St.

Anthony’s College
San Jose, Antique
Nursing Department

Name of Drug Classification and Indication and Side Effects or Adverse Nursing Responsibilities
(Dosage, Route, Mechanism of Contraindication Reactions
Frequency, Timing) Action
Generic Name: Classification: Indication: Assessment
 History: Allergy to pork products; pregnancy; lactation
Insulin  Treatment of type 1 (insulin-  Hypersensitivity: Rash, ana
 Physical: Skin color, lesions; eyeball turgor; orientation, reflexes,
Mechanism of dependent) diabetes phylaxis or angioedema
peripheral sensation; P, BP, adventitious sounds; R, adventitious sounds;
Brand Name: Action:  Treatment of type 2 (non–  Local: Allergy—local urinalysis, blood glucose
insulin-dependent) diabetes reactions at injection site—
Interventions
Insulin injection: Insulin is a hormone that cannot be controlled by redness, swelling, itching;
Humulin R, Humulin R diet or oral agents usually resolves in a few
secreted by the beta  Ensure uniform dispersion of insulin suspensions by rolling the vial
Regular U-500 cells of the pancreas  Regular insulin injection: days to a few weeks; a
(concentrated), Novolin Treatment of change in type or species gently between hands; avoid vigorous shaking.
that, by receptor-
ge Toronto (CAN), severe ketoacidosis or diabetic source of insulin may be  Give maintenance doses subcutaneously, rotating injection sites regularly
mediated effects,
Novolin R, Novolin R coma tried; lipodystrophy; pruritus to decrease incidence of lipodystrophy; give regular insulin IV or IM in
promotes the storage
PenFill, Regular Iletin of the body's fuels,  Treatment  Metabolic: Hypoglycemia; severe ketoacidosis or diabetic coma.
II, Velosulin Human of hyperkalemia with infusion ketoacidosis  Monitor patients receiving insulin IV carefully; plastic IV infusion sets
facilitating the
BR of glucose to produce a shift of have been reported to remove 20%–80% of the insulin; dosage delivered
transport of
potassium into the cells to the patient will vary.
metabolites and ions
Regular insulin (potassium) through  Highly purified and  Do not give insulin injection concentrated IV; severe anaphylactic
cell membranes and human insulins promoted for reactions can occur.
short courses of therapy  Use caution when mixing two types of insulin; always draw the regular
– It has an onset of stimulating the
synthesis of glycogen (surgery, intercurrent disease), insulin into the syringe first; if mixing with insulin lispro, draw
action (begins to
from glucose, of fats newly diagnosed patients, the lispro first; use mixtures of regular and NPH or regular
reduce blood sugar)
from lipids, and patients with poor metabolic and Lente insulins within 5–15 min of combining them; Lantus insulin
within 30 minutes of
proteins from amino control, and patients with (insulin glargine) cannot be mixed in solution with any other drug,
injection, reaches a
acids. gestational diabetes including other insulins.
peak effect at 1-3
 Insulin injection concentrated:  WARNING: Double-check, or have a colleague check, the dosage drawn
hours, and has effects
Treatment of diabetic patients up for pediatric patients, for patients receiving concentrated insulin
that last 6-8 hours.
with marked insulin resistance injection, or patients receiving very small doses; even small errors in
(requirements of > dosage can cause serious problems.
Intermediate Insulin  Carefully monitor patients being switched from one type of insulin to
200 units/day)
 Glargine (Lantus): Treatment another carefully; dosage adjustments are often needed.
– It has an onset of of adult patients with type 2 Human insulins often require smaller doses than beef or pork insulin;
action starting about diabetes who require basal monitor cautiously if patients are switched; lispro insulin is given 15 min
2 hours following insulin control of before a meal.
injection. It has a hyperglycemia  Store insulin in a cool place away from direct sunlight. Refrigeration is
peak effect 4-12 Treatment of adults and preferred. Do not freeze insulin. Insulin prefilled in glass or plastic
hours after injection, children > 6 yr who require syringes is stable for 1 wk refrigerated; this is a safe way of ensuring
 and a duration of baseline insulin control
action of 18-26
hours. Contraindication:
Drug classes:  Contraindicated with allergy
Antidiabetic to pork products (varies with
Hormone preparations; human insulin
not contraindicated with pork
Pregnancy Category B allergy).
 Use cautiously with
pregnancy (keep patients
Dosage: under close supervision; rigid
control is desired; following
8units delivery, requirements may
drop for 24–72 hr, rising to
Route: normal levels during next 6
wk); lactation (monitor
IV mother carefully; insulin
requirements may decrease
during lactation).
proper dosage for patients with limited vision or who have problems with
drawing up insulin.
 Monitor urine or serum glucose levels frequently to determine
effectiveness of drug and dosage. Patients can learn to adjust insulin
dosage on a sliding scale based on test results.
 Monitor insulin needs during times of trauma or severe stress; dosage
adjustments may be needed.
 WARNING: Keep life support equipment and glucose readily available to
deal with ketoacidosis or hypoglycemic reactions.
Teaching points
 Use the same type and brand of syringe; use the same type and brand of
insulin to avoid dosage errors.
 Do not change the order of mixing insulins. Rotate injection sites
regularly (keep a chart) to prevent breakdown at injection sites.
 Dosage may vary with activities, stress, diet. Monitor blood or urine
glucose levels, and consult physician if problems arise.
 Store drug in the refrigerator or in a cool place out of direct sunlight; do
not freeze insulin.
 If refrigeration is not possible, drug is stable at controlled room
temperature and out of direct sunlight for up to 1 month.
 Monitor your urine or blood for glucose and ketones as prescribed.
 Wear a medical alert tag stating that you have diabetes and are taking
insulin so that emergency medical personnel will take proper care of you.
 Avoid alcohol; serious reactions can occur.
 Report fever, sore throat, vomiting, hypoglycemic or hyperglycemic
reactions, rash.