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NURS 133 Long Acting and Short Acting Insulin

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jasmine's version from 2016-04-18 06:42

Section 1

Question Answer
Long Acting Insulin Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus
Long Acting Insulin actions Lower blood glucose by: stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production; Inhibition of lipolysis and proteolysis, enhanced protein synthesis
Long Acting Insulin therapeutic uses Control of hyperglycemia in diabetic patients
Elimination/Excretion of Long Acting Insulin Metabolized by liver, spleen, kidney, and muscle
Adverse/Side Effects of Long Acting Insulin Hypoglycemia, Anaphylaxis
Contraindications of Long Acting Insulin Hypoglycemia; allergy or hypersensitivity to a particular type of insulin, preservatives, or other additives; Use cautiously in renal/hepatic impairment; Pregnancy may temporarily increase insulin requirements; Safety not establish in children less than 6 years of age with glargine and less than 2 years of age with detemir
Drug/Food interactions of Long Acting Insulin Beta blockers, clonidine, and reserpine may mask some of the signs and symptoms of hypoglycemia; corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, and rifampin may increase insulin requirements; Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates may decrease insulin requirements; Concurrent use with pioglitazone or rosiglitazone may increase risk of fluid retention and worsening HF; Glucosamine may worsen blood glucose control; Fenugreek, chromium, and co-enzyme Q-10 may produce additive hypoglycemic effects
Medication administration of Long Acting Insulin Subcut
Nursing interventions of Long Acting Insulin Assess patient for signs and symptoms of hypoglycemia (anxiety; restlessness; mood changes; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; nausea; vomiting; tiredness; unusual thirst) periodically during therapy; Monitor body weight periodically, as changes in body weight may necessitate changes in insulin dose; Lab test considerations: monitor blood glucose every 6 hours during therapy, more frequently in ketoacidosis and times of stress; Hemoglobin AIC may also be monitored every 3-6 months to determine effectiveness; Caution: overdose is manifested by symptoms of hypoglycemia; Check type, dose, and expiration date with other licensed nurse, and Clarify ambiguous orders
Client education of Long Acting Insulin Instruct patient on proper technique for administration. Include type of insulin, equipment, storage, and place to discard syringes; Discuss importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen; Explain to patient medication controls hyperglycemia, and therapy is long term; Instruct patient in proper testing of serum glucose and ketones; Emphasize importance of compliance with nutritional guidelines and regular exercise as directed by health care professional; Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled; Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur; Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times; Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding or planning to breast feed; Emphasize the importance of regular follow up exam, especially during first few weeks of therapy
Evaluation/Desired outcomes of Long Acting Insulin Control of blood glucose levels in diabetic patients without the appearance of hypoglycemic or hyperglycemic episodes
Potential nursing diagnoses of Long Acting Insulin Non-compliance (patient/family teaching)
memorize

Section 2

Question Answer
Short Acting Insulin Short acting insulin can be subdivided into two groups: rapid acting (AnaLogs; insulin lispro, insulin aspart, and insulin glulisine) and slower acting (rDNA origin; regular or “natural” insulin and is available as Humulin R or Novolin R); Administration is in association with meals with an estimation of a meal occurring within 45 minutes of injection to control the post-prandial rise in blood glucose; Short acting insulins must be used in conjunction with an intermediate or long acting agent; (clear solutions); Rapid acting: control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus; Slow acting: indicated as an adjunct to diet and exercise to improve glycemic control in diabetes I and II mellitus. Both can be given intravenously
Short Acting Insulin actions Rapid acting: Lower blood glucose by: stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production; Inhibition of lipolysis and proteolysis, enhanced protein synthesis; These are rapid-acting insulins with a more rapid onset and shorter duration than regular insulin; should be used with an intermediate or long acting insulin. Slow acting: Regulation of glucose metabolism. Bind to insulin receptors on muscle and adipocytes and lower blood glucose by facilitating cellular uptake of glucose and simultaneously inhibiting the output of glucose from the liver
Short Acting Insulin therapeutic uses Rapid acting: Control of hyperglycemia with a more rapid onset and shorter duration than slow acting insulin in diabetic patients. Slow acting: Regulation of glucose metabolism; glucose lowering effect; control of hyperglycemia in diabetic patients
Elimination/Excretion of Short Acting Insulin Rapid acting: Metabolized by liver, spleen, kidney, and muscle. Slow acting: predominately cleared by metabolic degradation via a receptor-mediated process
Adverse/Side Effects of Short Acting Insulin Rapid acting: Hypoglycemia; anaphylaxis; pregnancy may temporarily increase insulin requirements; Safety not establish in children less than 3 years of age (lispro), children less than 4 years of age (glulisine), and less than 6 years of age (aspart). Slow acting: Hypoglycemia; allergic reactions; lipodystrophy; weight gain; peripheral edema; transitory reversible ophthalmologic refraction disorder
Contraindications of Short Acting Insulin Rapid acting: Hypoglycemia; Allegy or hypersensitivity to a particular type of insulin, preservatives, or other additives. Slow acting: During episodes of hypoglycemia or with hypersensitivity to such as Novolin R or one of its excipients
Drug/Food interactions of Short Acting Insulin Rapid acting: Beta blockers, clonidine, and reserpine may mask some of the signs and symptoms of hypoglycemia; Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, and rifampin may increase insulin requirements; Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates may decrease insulin requirements; concurrent use with pioglitazone or rosiglitazone may increase risk of fluid retention and worsening HF; Glucosamine may worsen blood glucose control; Fenugreek, chromium, and co-enzyme Q-10 may produce additive hypoglycemic effects. Slow acting: 173 drug interactions found at http://www.drugbank.ca/drugs/DB00030. May require dose adjustment and close monitoring with drugs that may increase blood glucose-lowering effect and susceptibility to hypoglycemia (e.g., oral anti-diabetic medications, ACE inhibitors, MAOIs), drugs that may reduce blood glucose-lowering effect leading to worsening of glycemic control (e.g., corticosteroids, sympathomimetic agents, atypical anti-psychotics), or drugs that may either potentiate or weaken blood glucose-lowering effect (e.g., beta blockers, clonidine, lithium salts); Alcohol may increase susceptibility to hypoglycemia; Pentamidine may cause hypoglycemia, sometimes followed by hyperglycemia; Hypoglycemic signs may be reduced or absent with sympatholytics (e.g., beta blockers, clonidine, guanethidine); Caution with K+-lowering medications or medications sensitive to serum K+ concentrations; thiazolidinediones (TZDs) may cause dose-related fluid retention and HF; observe for signs and symptoms of HF and consider dose reduction or discontinuation of TZDs if HF develops
Medication administration of Short Acting Insulin Rapid acting: Subcut, IV; dose depends on blood glucose, response, and many other factors. Slow acting: Subcut, IV; dose depends on blood glucose, response, and many other factors
Nursing interventions of Short Acting Insulin Rapid acting: Assess for symptoms of hypoglycemia (anxiety; restlessness, tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; nausea; vomiting; unusual thirst) periodically during therapy; Monitor body weight periodically-changes in weight may necessitate changes in insulin dose; Assess patient for signs of allergic reactions (rash, shortness of breath, wheezing, rapid pulse, sweating, low BP) during therapy; Lab test considerations: may cause decrease serum inorganic phosphate, magnesium, and potassium levels; Monitor blood glucose every 6 hours during therapy, and more frequently in ketoacidosis and times of stress; AIC may also be monitored every 3-6 months to determine effectiveness; Overdose is manifested by symptoms of hypoglycemia; Patient should eat within approximately 15 minutes of administration. Check type, dose, and expiration date with other licensed nurse, and clarify ambiguous orders. Slow acting: Follow same intervention guidelines as rapid acting; Patient should eat within approximately 30-45 minutes of administration
Client education of Short Acting Insulin Rapid acting: Instruct patient on proper technique for administration; Include type of insulin, equipment, storage, and place to discard syringes; Discuss importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen; Caution patient that insulin pens should not be shared with others, even if clean needles are used; Demonstrate technique for mixing insulins; Explain to patient that this medication controls hyperglycemia, and therapy is long term; Instruct patient in proper testing of serum glucose and ketones-these tests should be closely monitored during periods of stress or illness; Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional; Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled; Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur; Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding or planning to breast feed; Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times; Emphasize the importance of regular follow up, especially during first few weeks of therapy. Slow acting: Follow same client education guidelines as rapid acting
Evaluation/Desired outcomes of Short Acting Insulin Rapid acting: control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes. Slow acting: same as rapid acting for the purpose of glucose metabolism
Potential nursing diagnoses of Short Acting Insulin Rapid acting: Non-compliance (patient/family teaching). Slow acting: Non-compliance (patient/family teaching)
memorize