Insulin Use

Insulin - A common daily injection

     Insulin is a common medication found in many households in the United States used in the treatment of diabetes. It may be prescribed for any age group. It’s given as a subcutaneous injection but is very easy to learn to give. Some pharmacies provide them pre-packaged. The needles are short and sharp, and the injection is almost painless.  The length of the needle keeps the risk of injecting into a vein minimal and helps to keep the process simple to learn.  All you need to do is clean the injection site with alcohol, stick in the needle, and push the plunger. 

     Here’s the thing though—Insulin is a potent medication and commands a lot of respect. Therefore, I think it’s vital that you understand some of the basic principles and rules for its administration –just to be safe.

   The purpose of insulin injections is to attempt to copy the regular insulin pattern of the body produced by the pancreas.

 

     The pancreas produces a constant amount of insulin that balances liver glucose production with glucose use to maintain normal glucose levels between meals. The pancreas also produces extra insulin during meals to prevent spikes of elevated blood glucose after meals. The amounts produced at such times vary among individuals. Furthermore, insulin production increases whenever an individual has an illness, extreme stress, an infection, or takes medication that may artificially increase glucose levels. 

Facts About Insulin

Test

Normal Range

Significance of Abnormal Results

Fasting blood glucose test

< 100 mg/dL (5.6 mmol/L) Older adults: Levels rise 1 mg/dL per decade of age

Levels > 100 mg/dL (5.6 mmol/L) but <126 mg/dL (7.0 mmol/L) indicate impaired fasting glucose (IFG)

Levels > 126 mg/dL (7.0 mmol/L) obtained on at least two occasions are diagnostic of diabetes, even in older adults

Glucose tolerance test (2-hour post-load result)

<140 mg/dL (7/8 mmol/L)

Levels > 140 mg/dL (7.8 mmol/L) and <200 mg/dL (11.1 mmol/L) indicate impaired glucose tolerance (IGT)

Levels > 200 mg/dL (11.1 mmol/L) indicate provisional diagnosis of diabetes

Glycosylated hemoglobin (A1C) test

4%-6%

Levels of 5.7% to 6.4% indicate increased risk for development of diabetes.

Levels of >6.5% indicate diabetes

Levels >8% indicate poor diabetes control and need for adherence to regimen or changes in therapy

  • Knowing your blood glucose levels helps you determine if and how you might need to adjust your diet or your insulin dose to prevent episodes of extremely high or low blood sugars. Being able to keep blood glucose within a healthy range helps to reduce the risks of complications of diabetes and improves overall health and well-being.
  • Know how to work your monitoring device correctly. Follow the manufacturer’s instructions and use the test strips designated for the specific monitor.
  • Do not reuse or use expired strips.
  • Remember to change the test strip code in your monitor to match the new strips when you purchase a new package of test strips.
  • Regularly do quality control tests of your trips to make sure you are getting accurate test results.
  • Follow proper hand hygiene before testing your finger.
  • Make sure you have a good blood drop sample to do the test.
  • Clean the monitor thoroughly to remove any dried blood from the testing area.

Ignatavicius, Donna D., M. Linda Workman, Cherie R. Rebar, Nichole M. Heimgartner. Medical-Surgical Nursing> Concepts for Interprofessional Collaborative Care. (2018) 9th Ed. St. Louis: Elsevier. ((1296)

     Once blood glucose levels drop below 70 mg/dL, your body begins to alert you to the fact that you are blood sugar levels unstable. If your body responds as it should, the liver begins to release glycogen and protein breaks down into glucose.  If that chain of events doesn’t move along as it should, then life-threatening hypoglycemia may develop.

     Symptoms of hypoglycemia are different among people and not directly tied to blood glucose levels.  Therefore, it’s important to go by the symptom and not the blood sugar reading on the glucose monitor when deciding whether to head to the emergency room for treatment.

     Here is a list of symptoms that may occur during low blood sugar reactions.  A person may experience only a few or a lot of them.

Weakness         Shaky/tremulous               Sweaty

Fatigue             Heart-Pounding                 Hungry

Difficulty Thinking    Nervous/Anxious     Tingling

Confusion      Behavior Changes   Emotional Instability

Seizures  Loss of Consciousness        Brain Damage

Death

  • There are multiple injection sites available for giving an insulin injection. Where you choose to insert the needle can change the insulin absorption speed. The sites in the abdomen and two inches around the navel are considered the best for absorption.
  • Injections sites need to be rotated daily and allowed to heal before being reused. For absorption to work best, use one area of the body at a time, move through each possible injection site in that area before moving to a new area of the body. Staying in the same body area provides for greater consistency in the rate of absorption.
  • Don’t use heat or massage (rub) to help speed up how fast the insulin is absorbed. The opposite is true as well; don’t apply ice to slow it down.
  • Base the timing of when you take your insulin and when you eat on how rapidly your insulin acts. For instance, take fast-acting insulins about ten minutes before a meal if your blood sugar is within its normal range. Give regular insulin between twenty to thirty minutes before a meal since its effect is slightly slower.

Ignatavicius, Donna D., M. Linda Workman, Cherie R. Rebar, Nichole M. Heimgartner. Medical-Surgical Nursing> Concepts for Interprofessional Collaborative Care. (2018) 9th Ed. St. Louis: Elsevier. ((1294)

  • Store extra bottles (vials) of insulin in the refrigerator. Do not store in the freezer.
  • Keep vials out of direct sunlight.
  • Refrigerated insulin may be uncomfortable when used as an injection. Therefore, the insulin vial currently in use may be left out of the refrigerator at room temperature but out of direct sunlight for up to 28 days. Discard any remaining medication after 28 days.
  • Don’t shake the vials to mix them; instead, roll them between your palms. Discard the medication if it becomes cloudy or clumps together.
  • Prefilled syringes are stable for 30 days if stored in an upright position (needles pointing up) in the refrigerator.

Ignatavicius, Donna D., M. Linda Workman, Cherie R. Rebar, Nichole M. Heimgartner. Medical-Surgical Nursing> Concepts for Interprofessional Collaborative Care. (2018) 9th Ed. St. Louis: Elsevier. ((1297)

     There are four primary types of insulin injections, and each has a different peak and duration. You must know when your medication will peak and how long it lasts to manage your blood sugar levels effectively. 

     Rapid-Acting Insulins begin to work within 15 minutes. They peak within 30 minutes to 1 hour or 1 1-1/2 hour and last no longer than five hours at most. 

     Short-Acting Insulins begin to work within 3o minutes, peak at around two hours and thirty minutes up till five hours, and last anywhere from five to twelve hours.

     Intermediate-Acting Insulins usually begin to work around an hour after you take them, although some start as soon as 15 minutes, and some wait as late as five hours. They peak from one hour to fourteen though the average seems to be in the four hours to the fourteen-hour range and lasts between 10 to twenty-four hours.

     Long-Acting Insulins begin to work within one hour but no later than four hours after administration. The most peak between 6 and twelve hours and last up to twenty-four though some last as long as forty-two.

Mixing Insulins

  1. Read the order to determine the total amount of insulin you will have when the two are combined.
  2. Roll the two bottles between your hands to mix each.
  3. Clean the tops of each with alcohol
  4. Draw up air equal to the dose of NPH insulin to be given.
  5. Insert it into the bottle and remove the syringe from the NPH bottle.
  6. Draw up air equal to the dose of Regular Insulin needed.
  7. Insert it into the Regular insulin vial.
  8. Withdraw the dose required of Regular insulin.
  9. Check for and remove air bubbles.
  10. When the dose is correct, remove the syringe.
  11. Insert syringe in NPH bottle, withdrawn the ordered amount of NPH insulin.
  12. DO NOT push back air into the bottle if you have an air bubble.
  13. If you need to adjust for an air bubble, remove the syringe from the vial and fix it outside of the bottle.
  14. Confirm you have the correct dosage.
  15. Inject medication within 5-15 minutes.

Steps to Administering Insulin

  • Roll the vial gently between your palms to mix the insulin.
  • Clean the rubber stopper with an alcohol swab.
  • Remove the needle cover and pull back the plunger to draw air into the syringe. The amount of air should equal the insulin dose. Push the needle into the rubber stopper and inject the air into the vial.
  • Turn the bottle upside down and draw the insulin dose into the syringe.
  • Remove air bubbles by tapping the syringe or injecting air back into the bottle. Redraw the correct amount of insulin.
  • Remove the needle from the bottle. Recap the needle if you are not giving the shot immediately.
  • Select your injection site (one you have not used in the past month).
  • Clean the skin with alcohol.
  • Remove needle cap. Lightly pinch up an area of skin.
  • Insert the needle at a 90-degree angle.
  • Push the plunger down. Release the pinched skin.
  • Pull the needle straight out quickly. Do not rub the area.
  • Dispose of needle and syringe without recapping the needle in a puncture-proof container.

Ignatavicius, Donna D., M. Linda Workman, Cherie R. Rebar, Nichole M. Heimgartner. Medical-Surgical Nursing> Concepts for Interprofessional Collaborative Care. (2018) 9th Ed. St. Louis: Elsevier. ((1297)

YouTube Video Resources

How to Mix Insulins 

https://www.youtube.com/watch?v=O_kXOnrYYRA

Precautions for mixing Insulins

  • Never mix Lantus (long-acting insulin) with anything!
  • After mixing NPH and Regular Insulins, you must give the injection within in 5-15 minutes because regular insulin binds to NPH and decreases its action
  • Always check for signs of hypoglycemia (low blood sugar) before giving mixed doses because the mixture may make it worse. Symptoms include being sweaty, clammy, fast heart rate, confused, sugar less than 70

     Always withdraw the clear (Regular) Insulin from its vial first when you are mixing insulins before inserting a needle into the NPH (Cloudy) Insulin to prevent cross-contamination of the two.

How to Administer Insulin

https://www.youtube.com/watch?v=KP6Zm9vl3FM&t=94s

     People with diabetes cannot use food for energy the usual way because they do not have insulin, or the insulin does not do its job correctly in their bodies. Insulin is a hormone made in the pancreas, which is an organ located behind the stomach. Insulin lowers blood glucose levels. People with diabetes may inject insulin with a syringe two or more times each day, usually before a meal or at bedtime. Insulin lasts at least 28 days outside the refrigerator.  

How to Inject Insulin

https://www.youtube.com/watch?v=cmUXo4Crrm0

     The thought of giving yourself an inject is much scarier than the difficulty of actually doing it.  The process is straightforward. With a little practice, you’ll be handling it like a pro.  Plus, the needles are tiny and sharp. You hardly feel them now! It’s almost painless.

Equipment:

Syringe: The size syringe you use depends on how much medication you need to give. You use the size that allows you to give just one short.  There are three sizes of syringes. (30 units-50units-100 units) Choose the one that your dosage falls below.

Alcohol wipe

Insulin: Keep the insulin in the refrigerator when you first get it.  Pull it out to warm it up about thirty minutes before you need it before the first dose of the new bottle. You may leave insulin at room temperature for 28-42 days; therefore, after opening a vial, warm it up as usual by gently rolling it between the hands.