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INSULIN (SUB-Q INSULIN PUMPS (advantages (increase compliance, dont have…

- - - - if removed, change settings, cap the tubing and cover insertion site
  - - - increased freedom
      - increased risk for insulin resistance
  - - - pt trying to save money
      - reusing needles for injection
      - education can help with that
      - not changing the site
    - - needle may migrate out and pt may not notice
        
        result in s/s of hyperglycemia, hyperkalemia
- - - - standard concentration is 1 unit concentration = 100u/mL
  - - - once its opened, keep @ room temp & dark setting
      - cold insulin hurts more
  - - - insulin aspart (NovoLog)
      - insulin lispro (humalog)
      - peaks at 1-3 hours
        
        highest concen. = highest risk for complications
      - duration 3-5 hours
      - soon as they have meal, halfway into meal
    - - in hospital setting (not given subcut)
        
        can be given subcut at home
      - regular human insulin
      - peaks at 2-4
      - duration 5-7 hours
      - only insulin we give IV - what we give for insulin infusion
        
        it will be out of the body really quick
        
        administer something subcut BEFORE we stop the infusion
    - - can be combined with rapid acting insulin
      - peak 4 hours
      - duration is 17-24 hours
      - isophane insulin NPH
      - given frequently in long term care, with management of glucose
      - onset 1-4 hours
    - - does not have a peak
      - receives 1 time a day
      - insulin glargine (Lantus)
        
        big in peds pts. prescribed at noon (at school)
        
        school nurses will ensure they have their meds
      - etemir (Levemir)
  - - - lantus
        
        intermediate may be given twice a day
    - - combinations of insulin
        
        multiple meds prescibed
      - start off 1/3 being long acting and 2/3 being rapid acting
        
        changes based on patient's response
    - - correction (sliding) scale (rapid acting in hospital setting)
        
        check glucose to see if insulin is needed
        
        if it says call physican call first
        
        if it says give units then call physician, do just that
        
        tray of food has to be in front of them b4 giving insulin (STANDARD)
        
        GIVE BEFORE A MEAL (FOR THE TEST)
        
        its safer to give after a meal when trying to mimic the pancreas
      - carbohydrate correction scale (rapid acting in hospital setting)
        
        1 exchange per 15 grams of carb =
        
        prescribed x units per carb exchange
        
        e.g. 4 exchanges give x units
        
        e.g. give 1 u per carb exchange
        
        this increases pt compliance by not taking away what pt likes to eat, but prevents hyperglycemia
        
        prescribed AFTER meals
- - - - given through dual chamber
  - - - insulin causes K+ to go into the cell = increases risk for HYPOkalemia
- - - - (VIAL) 45 degree angle
  - - - rapid acting (before eating)
      - short-acting
      - intermediate- twice a day
      - long acting every 24 hrs
- - - - educate pt to alternate sites
  - - - body secretes hormone for growth and repair causing an increase of glucose levels in the am
  - - - dont eat in the evening, the body breaks down glycogen resulting in high glucose in am
- - - - GI
      - hypoglycemia
      - sometimes weight gain
    - - if they skip a meal and still take med, they become hypoglyglemic
- - - - important in hemoglobin synthesis
- - - - increased glucose in tract, bacteria feed on sugar
        
        monitor for bloody urine
- - - - joint pain at times
    - - increases BP
- - - - can be a severe problem
        
        HHS pts with t2dm
- - - - sprite, NO diet, we want to increase glucose
- - - - increases risk for clots
      - increases risk for ischemia
  - - - what to do for pts. in certain situations
      - reduces complications and length of stay
    - - even though its high, they have stressors present
- - - - still have to change diet/exercise, and antirejection meds
        
        at increased risk of infection for a lifetime b/c of medication
  - - - from another person
  - - - start off with ice chips and gradually increase intake
- - - - educate parents/family as well as child
- - - - constipation
      - indigestion
      - side effects slow down with use of the medication
      - increased risk of pancreatitis
- - - - may forget theyve taken meds, and retake them
      - may forget to take meds