Question

Medication Learning Template - Regular insulin accucheck 1. Expected Pharm Action? 2. Complications? 3. Contraindications/precautions 4. Therapeutic Use 5. Medication Administration 6. Interactions 7. Nursing Interventions 8. Client Education 9. Evaluation of Medication Effectiveness

Answer 1

Regular insulin is a short acting, synthetic form of the hormone. The body uses insulin to process sugar that enters the blood stream as part of the digestive process. In patients with diabetes mellitus, the pancreas will not produce enough insulin to move the glucose from the blood into cells that use it for energy. so diabetic patients require extra insulin.

1. The primary activity of insulin is the regulation of glucose metabolism. Insulin promotes glucose and aminoacid uptake into muscle and adipose tissues, and other tissues except brain and liver. It also has an anabolic role in stimulating glycogen, fatty acid, and protein synthesis. Insulin inhibits gluconeogenesis in the liver. Insulin binds to the insulin receptors(IR). The binding of insulin to the alpha subunit of IR stimulates the tyrosine kinaseactivity intrinsic to the beta subunit of the receptor. The bound receptor is able to auto phosphorylate and phosphorylate numerous intracellular substrates such as insulin receptor substates proteins. These activated proteins inturn lead to the activation of down stream signaling molecules including P13 kinasssse and AKT. AKT regulates the activity of glucose transporter 4 and protein kinase C which plays major role in metabolism and catabolism.
2. Complications or side effects of human insulin are

Most common side effects includes

• Swelling of arms and legs
• Weight gain
• Hypo glycemia ( symptoms includes sweating, dizziness or light headedness, hunger, increased heart rate, tingling in hands, feet, lips or tongue, trouble in concentration, confusion, blurred vision, slurred speech)
• Injection site reactions including redness, swelling, itching.
• Skin changes at the injection site such as lipo dystrophy, shrinking or thickening at the injection site.

Serious complications or side effects includes

• Severe hypoglycemia ( symptoms includes mood changes, confusion including delirium, light headedness, sleepiness, blurred vision, head ache, weakness or fatigue, lack of coordination, loss of consciousness)
• low blood potassium( hypokalemia)
• Serious allergic reactions including a rash all over the body, trouble respiration, increased heart rate, sweating, fainting.
• swelling of hands and feet.
• Heart failure

3. Contra indications or precautions includes

• Hypoglycemia
• Hyper sensitivity to insulin and its components
• Hypoglycemia may occur and is the most common side effects
• Severe life-threatening allergic reactions including anaphylaxis may occur.
• Hypokalemia may occur because insulin stimulates movement of potassium from bllod into cells.
• Hepatic impairment may reduce the insulin requirement.
• Intravenous administration increases the risk of hypoglycemia and hypokalemia.

4. Therapeutic uses of insulin includes

Treatment of high blood glucose such as in Diabetes Mellitus Type 1, diabetes Mellitus Type 2, Gestational diabetes mellitus, Diabetic keto acidosis, Hyper osmolar hyper glycemia, Used along with glucose to treat high blood potassium levels.

5. The most common route of insulin administration is subcutaneous insulin injections. Insulin can be delivered using vials and syringes, insulin pens, and insulin pumps.

Regular human insulin is available in two concentrations 100 units of insulin per ml and 500 units of insulin per ml.

Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to the start of a meal. Administer U-500 insulin subcutaneously 2 to3 times a day approximately 30 minutes prior to start of a meal.

6. Insulin can react with other medications

• Thiazolidinediones interact with insulin and cause fluid retention and heart failure.
• Anti depressant drugs such as fluoxetine, MAO inhibitors.
• Anti hyper tensive drugs such as enlapril, lisinopril, losrtan, propranolol
• Disopyramide
• Salicylates such as aspirin
• Octreotide
• Pentoxifylline
• Cortico steroids and sympathomimetic drugs
• Estrogen and progesterone
• Olenzapine, clozapine
• Isoniacid
• Danazol, glucagon, somatotropin, thyroid hormones

7. Nursing interventions while administering insulin includes

• Prepare correct dosage of drug. Always cross check before administration
• Before giving insulin gently roll the bottle between your palms to mix and warm the solution
• Eliminate air bubbles from the syringe
• Cleanse the site with alcohol and allow to dry
• Give injection subcutaneously and always rotate the site to prevent necrosis
• Check whether patient is been eating his normal diet
• If the patient is on NPO not receive his regular insulin dosage as it may cause hypoglycemia. Notify physician for instructions.

8. Client education regarding insulin administration includes

• Allow patient to ask questions and discuss about insulin administration
• Explain every step of insulin administration to patients
• Advise the patient to check blood glucose level using glucometer regularly
• Demonstrate patient about the device that has been prescribed for delivery of insulin
• Discuss possible injection sites and need for site rotation
• Discuss about storage of insulin and device used
• Have patient redemonstrate insulin and blood glucose monitoring techniques
• Discuss regarding action of insulin and dose adjustment
• Instruct do not skip meals
• Educate about the importance of exercise and healthy food habits

9.Nursing evaluation of medication effectiveness of human insulin includes

• Monitor patients response to therapy
• Monitor for any adverse effects
• Monitor for patient compliance to drug therapy
• Evaluate patient's understanding of drug regimen.
• Evaluate the blood sugar levels periodically to assess the effectiveness of drug dosage.

Keep a record of the blood glucose level values