INSULUN ADMINISTRATION

BY: NURZIA PASIL

INTRODUCTIONDiabetes mellitus (DM), commonly referred to as diabetes, is a

group of metabolic diseases in which there are high blood sugar levels

over a prolonged period. It is due to either the pancreas not producing

enough insulin or the cells of the body not responding properly to the

insulin produced.

Type I DM results from the body's failure to produce enough insulin. This form was

previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile

diabetes". The cause is unknown.begins most commonly in childhood or

adolescence.

Type II DM begins with insulin resistance, a condition in which cells fail to

respond to insulin properly. As the disease progresses a lack of insulin may also

develop.This form was previously referred to as "non insulin-dependent diabetes

mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body

weight and not enough exercise.

: Insulin is a naturally-occurring hormone

secreted by the pancreas. Insulin is required

by the cells of the body in order for them to

remove and use glucose from the blood. Cells

use glucose to produce energy that they need

to carry out their functions.

INSULIN OVERVIEW

TYPES OF INSULIN

INSULIN ROUTES OF

DELIVERY1.INJECTION

2. INFUSSION

3. INHALATION

INJECTION:

Insulin may be injected into the subcutaneous tissue of the

upper arm and the anterior and lateral aspects of the

thigh, buttocks, and abdomen (with the exception of a

circle with a 2-inch radius around the navel).

Intramuscular injection is not recommended for routine

injections. Rotation of the injection site is important to

prevent lipohypertrophy or lipoatrophy. Rotating within

one area is recommended (e.g., rotating injections

systematically within the abdomen) rather than rotating

to a different area with each injection. This practice may

decrease variability in absorption from day to day.

ROTATING SITEFor your insulin to work best, don't use the

exact same site each time you inject. There are

different sites where you can inject throughout

the day. Refer to the image above. This is called

site rotation and involves following a regular

pattern as you move from site to site.

1. Fastest from the abdomen (stomach)2.A little slower from the arms3.Even more slowly from the legs4.Most slowly from the

buttocks

INSULIN PREPARATION

1. Wash hands

2. Wear gloves. Change gloves in between patients contact

3. Inspect regular insulin for clarity.

4. Gently rotate NPH insulin to mix well

5. Wipe off the top of vials with an alcohol pad

6. Draw amount of air equal to the no units of required insulin

into the syringe, inject no of units of air, inject into the vial.

7. Inspect for air bubbles.

8. The nurse shall label the insulin bottle with a date and initials

upon opening.Insulin may be kept refrigerated or stored at room

temperature.

9. The nurse shall dispose of the insulin bottle after 28 days from

the date labeled on thebottle.

10.Administer Insulin:

INJECTION TECHNIQUE

1. Injections are made into the subcutaneous tissue. Most individuals

are able to lightly grasp a fold of skin, release the pinch, then inject at

a 90° angle. Thin individuals or children can use short needles or

may need to pinch the skin and inject at a 45° angle to avoid

intramuscular injection, especially in the thigh area.

2. Inject Insulin at room temperature

3. Make sure no air bubbles remain in the syringe before injection.

4. Wait until typ insulin for clarityical alcohol (if used) have

evaporated completely before injection

5. Keep muscles in the injection area relaxed, not tense, when

injecting

6. Penetrate skin quickly.

7. Do not change direction of needle during insertion and withdrawal

of needle.

8. Do not reuse needle. Wash hands and properly dispose of the

syringe.

INJECTION SRINGES For years, injection of insulin with a

needle and syringe was the only option.

Syringes are still the best choice for most

people who mix different types of insulin

for a single injection.

Insulin pensInsulin pens combine an insulin

container and syringe in one

compact device. Two types are

available: reusable and prefilled.

With reusable pens, you load a

cartridge of insulin into the pen,

attach a needle, dial in your insulin

dose, and press the plunger to

administer the injection. Prefilled

pens contain a built-in insulin

cartridge and are even easier to use,

Jet injectors

Jet injectors use a high-pressure jet of air to send a fine stream of

insulin through the skin. Although jet injectors eliminate the need for

needle sticks, they cause as much pain as insulin injections and often

result in bruises. In addition, jet injectors are bulky and expensive,

adding to the reasons they are not widely used.

External insulin pumps

Some people who require frequent insulin injections do better with

an external insulin pump, which more closely mimics the work of

the pancreas. The pump is a small, portable device (usually worn at

the waist) that delivers insulin through a tube (a catheter) attached

to a small needle inserted just below the skin of the abdomen or

thigh.

The pump is easy to use. It is programmed to automatically deliver a continuous

amount of insulin throughout the day. Before meals, the user presses a button to

deliver the extra insulin needed.

Insulin pumps are primarily used by people with type 1 diabetes, but more type 2

patients are starting to use the pump.

.

•INFUSSION

Human regular insulin may be injected

directly into the vein in a hospital setting

under close medical supervision only. Insulin

is added to intravenous fluids, and the insulin

dose and blood sugar are strictly monitored.

The intravenous route of delivery is ONLY

given under a doctor’s orders in a hospital to

facilitate the management

•INHALED INSULIN

In 2006, the FDA approved Exubera, the first

inhaled insulin. Exubera was a dry powder

administered with a device similar to an asthma

inhaler. It could take the place of premeal insulin

injections but could not be used as a substitute for

longer-acting insulin needed in the morning or

before bed. Exubera was pulled from the market

in late 2007 due to low sales, partly because of

concerns from doctors whether it was safe for the

lungs

GENERAL PRECAUTIONS

HYPOGLYCAEMIA, HYPOKALEMIA, LIPODSTROPHY

AND HYPERSENSITIVITY ARE AMONG THE

POTENTIAL CLINICAL ADVERSE EFFECTS

ASSOCIATED WITH THE USE OF ALL INSULINS.

INSULIN ADMINISTRATION

1. SYRINGE USE

2. NURSE VERIFICATION

3. LABELING

4. DISCARDING

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