Insulin

Hormone manufactured by beta cells of pancreas

Controls the storage and utilization of amino acids and fatty acids
Lowers blood glucose levels by inhibiting glucose production by liver
Potentially life threatening deficiency of insulin: ketoacidosis
Onset: when insulin 1st begins to act in body
Peak: exerting maximum action
Duration: length of time insulin remains in body
rapid action: regular, analogs
intermediate action: NPH, lente, humulin N, Novolin N
Long Acting: Lantus, Humulin U, Levemir
Diabetes mellitus
Chronic condition in which insufficient insulin is produced by the pancreatic beta cells
(type 1) or in addition to less insulin produced the body cells become resistant to insulin
(type 2)
About 90% to 95% of the cases of diabetes are of the type 2 variety; many of these are
controlled with diet, exercise, and possibly the addition of an oral hypoglycemic drug
insulin dependent: Type 1, usually born with it. Produce insufficient amounts of insulin,
rapid onset, before age 20, more symptoms, more difficult to control
Non-insulin dependent: Type 2. Decreased production of insulin; decreased sensitivity of
cells to insulin making cells (resistant); may occur at any age; more stable and easier to
control.
3 P's
Polydipsia: Excessive thirst
Polyphagia: Eating large amounts of food
Polyuria: Increased urination
Risk Factors Type 2 Diabetes

Obesity
Older age
Family history of diabetes
History of gestational diabetes
1

Impaired glucose tolerance

Minimal or no physical activity
Race/ethnicity (African Americans, Hispanic/Latino Americans, Native
Americans, and some Asian Americans)
Action and Uses

Activates a process that helps glucose molecules enter the cells of striated muscle and
adipose tissue
Promotes protein synthesis
Properties of insulin: Onset, peak, duration
Controls type 1 diabetes mellitus, type 2 diabetes, severe diabetic ketoacidosis
Treats hypokalemia in combination with glucose

Adverse Reactions, Contraindications, and Precautions

Adverse reactions: - Hypoglycemia; hyperglycemia; allergic reaction
Contraindicated in patients: - With hypersensitivity, hypoglycemia
Used cautiously in patients: - With renal and hepatic impairment, during pregnancy and
lactation
Nursing Assessment for Diabetes
Preadministration assessment:
Make general assessment of skin, mucous membranes, and extremities, with attention
given to any sores or cuts and any ulcerations or other skin or mucous membrane changes
Document type and dosage of insulin, if used; type of diabetic diet; average results of
glucose in the patient's chart
Ongoing Nursing assessment for Diabetes
Assess for signs and symptoms of hypoglycemia and hyperglycemia
Notify health care provider if blood glucose level is greater than 400 mg/dL
Expected outcomes for Diabetes:
Patient needs related to management of adverse reactions
Reduction in anxiety and fear
Improved ability to cope with the diagnosis

Promoting an optimal response to Diabetes therapy

Read label of the insulin bottle carefully for name, source of insulin, number of units per
milliliter
When mixing insulins:
Ask whether insulins were given separately or together if patient had been using insulin
mixtures before admission
When rotating injection sites for insulin:
After giving injection, record site used; note any inflammation or skin reactions
Blood and urine testing for diabetes
Use second voided specimen to check glucose or acetone levels if urine testing is done
For acute confusion in a diabetic
Never give oral fluids or substances used to terminate hypoglycemic reaction to patient
unless swallowing and gag reflexes are present
Deficient fluid volume:
Treat diabetic ketoacidosis with fluids, correction of acidosis and hypotension, low doses
of regular insulin
Educating the patient and family regarding diabetes:
Educate on the storage of insulin and purchase of needle and syringe
Explain the preparation of insulin administration
Emphasize and explain the recommended diet
Oral Antidiabetic Drugs
Used to treat patients with type 2 diabetes that is not controlled by diet and exercise alone
Not effective for treating type 1 diabetes
Types: Sulfonylureas, biguanides, glucosidase inhibitors, meglitinides, thiazolidinediones
Nursing Diagnosis for Diabetes

Acute Confusion related to hypoglycemia effects on mentation

Deficient Fluid Volume related to fluid loss during DKA
Anxiety related to uncertainty of diagnosis, testing own glucose levels, selfinjection, dietary restrictions
Ineffective Breathing Pattern related to hyperventilation in lactic acidosis with
metformin use

In promoting an optimal response to diabetic therapy

Sulfonylureas: Give glipizide 30 minutes before meal due to food delays
Biguanides: Administer metformin two or three times a day with meals
Meglitinides: Give repaglinide 15 minutes, up to 30 minutes, before meal
Thiazolidinediones: If dose missed at usual meal, take drug at the next meal
For Ineffective breathing pattern in diabetic patient: Monitor patient for symptoms of
lactic acidosis, unexplained hyperventilation, myalgia, malaise, GI symptoms, unusual
somnolence

(RAI) Injection/Humulin:

Onset: 30-60 min. Peak: 2-4hrs. Duration: 8-2hrs

(RAI) Lispro/Humalog:

Onset: 5-10 min. Peak: 30-1.5 hr. Duration: 2-5hr.

(RAI) Aspart/Novolog:

Onset: 5-10 min. Peak: 1-3hrs. Duration: 3-5hrs.

(IAI) Suspension:

Onset: 1.5 hr. Peak: 4-12hr. Duration: 24hrs.

(LAI) Glargine/Lantus:

Onset: 1hr. Peak: Steady no Peak. Duration: 24hr.

(Mixed) Isophane Suspension: Onset: 30-60min. Peak: 2-4hr. then 6-12hr. Duration: 68hr. then 18-24hr.

QUESTIONS
Metformin: Instruct patient to discontinue drug therapy; notify primary health care
provider if any distress occurs
What would you most likely give to a hypoglycemic PT who is having a reaction: Orange
juice
When blood glucose levels are high, glucose molecules attach to hemoglobin in the red
blood cells.
Hormone secreted by the alpha A cells of the pancreas that increases the concentration of
glucose in the blood: Glucagon
Glycosylated hemoglobin measures average blood glucose over what time period: Past 4
months

TRUE OR FALSE
Insulin is a hormone produced by the liver that regulates how glucose gets into cells and
is used for energy.
False
Insulin is a hormone produced by the pancreas that regulates how glucose gets into cells
and is used for energy.
Protein and fat metabolism also require insulin.

True

Diabetes mellitus is a chronic condition in which insufficient insulin is produced by the

pancreatic beta cells (type 1) or in addition to less insulin produced the body cells
become resistant to insulin (type 2). True
Your patient is out of his regular insulin so you substitute it for a different brand False
Exposure to stress, such as infection, fever, surgery, or trauma may cause a loss of control
of blood glucose levels in patients who have been stabilized with oral antidiabetic drugs
True
Older adults may have a decreased sensitivity to sulfonylureas and may require a dosage
reduction
False
When mixing lispro with a longer acting insulin the longer acting is drawed up 1st
False

THE END