Insulin: How To Give A Mixed Dose
Many people with diabetes need to take insulin to keep their blood glucose in a good range. This can be scary for some people, especially for the first time. The truth is that insulin shots are not painful because the needles are short and thin and the insulin shots are placed into fatty tissue below the skin. This is called a subcutaneous (sub-kyu-TAY-nee-us) injection. In some cases, the doctor prescribes a mixed dose of insulin. This means taking more than one type of insulin at the same time. A mixed dose allows you to have the benefits of both short-acting insulin along with a longer acting insulin — without having to give 2 separate shots. Usually, one of the insulins will be cloudy and the other clear. Some insulins cannot be mixed in the same syringe. For instance, never mix Lantus or Levemir with any other solution. Be sure to check with your doctor, pharmacist, or diabetes educator before mixing. These instructions explain how to mix two different types of insulin into one shot. If you are giving or getting just one type of insulin, refer to the patient education sheet Insulin: How to Give a Shot. What You Will Need Bottles of insulin Alcohol swab, or cotton ball moistened with alcohol Syringe with needle (You will need a prescription to buy syringes from a pharmacy. Check with your pharmacist to be sure the syringe size you are using is correct for your total dose of insulin.) Hard plastic or metal container with a screw-on or tightly-secured lid Parts of a Syringe and Needle You will use a syringe and needle to give the shot. The parts are labeled below. Wash the work area (where you will set the insulin and syringe) well with soap and water. Wash your hands. Check the drug labels to be sure they are what your doctor prescribed. Check the expiration date o Continue reading >>
Proper Use
Drug information provided by: Micromedex Make sure you have the type (beef and pork, pork, or human) and the strength of insulin that your doctor ordered for you. You may find that keeping an insulin label with you is helpful when buying insulin supplies. The concentration (strength) of insulin is measured in USP Insulin Units and USP Insulin Human Units and is usually expressed in terms such as U-100 insulin. Insulin doses are measured and injected with specially marked insulin syringes. The appropriate syringe is chosen based on your insulin dose to make measuring the dose easy to read. This helps you measure your dose accurately. These syringes come in three sizes: 3/10 cubic centimeters (cc) measuring up to 30 USP Units of insulin, ½ cc measuring up to 50 USP Units of insulin, and 1 cc measuring up to 100 USP Units of insulin. It is important to follow any instructions from your doctor about the careful selection and rotation of injection sites on your body. There are several important steps that will help you successfully prepare your insulin injection. To draw the insulin up into the syringe correctly, you need to follow these steps: Wash your hands with soap and water. If your insulin contains zinc or isophane (normally cloudy), be sure that it is completely mixed. Mix the insulin by slowly rolling the bottle between your hands or gently tipping the bottle over a few times. Never shake the bottle vigorously (hard). Do not use the insulin if it looks lumpy or grainy, seems unusually thick, sticks to the bottle, or seems to be even a little discolored. Do not use the insulin if it contains crystals or if the bottle looks frosted. Regular insulin (short-acting) should be used only if it is clear and colorless. Remove the colored protective cap on the bottle. Do not Continue reading >>
Insulin
Make sure you know which type (or types) of insulin to use, how much to inject, and what time of day to use it. Each time you collect a prescription, check the container to make sure it is the right insulin for you. Store unopened insulin in a refrigerator until it is needed. In this article About insulin Type of medicine Insulin Used for Diabetes mellitus Also called Short-acting insulins Soluble insulin: Actrapid®, Humulin S®, Insuman® Rapid, Insuman® Infusat; Hypurin® Bovine Neutral, Hypurin® Porcine Neutral Insulin aspart: NovoRapid®; Fiasp® Insulin glulisine: Apidra® Insulin lispro: Humalog® Intermediate and long-acting insulins Insulin degludec: Tresiba®; Xultophy® (in combination with liraglutide) Insulin detemir: Levemir® Insulin glargine: Lantus®; Abasaglar®; Toujeo® Insulin zinc suspension: Hypurin® Bovine Lente Isophane insulin: Insulatard®, Humulin I®, Insuman® Basal, Hypurin® Bovine Isophane, Hypurin® Porcine Isophane Protamine zinc insulin: Hypurin® Bovine Protamine Zinc Biphasic insulins Biphasic insulin aspart: NovoMix® 30 Biphasic insulin lispro: Humalog® Mix25, Humalog® Mix50 Biphasic isophane insulin: Humulin M3®, Insuman® Comb 15, Insuman® Comb 25, Insuman® Comb 50, Hypurin® Porcine 30/70 Mix Available as Injection - as vials, cartridges and pre-filled pens Insulin is a hormone which is made naturally in your body, in the pancreas. It helps to control the levels of sugar (glucose) in your blood. If your body does not make enough insulin, or if it does not use the insulin it makes effectively, this results in the condition called sugar diabetes (diabetes mellitus). People with diabetes need treatment to control the amount of sugar in their blood. This is because good control of blood sugar levels reduces the risk of comp Continue reading >>
Regular-insulin, Injectable Solution
Insulin regular (human) injectable solution is available as brand-name drugs. It’s not available in a generic form. Brand names: HumuLIN R, NovoLIN R. Insulin regular (human) comes in three forms: injectable solution, powder for inhalation, and an intravenous injection. Insulin regular (human) injectable solution is used along with a healthy diet and exercise to control high blood sugar caused by type 1 or type 2 diabetes. Low blood sugar warning: Insulin regular (human) can cause low blood sugar (hypoglycemia). If you have a low blood sugar reaction, you’ll need to treat it right away. Symptoms can include: hunger dizziness shakiness lightheadedness sweating irritability headache fast heart rate confusion Thiazolidinedione warning: Taking certain diabetes pills called thiazolidinediones (TZDs) with insulin regular (human) may cause heart failure in some people. This can happen even if you’ve never had heart failure or heart problems before. If you already have heart failure, it may get worse. Your healthcare provider should monitor you closely while you’re taking TZDs with insulin regular (human). Tell your doctor right away if you have new or worse symptoms of heart failure, including: shortness of breath swelling of your ankles or feet sudden weight gain Infection warning: Do not share insulin vials, syringes or prefilled pens with other people. Sharing or reusing needles or syringes with another person puts you and others at risk for various infections. Insulin regular (human) is available as an over-the-counter (OTC) and prescription drug. It comes as a solution that you inject subcutaneously (under your skin). Your healthcare provider will show you how to give yourself the injection. You can also follow this guide for self-injection. Insulin regular (human Continue reading >>
Insulin Safety During A Hospitalization
If you need to be hospitalized If you are someone who requires insulin, one of the most important things you can do to stay safe is to have an emergency plan in the event you become ill and need to be hospitalized. In preparing for such an emergency, it's important to take into consideration that you may be too ill to speak for yourself at this time. Therefore, you should always designate another individual who can assist in this process, as needed. If you are hospitalized, or admitted for any emergent situation, it will be very important for you to tell your doctor and nurse the type of insulin you take, what dose and how you are taking insulin. You should carry an updated list of all medications you take with you at all times. Ideally, it is safest to bring your medications and insulin delivery system into the hospital to prevent any misunderstandings. It will also be helpful to inform the health care team of your recent blood sugar readings. However, keep in mind, your usual insulin requirement may change with possible illness or emergent care. Be prepared for potential changes in your insulin regimen, which may be needed during your condition and as determined by your doctor. During your hospitalization or for emergency care, you (or whomever you have designated) will need to pay close attention to your care. Here are some additional tips to avoid errors with your insulin during hospitalization: Be sure the nurse confirms your identity with two identifiers before any insulin injection. For example, calling you by your first name and checking your arm band. Never accept an insulin injection without the nurse checking you identification band or scanning it if the hospital uses bar coding. Your identification band must always be legible. Have the nurse confirm the type Continue reading >>
- Rob Kardashian Home After Hospitalization: Surprise Diabetes Diagnosis Was a "Wake Up Call," Source Says
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Patterns of Insulin Concentration During the OGTT Predict the Risk of Type 2 Diabetes in Japanese Americans
To Hold Or Not To Hold: Understanding Insulin
You’re about to walk into your patient’s room with a syringe full of insulin. The unit secretary shouts, “Hey. The physician just made your patient NPO.” Ugh...now what? Do you give the insulin? Do you hold it? Are you confident that you would know what to do every time? If you don’t, you’re not alone. However, by understanding the different CATEGORIES of insulin, I guarantee you will! There are 3 categories of insulin: Basal, Prandial (bolus), and Correction (sliding scale). Basal (Lantus, NPH, Levemir) This is the insulin your body needs just to meet its basal metabolic functions. Let’s say you decide not to eat for a day. If you’re NOT a diabetic, your cells still need glucose for energy, so your liver continuously kicks out a small amount of glucose (gluconeogenesis) – prompting your pancreas to secrete a small amount of insulin – to feed your body’s cells (energy). Remember? Insulin acts as the key to unlock the door of the cell to let the glucose in. If you ARE a diabetic and decide not to eat, your liver will still kick out glucose but since your pancreas doesn’t secrete insulin (Type I), all of your insulin needs, need to come exogenously (shot) – we need to give you a shot of basal insulin…even when you’re not eating – remember, the liver will still kick out glucose! 24 hours a day – 365 days a year – you have glucose in your bloodstream whether you’re eating it or your liver is kicking it out! Therefore, basal insulin should NEVER be held. Patients with Type I diabetes need basal insulin 24 hours a day. If they are NPO, the general rule of thumb is that they need ½ of their usual dose. For example, if they are on 50 units of Lantus a day, when they are NPO, they need approximately 25 units. Prandial (Novolog, Humalog) Its Continue reading >>
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 >>
Insulin Administration
Injection and infusion are the two ways to deliver insulin. Injection is the most common, and infusion is the most the most sophisticated. Injection Insulin syringe: This is the most common insulin delivery method. The classic injection device is an insulin syringe. The plastic, disposable syringes currently are available in three sizes, and hold up to 30, 50 or 100 units of insulin. The needles are fine (up to 31 gauge) with lengths ranging from 3/16th of an inch for infants, to ½ inch or more for adults. The insulin is injected into the layer of fat (subcutaneous tissue) just under the skin. (Rarely, insulin may be injected into a muscle. This should happen only under a medical supervision in a hospital or medical care setting.) A popular alternative to the insulin syringe is an insulin pen. An insulin pen has a replaceable reservoir of insulin called a cartridge, a replaceable needle to puncture the skin and to deliver insulin to the subcutaneous tissue, a dial to choose the insulin dose, and a mechanical pumping or insulin release mechanism. These may be disposable devices or re-useable devices with disposable insulin cartridges. They are very convenient for active individuals taking multiple injections, as well as those who are visually or dexterity-challenged. Continuous Subcutaneous Insulin Infusion Device: Continuous subcutaneous insulin infusion (CSII) devices (also known as insulin pumps) are the most sophisticated form of insulin delivery. These are small, computerized devices that are programmed to deliver insulin under the skin. The insulin pump is durable and lasts for years, but the insulin supply and certain pump components (insulin reservoir, tubing and infusion set) are changed every few days. We have provided more detailed information in the insulin Continue reading >>
Insulin Administration
Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the American Diabetes Association’s position statement “Continuous Subcutaneous Insulin Infusion” for further discussion on this subject.) INSULIN Insulin is obtained from pork pancreas or is made chemically identical to human insulin by recombinant DNA technology or chemical modification of pork insulin. Insulin analogs have been developed by modifying the amino acid sequence of the insulin molecule. Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin lispro and insulin a Continue reading >>
Insulin: From Prescription To Administration
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 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 insul Continue reading >>
About Fast-acting Mealtime Insulin
What is mealtime insulin? Mealtime insulins are fast-acting insulins that are taken immediately before or after meals. As you eat, your blood sugar naturally goes up, or “spikes.” Humalog® (a fast-acting insulin) works to manage those blood sugar spikes and may help keep your sugar levels in balance. Humalog should be taken within 15 minutes before eating or right after eating a meal. People who take Humalog will usually continue to take longer-acting insulin to help manage blood sugar levels at night and between meals. Taking mealtime insulin in addition to longer-acting insulin may help to control blood sugar levels throughout the day. Low blood sugar (hypoglycemia) is the most common side effect of Humalog that may be severe and cause unconsciousness (passing out), seizures, and death. Test your blood sugar levels as your doctor instructs. Talk to your doctor about low blood sugar symptoms and treatment. The orange area shows how blood sugar levels typically rise after meals. The pattern of insulin action may vary in different individuals or within the same individual. Comparing types of insulin Take a look at our overview below to find out about the different types of insulin. You’ll notice that there are differences in when the types of insulin reach your bloodstream, when they “peak” in your body, and how long they can last (length of time the insulin keeps lowering your blood sugar). Fast-acting insulin (also called rapid-acting) is absorbed quickly and starts working in about 15 minutes to lower blood sugar after meals. Humalog fast-acting insulin should be taken 15 minutes before eating or right after eating a meal. Depending on the type of diabetes you have, you may need to take Humalog with a longer-acting insulin or oral anti-diabetes medication. Continue reading >>
- Fiasp, a new, ultra-fast acting mealtime insulin is available for the treatment of diabetes in adults
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Calculating Insulin Dose
Incorrect Insulin Administration: A Problem That Warrants Attention
Go to: In Brief Incorrect administration of insulin (e.g., too little, too much, or at wrong times) can result in transient and serious hypo- and hyperglycemia, wide glycemic excursions, and diabetic ketoacidosis. The authors systematically assessed the insulin-related knowledge and injection skills of a sample of adults with diabetes and found that errors in self-administering insulin, including choosing an incorrect insulin dose, were common. Injection site selection and diabetes numeracy were also concerns. Correct timing of injections and confidence in choosing correct doses, but not skills scores, related to better A1C and blood glucose levels. Approximately 31% of diabetes patients are treated with insulin (1). Specifically, 15.4% (± 1.4%) use insulin only, and 13.6% (± 11.1%) use insulin plus oral medications (2). Insulin therapy, which is necessary to achieve glycemic control for all individuals with type 1 diabetes and many with type 2 diabetes, is related to two important acute complications: hyperglycemia and hypoglycemia. The cost/benefit considerations of insulin treatment have been examined in older adults, most of whom had type 2 diabetes. The authors reported that better glycemic control led to fewer hospitalizations and deaths due to hyperglycemia (3), but more hospitalizations and emergency room visits related to hypoglycemia (4). In a large sample of adults with type 1 diabetes of >20 years’ duration, severe hypoglycemia was common in individuals with both low and high A1C levels, suggesting that having a high A1C does not protect against severe hypoglycemia. Diabetic ketoacidosis (DKA) frequency was highest in those with high A1C levels, and especially those with an A1C >10% (5). Therefore, in addition to A1C testing, self-monitoring of blood glu Continue reading >>
Insulin Types
What Are the Different Insulin Types? Insulin Types are hormones normally made in the pancreas that stimulates the flow of sugar – glucose – from the blood into the cells of the body. Glucose provides the cells with the energy they need to function. There are two main groups of insulins used in the treatment of diabetes: human insulins and analog insulins, made by recombinant DNA technology. The concentration of most insulins available in the United States is 100 units per milliliter. A milliliter is equal to a cubic centimeter. All insulin syringes are graduated to match this insulin concentration. There are four categories of insulins depending on how quickly they start to work in the body after injection: Very rapid acting insulin, Regular, or Rapid acting insulins, Intermediate acting insulins, Long acting insulin. In addition, some insulins are marketed mixed together in different proportions to provide both rapid and long acting effects. Certain insulins can also be mixed together in the same syringe immediately prior to injection. Rapid Acting Insulins A very rapid acting form of insulin called Lispro insulin is marketed under the trade name of Humalog. A second form of very rapid acting insulin is called Aspart and is marketed under the trade name Novolog. Humalog and Novolog are clear liquids that begin to work 10 minutes after injection and peak at 1 hour after injection, lasting for 3-4 hours in the body. However, most patients also need a longer-acting insulin to maintain good control of their blood sugar. Humalog and Novolog can be mixed with NPH insulin and are used as “bolus” insulins to be given 15 minutes before a meal. Note: Check blood sugar level before giving Humalog or Novalog. Your doctor or diabetes educator will instruct you in determini Continue reading >>
What Are The Routes Of Administration For Insulin?
Insulin is only available as a liquid preparation. Depending on different circumstances it can: be injected subcutaneously (in the skin) via an insulin syringe, pre-filled pen device or insulin pen for certain patients with type 1 diabetes, be delivered as an insulin infusion via a wearable personal insulin pump be administered through an intravenous insulin infusion Injecting insulin subcutaneously How insulin is supplied There are several means by which it can be supplied for use subcutaneously (in the skin): It can be drawn out of an insulin vial ONLY using an insulin syringe. When injecting insulin, it is important to allow at least 10 seconds before the needle is removed. This helps to ensure that the full insulin dose administered is absorbed. Wet skin at the injection site after the needle is removed could be insulin that has not been absorbed. It can be provided as a prefilled pen device, which is disposed of once empty. It can be provided as a cartridge that can be loaded into an insulin pen. Insulin should never be drawn out of a cartridge using a syringe. How insulin should be administered subcutaneously When insulin is to be administered subcutaneously by injection, the injection site should be clean and the person giving the insulin should wash their hands. In the UK, 4-6mm sized needles tend to be used most commonly. Prior to each administration, usual advice is to draw up insulin or dial up the dose using an insulin pen. The user is then asked to perform an ‘air shot’. This is where 2-3 units are discharged into the air to ensure that the syringe or insulin pen are working correctly. Provided that this demonstrates insulin release, the required treatment dose can then be drawn or dialled up. The appropriate injection site is then chosen. The recommend Continue reading >>
The Dos And Don'ts Of Insulin Injections
When diet, exercise, and oral medications aren’t enough to manage type 2 diabetes, it may be time for insulin. The most important aspect of insulin therapy is using it exactly as prescribed. Still, remembering all the little details can be tricky, and certain mistakes are common. By following these dos and don’ts, you can avoid medication mishaps and keep insulin working as it should. DO: Rotate the insertion site (while keeping the body part consistent). “Insulin is absorbed at different speeds depending on where you inject it, so it’s best to consistently use the same part of the body for each of your daily injections,” says Doreen Riccelli, BSN, director of education at Lake Pointe Medical Center in Rowlett, Texas. “For example, don’t inject yourself in the abdomen on Saturday and in the thigh on Sunday,” she says. “If you choose the thigh for your evening injection, then use the thigh for all of your evening injections.” That said, within the specific body area, it’s important to move each injection site at least one finger’s width from the previous injection site to avoid the creation of hard lumps or extra fat deposits, which could change the way insulin is absorbed. DON’T: Store insulin incorrectly. Insulin can generally be stored at room temperature (59 to 86° F), either opened or unopened, for one month. When kept in the refrigerator, unopened bottles last until the expiration date printed on the bottle. Opened bottles stored in the refrigerator should be used or discarded after a month. Never store insulin in direct sunlight, in the freezer, or near heating or air conditioning vents, ovens, or radiators. It should also not be left in a very warm or cold car. Store it in an insulated case if needed. DO: Work closely with your doctor. Continue reading >>
- How Gut Bacteria Affects Diabetes, Plus Gut Health Dos and Donts
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- New diabetes treatment could eliminate need for insulin injections
