1. The client/caregiver can state the action of insulin.
    1. Helps to control blood sugar levels in clients with type 1 diabetes mellitus.
    2. It is administered by insulin subcutaneous injection or insulin pump.
    3. Types of insulin are
      1. Humalog, Novolog (very short acting). The onset of action is 5 to 15 minutes, and the peak effect is after 30 to 60 minutes.
      2. Regular (short-acting). The onset of action is 30 minutes. The peak effect is after 2 to 5 hours.
      3. NPH (intermediate-acting). The onset of action is in 1 to 2.5 hours. The peak effect is after 8 to 14 hours.
      4. Lente (intermediate-acting). The onset of action is 1 to 2.5 hours. The peak effect is after 8 to 12 hours.
      5. Ultra Lente (long-acting). The onset of action is 4 to 6 hours. The peak effect is after 10 to 18 hours.
      6. Premixed combinations have the onset of action in 30 minutes. The peak effect is after 7 to 12 hours. Examples of combinations are 70/30 (70 intermediate/30 rapid-acting), 50/50 (50 intermediate/50 rapid-acting), and 75/25 (75 intermediate/25 rapid-acting).
      7. Lantus (insulin glargine). It has a constant long duration with no defined peak of action. It is usually given once a day and usually at bedtime.
  2. The client/caregiver can list possible adverse reactions to insulin.
    1. Hypoglycemia or low blood sugar
      • Headache
      • Sweating
      • Hunger
      • Nervousness
      • Weakness
      • Restlessness or sweating during sleep
    2. Hyperglycemia or high blood sugar
      • Flushed
      • Dry skin
      • Nausea
      • Fatigue
      • Headache
      • Dizziness
    3. Allergic reaction (seek emergency treatment)
  3. The client/caregiver can list precautions when storing, preparing, and administering insulin.
    1. Keep insulin vials that are currently in use at room temperature. When not needed, store in the refrigerator. Never freeze insulin.
    2. Take insulin exactly as prescribed, and never adjust the dose without orders from the physician.
    3. Do not interchange beef, pork, or human insulins.
    4. Lantus insulin should never be mixed with other insulins.
    5. Never use insulin that has changed color or consistency.
    6. Rotate sites to prevent skin complications using the abdomen, upper and outer thighs, upper arms, and buttocks.
    7. Administer insulin promptly (within 5 minutes) after mixing insulins.
    8. Use only insulin syringes to administer insulin.
    9. Press—do not massage the injection site after administration of insulin.
    10. Dispose of syringes in an impermeable container.
  4. The client/caregiver can list other precautions when taking insulin.
    1. Limit cigarette smoking because it decreases the amount of insulin absorbed when given subcutaneously.
    2. Avoid alcohol and aspirin, which may increase the effect of insulin.
    3. Never omit meals.
    4. Carry a snack (source of simple sugar) at all times in case of low blood sugar.
    5. Wear a medical identification bracelet.
    6. Monitor and record blood or urine glucose levels.
    7. Monitor factors that affect the amount of insulin required:
      1. Follow diet closely as instructed.
      2. Exercise daily in constant amounts.
      3. Use stress management techniques.
      4. Obtain prompt treatment for any infections.
      5. Test blood sugar more frequently if a change in diet, activity, stress, illness, or infection occurs, and notify the physician.
    8. Keep follow-up appointments with the physician and laboratory.
    9. Report any signs of hypoglycemia, that is, headache, sweating, hunger, nervousness, and weakness.
    10. Report any signs of hyperglycemia, that is, flushed, dry skin; nausea; fatigue; headache; and dizziness.
  5. The client/caregiver can list measures to safely use an insulin pump.
    1. The insulin pump is used for continuous (24-hour) insulin delivery.
    2. The insulin pump has a pump reservoir and a computer chip that allows the user to control the exact amount of insulin being delivered and is battery operated.
    3. They are approximately the size of a beeper. It is attached to a thin plastic tube that has a soft cannula or needle at the end to deliver insulin.
    4. The cannula (needle) is inserted under the skin, usually on the abdomen. It needs to be changed every 3 days.
    5. The tubing can be disconnected when showering or swimming.
  6. The client/caregiver can demonstrate syringe preparation.
    1. Wash hands thoroughly.
    2. Assemble equipment: syringe, insulin, alcohol swab.
    3. Check that you are using the appropriate type of insulin and that it has not expired.
    4. Verify that you are using the appropriate type of syringe (only insulin syringe).
    5. Roll the insulin bottle gently to mix it.
    6. Cleanse the top of the bottle with alcohol.
    7. Pull the plunger of the syringe back the number of units of insulin to be injected, not allowing the needle to touch anything.
    8. Insert the needle into the bottle and inject air.
    9. Invert the bottle and syringe, and slowly withdraw the prescribed amount of insulin, being sure that the needle is under the fluid level.
    10. Check the syringe for air bubbles, and remove them by tapping the syringe. Draw up more insulin, and discard excess if necessary for an accurate amount.
  7. The client/caregiver can demonstrate the procedure for insulin injection.
    1. Wash hands. Check the previous rotation site and select the new site.
    2. Prepare the injection site by swabbing the center of the area with alcohol and moving outward in a circular manner about 2 inches. Allow the area to air dry.
    3. Pinch the skin approximately 2 inches with thumb and forefinger at the injection site, not touching the area that was cleaned.
    4. Inject the needle into the skin using a quick, firm motion at a 45-degree (normal weight) or 90-degree angle (obese patient).
    5. Inject insulin slowly into the tissue. Remove the needle, and hold the swab over the site briefly.
    6. Place the manufacturer’s needle guard to cover the needle and dispose syringe/needle in a safety container.
  8. The client/caregiver can list sites of the body for insulin injections.
    1. Upper arms
    2. Abdomen
    3. Thighs
    4. Buttocks

Resources

American Diabetes Association
800-232-3472
www.diabetes.org
Medical supply company
Pharmacist

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care.
Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins. Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott
Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com

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