Question

You are caring for a patient who is diabetic and has insulin regular and insulin isophane NPH ordered to control their blood sugar.

1. What is the differences to these two insulins? Include the onset, peak, and duration times along with any other differences.
2. What assessment would the nurse make prior to administering either medication?
3. How does 70/30 insulin compare to these insulins?
4. What teaching would be included to this patient including storage?
5. What would the nurse monitor for in the patient who is taking these medications?
6. Why would glucagon be ordered for this patient?

Answer 1

1. insulin regular(human insulin) is a short-acting insulin. it is a more rapid onset. it is mostly used in pregnant women, those with an allergy towards animal-derived insulin, the first stage of insulin therapy, for the intermittent use of insulin.it is a clear solution with an onset of action (1/2 to 1 hour), peak action is produced only after 2-4 hours and duration up to 6-8 hours.

while NPH(neutral protamine Hagedorn) is intermediate-acting insulin with a cloudy appearance. the onset of action is 1-2 hours, peak action time is 8-10 hours with a duration of 20-24 hours. it can be mixed with insulin regular for more action.

2. regular insulin nursing consideration

• since regular insulin is clear, check for cloudy, discoloured or viscous, if yes do not administer.
• do not administer concentrated regular insulin (U-500) IV
• assess for the symptoms of hypoglycemia
• periodically monitor body weight.
• monitor blood glucose level every 6 hours.
• when mixing insulins always draw insulin R firstly to avoid contamination.

NPH nursing considerations

• administer within 30-6- minutes before a meal.
• check for hypoglycemia
• should be stored in a cool place
• check body weight periodically to adjust the dose
• check blood glucose level periodically
• NPH should not be used in the management of ketoacidosis.

3. 70/30 insulin

It is a mixture of 70% intermediate-acting insulin (isophane) and 30% short-acting insulin (regular). it starts to work within a short period of time and lasts for a longer time. it can be used alone or along with other antidiabetic drugs. it is cloudy or milky in appearance. it should mix by turning up and down for 10 times but do not shake. should not mix with other insulins.

4.storage of insulin

• should be stored in a cool place but no need to store in the freezer.
• not good to use when exposed to very hot or cold weather.
• if insulin is stored in room temperature for 28 days, throw away
• check for the appearance of insulin. (clear solution should be clear throughout the use)