbohydrates, and proteins, and to convert glycogen to fat. Insulin administration also enables these patients to replete their liver glycogen stores. For the treatment of type 1 diabetes mellitus or for type 2 diabetes mellitus inadequately managed by diet, exercise, and oral hypoglycemics. For the treatment of gestational diabetes or for the treatment of patients with pre-existing diabetes mellitus (Type 1 or type 2) who are now pregnant. For pregnant patients with preexisting diabetes prior to pregnancy. General information on insulin dosage, regardless of insulin type administered: • Dosage must be individualized; fasting or preprandial bloo Continue reading >>

Diabetic Emergencies, Diabetic Ketoacidosis In Adults, Part 3

Diabetic Emergencies, Diabetic Ketoacidosis In Adults, Part 3

Clinical Management Treatment consists of rehydration with intravenous fluids, the administration of insulin, and replacement of electrolytes. General medical care and close supervision by trained medical and nursing staff is of paramount importance in the management of patients with DKA. A treatment flowchart (Table 1.3) should be used and updated meticulously. A urine catheter is necessary if the patient is in coma or if no urine is passed in the first 4 hours…. Replacement of water deficit Patients with DKA have severe dehydration. The amount of fluid needing to be administered depends on the degree of dehydration (Table 1.4). Fluid replacement aims at correction of the volume deficit and not to restore serum osmolality to normal. Isotonic solution NaCl (0.9%) (normal saline; osmolality 308 mOsm/kg) should be administered even in patients with high serum osmolality since this solution is hypotonic compared to the extracellular fluid of the patient. 10 The initial rate of fluid administration depends on the degree of volume depletion and underlying cardiac and renal function. In a young adult with normal cardiac and/or renal function 1 L of normal saline is administered intravenously within the first half- to one hour. In the second hour administer another 1 L, and between the third and the fifth hours administer 0.5–1 L per hour. Thus, the total volume in the first 5 hours should be 3.5–5 L [1]. If the patient is in shock or blood pressure does not respond to normal saline infusion, colloid solutions together with normal saline may be used.1,6 Some authors suggest replacement of normal saline with hypotonic (0.45%) saline solution after stabilization of the hemodynamic status of the patient and when corrected serum sodium levels are normal.8 However, this appro Continue reading >>

Mmpr019 Protocol For The Administration Of Insulin

Mmpr019 Protocol For The Administration Of Insulin

TO ADULTS WITH DIABETES IN THE COMMUNITY BY NON- REGISTERED PRACTITIONERS Table of Contents Why we need this Policy........................................................................................................ 4 What the Policy is trying to do .............................................................................................. 4 The Safer use of insulin focuses on giving: ........................................................................ 4 With the appropriate: ........................................................................................................ 4 Which stakeholders have been involved in the creation of this Policy ................................. 5 Any required definitions/explanations .................................................................................. 5 Key duties .............................................................................................................................. 5 Medicines Management Committee (MMC) .................................................................... 5 Medical Director ................................................................................................................ 5 Clinical Directors ................................................................................................................ 5 Heads of Service ................................................................................................................ 5 Diabetes Specialist Nursing Team ..................................................................................... 5 Modern Matrons/ Lead Practitioner ................................................................................. 6 Registered Nurses ...................................................................... Continue reading >>

The Right Route: The Site Of Injection Matters

The Right Route: The Site Of Injection Matters

Case 1 A 46 year old morbidly obese diabetic patient arrives in your ED with hypoglycemia, altered mental status and diaphoresis, and no peripheral venous access. You order IM Glucagon until IV access can be established and an amp of D50 can be given. The nurse gives the IM injection using the dorsogluteal site, and attempts at IV access continue. After 15 minutes, there is no marked change in the patient’s condition and an IO is placed to treat hypoglycemia. Why didn’t the Glucagon help? Case 2 A 55 year old woman with metastatic cancer, on an IV Dilaudid pump, is brought to the ED by her son for management of increasing pain that is not managed with the continuous infusion and intermittent boluses of 1 mg Dilaudid. She is grim and quiet and you can see that she is in severe pain. However, she is extremely cachectic, with no IV access, no fat and very little muscle mass. You cringe at the thought of a painful IM injection. Your nurse suggests a 2 mg dose of subq Dilaudid. You appreciate the recommendation and write the order. While in most EDs, nurses perform injections, in wilderness, prehospital, and disaster situations, physicians or paramedics must provide injections, so it is important to understand the anatomic principles of injection. Currently the most commonly used sites for the rapid delivery of rescue medications are the IV, IM, and subcutaneous sites. These routes result in differences in drug absorption, onset of action, and duration of action of rescue medications. IV drug administration achieves high plasma concentrations rapidly in plasma and tissues. Muscles are very vascular structures, and IM absorption occurs by drug diffusion from interstitial fluid and capillary membranes into plasma, and so onset of action is longer than IV injection. IM abso Continue reading >>

The Route Of Administration Influences The Effect Of Estrogen On Insulin Sensitivity In Postmenopausal Women*

The Route Of Administration Influences The Effect Of Estrogen On Insulin Sensitivity In Postmenopausal Women*

Objective To determine the effect of transdermal estrogen on insulin sensitivity in postmenopausal women and to compare this effect with changes observed with oral conjugated equine estrogens. Design Fourteen postmenopausal women were randomized to receive a transdermal E2 patch, 0.1 mg, for 25 days each month (n=7) or transdermal E2 with added medroxyprogesterone acetate (MPA), 10 mg, from days 16 to 25 each month (n=7). An insulin tolerance test (ITT) was performed at baseline and between days 23 and 25 during the 2nd month of treatment to assess insulin sensitivity. Values for the disappearance of glucose (Kitt) were calculated and compared with values obtained from women receiving 1.25 mg of oral equine estrogens (n=8). Results Women receiving transdermal E2 alone demonstrated improved insulin sensitivity. The Kitt glucose values increased by 13.2%, compared with a 23.9% decrease in Kitt values observed with 1.25 mg of conjugated equine estrogen. The group treated with transdermal E2 and MPA had a reduction in insulin sensitivity. Insulin clearance was enhanced only with transdermal estrogen and was significantly delayed (blunted clearance) with the addition of MPA to transdermal E2 and with oral estrogen. Conclusion We previously demonstrated a bimodal effect of oral equine estrogens on insulin sensitivity with an improvement occurring with the lower dose of 0.625 mg but with a deterioration with the dose of 1.25 mg. Here we suggest that this effect may be related to a first-pass hepatic-portal effect in that transdermal E2 (0.1 mg), which may be equated more closely with the larger dose of oral estrogen (1.25 mg), improved insulin sensitivity. Progestin, however, appeared to attenuate the beneficial effects of transdermal estrogen and may alter the clearance of in Continue reading >>

What Are The Possible Side Effects Of Insulin Lispro (humalog, Humalog Cartridge, Humalog Kwikpen, Humalog Pen)?

What Are The Possible Side Effects Of Insulin Lispro (humalog, Humalog Cartridge, Humalog Kwikpen, Humalog Pen)?

HUMALOG (insulin lispro) Injection DESCRIPTION HUMALOG® (insulin lispro injection) is a rapid-acting human insulin analog used to lower blood glucose. Insulin lispro is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli. Insulin lispro differs from human insulin in that the amino acid proline at position B28 is replaced by lysine and the lysine in position B29 is replaced by proline. Chemically, it is Lys(B28), Pro(B29) human insulin analog and has the empirical formula C257H383N65O77S6 and a molecular weight of 5808, both identical to that of human insulin. HUMALOG has the following primary structure: HUMALOG is a sterile, aqueous, clear, and colorless solution. Each milliliter of HUMALOG U-100 contains insulin lispro 100 units, 16 mg glycerin, 1.88 mg dibasic sodium phosphate, 3.15 mg Metacresol, zinc oxide content adjusted to provide 0.0197 mg zinc ion, trace amounts of phenol, and Water for Injection. Insulin lispro has a pH of 7.0 to 7.8. The pH is adjusted by addition of aqueous solutions of hydrochloric acid 10% and/or sodium hydroxide 10%. Each milliliter of HUMALOG U-200 contains insulin lispro 200 units, 16 mg glycerin, 5 mg tromethamine, 3.15 mg Metacresol, zinc oxide content adjusted to provide 0.046 mg zinc ion, trace amounts of phenol, and Water for Injection. Insulin lispro has a pH of 7.0 to 7.8. The pH is adjusted by addition of aqueous solutions of hydrochloric acid 10% and/or sodium hydroxide 10%. font size A A A 1 2 3 4 5 Next What is Type 2 Diabetes? The most common form of diabetes is type 2 diabetes, formerly called non-insulin dependent diabetes mellitus or "adult onset" diabetes, so-called because it typically develops in adults over age 35, though it can develop at any age. Type 2 diabetes i Continue reading >>

7.3 Intradermal And Subcutaneous Injections

7.3 Intradermal And Subcutaneous Injections

Intradermal injections (ID) are injections administered into the dermis, just below the epidermis. The ID injection route has the longest absorption time of all parenteral routes. These types of injections are used for sensitivity tests, such as TB (see Figure 7.13), allergy, and local anesthesia tests. The advantage of these tests is that the body reaction is easy to visualize, and the degree of reaction can be assessed. The most common sites used are the inner surface of the forearm and the upper back, under the scapula. Choose an injection site that is free from lesions, rashes, moles, or scars, which may alter the visual inspection of the test results (Lynn, 2011). Equipment used for ID injections is a tuberculin syringe calibrated in tenths and hundredths of a millilitre, and a 1/4 to 1/2 in., 26 or 27 gauge needle. The dosage of an ID injection is usually under 0.5 ml. The angle of administration for an ID injection is 5 to 15 degrees. Once the ID injection is completed, a bleb (small blister) should appear under the skin. Checklist 56 outlines the steps to administer an intradermal injection. Disclaimer: Always review and follow your hospital policy regarding this specific skill. Do not aspirate. It is not necessary to aspirate because the dermis is relatively without vessels. Always take steps to eliminate interruptions and distractions during medication preparation. If the patient expresses concerns about the medication or procedure, stop and explore the concerns. Re-verify order with physician if appropriate. Steps Additional Information 1. Prepare medication or solution as per agency policy. Ensure all medication is properly identified. Check physician orders, Parenteral Drug Therapy Manual (PDTM), and MAR to validate medication order and guidelines for admin Continue reading >>

Nanoparticle Insulin Drug Delivery — Applications And New Aspects

Nanoparticle Insulin Drug Delivery — Applications And New Aspects

1. Introduction Insulin is a hormone secreted from the β cells of the islets of Langerhans, specific groups of cells in the pancreas. Insulin is a protein consisting of two polypeptide chains, one of 21 amino acid residues and the other of 30, joined by two disulfide bridges. It was isolated in 1921 with its first clinical use in 1922 [1]. Insulin is prepared different techniques; One of these isolated from animals and the other is biotechnological preparation using with the recombinant DNA techniques [2, 3]. Insulin is a important player in the control of intermediary metabolism and profound effects on both carbohydrate and lipid metabolism. It has significant influence on protein and mineral metabolism [4, 5]. The traditional and most predictable method for the administration of insulin is by subcutaneous injections. This method is often painful and hence, deterrent to patient compliance especially for those requiring multiple dose injections of four times a day. Also, there have been reports of hypoglycemic episodes following multi dose injections of insulin [6, 7]. Several new approaches to the method have been adopted to decrease the suffering of the diabetic patients including the use of supersonic injector, infusion pump, sharp needles and pens. Some insulin delivery routs so problematic way for example oral administration; Oral delivery eliminates the pain caused by injection, psychological barriers associated with multiple daily injections. Oral delivery of insulin as a non-invasive therapy for Diabetes Mellitus is still a challenge to the drug delivery technology, because insulin is degraded by the enzymes in the acidic environment of stomach. Otherwise insulin delivery via transdermal delivery is so popular way of insulin administration but there are some di Continue reading >>

Description And Brand Names

Description And Brand Names

Drug information provided by: Micromedex Descriptions Insulin is one of many hormones that helps the body turn the food we eat into energy. Also, insulin helps us store energy that we can use later. After we eat, insulin works by causing sugar (glucose) to go from the blood into our body's cells to make fat, sugar, and protein. When we need more energy between meals, insulin will help us use the fat, sugar, and protein that we have stored. This occurs whether we make our own insulin in the pancreas gland or take it by injection. Diabetes mellitus (sugar diabetes) is a condition in which the body does not make enough insulin to meet its needs or does not properly use the insulin it makes. Without insulin, glucose cannot get into the body's cells. Without glucose, the cells will not work properly. To work properly, the amount of insulin you use must be balanced against the amount and type of food you eat and the amount of exercise you do. If you change your diet, your exercise, or both without changing your insulin dose, your blood glucose level can drop too low or rise too high. A prescription is not necessary to purchase most insulin. However, your doctor must first determine your insulin needs and provide you with special instructions for control of your diabetes Insulin can be obtained from beef or pork pancreas glands. Another type of insulin that you may use is called human insulin. It is just like the insulin made by humans but it is made by methods called semi-synthetic or recombinant DNA. All types of insulin must be injected because, if taken by mouth, insulin is destroyed in the stomach. Insulin is available only with your doctor's prescription. Copyright © 2018 Truven Health Analytics Inc. All rights reserved. Information is for End User's use only and may no Continue reading >>

More in insulin