1.
Animal source – beef/ pork : rarely given because it causes allergic reaction2. Human – has less antigenetic property
Ex. Humulin – most commonly used
If kid is allergic to chicken – don’t give measles vaccine, it comes from chicken embryo.
3. Artificially compound B. Types of Insulin
Types of Insulin Onset Peak Given Color &
Consistenc y
Durati on
1. Rapid Acting Insulin - Regular Acting - Humulin R - Semi-Lente - Crystallized Zinc - Velosulin
2-4 hrs. 3x/day Clear 6-8 hrs.
2. Intermediate Insulin - NPH (Non-protamine Hagedorn 1)
OD Cloudy 24 hrs.
3. Long Acting Insulin - Ultra Lente
5 R’s Of Insulin Administration
1. Right Patient: Give insulin only if there are signs of glycosuria & hypergylcemia 2. Right Drug : Administer right type of Insulin
3. Right Route: Not given P.O., insulin destroyed in the GIT by proteinase Given: SQ, IM, I.V.
Humulin R
Crystalline Zinc Incorporated w/ water, given by drip (IVF) Regular Insulin
4. Right Time:
Best time given – 60-90 minutes before meal or an hour before meal
Physiologic effect of insulin will parallel the absorption of glucose 5. Right Dose: Know stock dose of insulin
10 ml vial
40 units/ml or 80 units/ml or 100 units/ml Nsg Mgt For Insulin Therapy:
1. Administer insulin at room temperature. Do not expose to sunlight
• Refrigerate insulin once opened only
• Before administration, gently roll vial between palms. Avoid shaking to prevent formation of bubbles
4-8 ounces of softdrinks 4-8 ounces of fruitjuice
1 tbs. of sugar ---best alternative, put in oral cavity
5 ml of honey 5 ml of karo syrup 2-4 pcs. Of candies
2 slices of graham crackers 2. Use gauge 25 – 26 needle : Tuberculin syringe
3. Administer insulin at either 45 or 90° depending on the client tissue deposit.
5. Don’t aspirate after injection
•
Rotate injection site to prevent lipodystrophy (atrophy/ hypertrophy of SQ tissue)Deltoid Upper Arm R & L
Rectus Femoris R & L IM Below breast
Vastus Lateralis Lower Central Abdominal Wall SQ Gluteus Maximus Lateral thigh R & L
Below scapula R & L Buttocks R & L 6. Most accessible site – abdomen
7. When mixing 2 types of insulin, aspirate
1st regular/ clear – before cloudy to prevent contaminating clear insulin & to promote accurate calibration.
8. In giving insulin:
Before meals but if pt. eating already: Give insulin
If pt. already eaten 2 hrs. : Do not give, repeat CBC> MD will adjust the dose 9. 1ml or cc of tuberculin = 100 units of insulin 10. Monitor for signs of complications:
a. Allergic reactions b. Lipodystrophy
c. Somogyi’s Phenomenon
– Rebound Effect of Insulin characterized by hypoglycemia followed by periods of hyperglycemia (Insulin Shock, Hyperinsulinism, Insulin Overdose, Hyperglycemia)
d/t
• Occurs w/ insulin overdose
• Prolonged NPO, vomiting
• Long interval of insulin from the serving of food
* If allowed to eat, give anything to eat an hour after administration of insulin Sx: Hunger Pangs
Double Vision
Pallor, cold clammy skin Tremors
Mgt:
1. Give 20-30 gm of carbo 2. Drugs
Epinephrine 1.1000 SQ Glucagon 1-2 mg IM
*IV glucose H20 ---- D50% by IV push ---- D5W by venoclysis
2. TYPE 2 DIABETES MELLITUS Most Feared Complication of Type II DM
Hyper ↑ osmolarity = severe dehydration Osmolar
Monitor For:
*Presence of any of these even if pt. is NIDDM insulin is required
Coma – S/Sx: headache, restlessness, seizure, decrease LOC Dx :
1.
FBS: N 80 – 120 mg/dlIncrease , 3 consecutive times 3 P’s & 1G = confirmed DM
2.
Oral Glucose Tolerance (OGTT) Most sensitive test3.
Random Blood Sugar : Increased4.
Alpha Glucosylated Hgb : Elevated (Normal: <9 %) Nsg Mgt:- Same as DKA except don’t give NaHCO3!
1. Can lead to coma – assist mechanical ventilation
2. Administer .9NaCl – isotonic solution, followed by .45NaCl hypotonic solution to counteract dehydration.
3.Monitor VS, I&O, blood sugar levels 4.Administer meds
a.) Insulin therapy – IV
Regular Acting Insulin – clear b.) Antibiotic to prevent infection Tx:
1. Give OHA O ral
H ypoglycemic Fx: Stimulates pancreas to secrete insulin A gents
Classifications of OHA:
1.
1st Generation SulfonylureasFx: Given to stimulate B-cell to secrete endogenous insulin a. Chlorpropamide (Diabenase)
b. *Tolbutamide (Orinase)
2.
2nd Generation Sulfonylureasa.
Diabeta (Micronase)b.
Glipside (Glucotrol)3. Biquanides
- Increase uptake of glucose by the cell but prolonged use may cause lactic acidosis Ex. Metformin
Glucophage Nsg Mgt or OHA:
1. Administer with meals – to lessen GIT irritation & prevent hypoglycemia
2.
Avoid alcohol (alcohol + OHA = severe hypoglycemic reaction) ---leads to antabuse (Disulfiram) toxicityNsg Mgt For DM:
1. Monitor for PEAK action of OHA & insulin
DIABETIC 3. Monitor VS, I&O, neurocheck, blood sugar levels.
4. Administer insulin & OHA therapy as ordered.
5.
Monitor signs of hyperglycemia & hypoglycemia.-Pt DM –“ hinimatay”
- You don’t know if hypo or hyperglycemia - Give simple sugar (Brain can tolerate high sugar, but brain can’t tolerate low sugar!)
*Cold, clammy skin – Hypoglycemia – Orange Juice or simple sugar
*Warm to touch, dry – Hyperglycemia – Administer insulin
6.
Provide nutritional intake of Diabetic Diet:-Or offer alternative food products or beverage.
-Lots of orange juice.
7.
Exercise – after meals to promote increase glucose utilization- After strenuous exercise, glucose is already consumed even w/o insulin Pre-breakfast insulin: For pt. who exercised already—decrease dose of insulin Athletes: Take snacks in between exercise
8. Monitor complications of DM
a. Atherosclerosis – HPN, MI, CVA
b.
Can affect the small minute capillaries of eyes & kidney leading to : Microangiopathies (thickening) c. Eyes – Diabetic retinopathy , Premature cataract & blindnessd. Kidneys – Recurrent pyelonephritis & Renal Failure e. Gangrene formation
f. Peripheral Neuropathy
-
Diarrhea/ Constipation-
Sexual impotence (Complication of HPN & DM) g. Shock9.
Foot Care Mgt d/t delayed wound healing especially of extremities a. Avoid waking barefootedb. Cut toe nails straight
c. Apply lanolin lotion – prevent skin breakdown d. Avoid wearing constrictive garments
e. No Crossing of legs
f. Avoid local cold application in extremities
g. Never elevate legs on pillow to prevent tissue ischemia unless there are sx of leg edema
10.
Encourage annual eye & kidney exam 11. Avoid smoking d/t vasoconstriction12.
Monitor urinalysis for presence of ketones or Blood or serum – more accurate 13. Assist in surgical wound debridement14.
Monitor signs of DKA & HONKC15.
Assist surgical procedure: BKA or above knee amputation D. DM ASSOCIATED WITH OTHER DISORDERa.) Pancreatic tumor