Insulin NCLEX Nursing Pharmacology Review
Nursing Pharmacology Guide on Insulin
Insulin is a medication used in the management of diabetes. In healthy individuals, the beta cells of the pancreas produce the hormone insulin which is essential in using and storing glucose.
However, patient with diabetes require insulin shots to supply the body with this hormone in order to regulate the glucose and convert it to energy. Insulin comes in different preparations, such as vials, cartridges, prefilled pens, pumps, and inhalers.
Also, there are different types of insulin based on their onset and duration. Insulin was previously prepared using beef and pork pancreas. However, recombinant DNA technology has enabled pharmaceutical companies to create a purer form of insulin, eliminating the risks for allergic reactions or sensitivities to animal-sourced insulin.
The nursing management of patients on insulin therapy involves monitoring of blood sugar levels, teaching on how to self-administer, and ensuring patient compliance.
Indications for Insulin
Insulin is primarily given to diabetes, a set of diseases that result from the body’s inability to regular the amount of glucose or sugar in the blood. Insulin is indicated for a variety of diabetes-related diseases, such as:
- Type 1 diabetes. Insulin injections are needed by patients with Type 1 diabetes because they do not have healthy beta cells that produce insulin. On the other hand,
- Type 2 diabetes. Patients with Type 2 diabetes beta cells are still functional in producing insulin. However, the body do not respond well to the insulin, so they may also be prescribed with specific insulin shots to aid in converting glucose to energy.
- Diabetic ketoacidosis (DKA). Ketones build up as a result of the lack of insulin in the body. DKA can be managed by continuing long-acting insulin analogues, administering IV insulin as needed, and monitoring of blood glucose and ketone levels.
- Gestational diabetes. Pregnant women may experience diabetes during their pregnancy. Oral anti-diabetics are initially prescribed; however, insulin may be given if the oral anti-diabetic medications are not effective in controlling the blood sugar levels.
Actions of Insulin
The desired action of insulin is to replace endogenous insulin which is not produced by the pancreas in patients with diabetes. Insulin circulates through the blood stream and reacts with the insulin receptor of the body cells to stimulate the conversion of glucose to glycogen, turning it into energy the body requires to perform various functions and processes.
Insulin differs on onset, peak, and duration once injected subcutaneously, intramuscularly, or intravenously. The following are the types of insulin based on speed:
- Rapid-acting insulin – works quickly to lower blood glucose levels; has an onset of just within a few minutes after administration; usually given just before or with meals
- Regular or short-acting insulin – works within 30 minutes to an hour and lasts for 3 to 6 hours
- Intermediate-acting insulin – works within 2 to 4 hours and lasts for up to 18 hours
- Long-acting insulin – works for up to a whole day
- Mixed or combination insulin – a combination of short and long-acting insulin
The types of insulin based on their source include:
- Animal insulin – from beef and pork pancreas
- Human insulin – made in the laboratory; does not actually come from humans as the name suggests
- Analogue insulin – laboratory-grown human insulin which is modified to achieve the desired speed of action
Side Effects and Adverse Effects of Insulin
The common side effects of insulin are:
- Injection site reactions – such as pain, redness, irritation
- Weight gain
Adverse reactions associated with insulin may include:
- Muscle cramps, weakness or irregular heartbeat – signs of low potassium level in the blood
- sudden sweating, fast heartbeat, shaking, dizziness, peripheral neuropathy (tingling of hands or feet), blurred vision, dizziness, or hunger – signs of hypoglycemia or low blood sugar
Contraindications and Cautions against Insulin
There are different considerations related to the intake of insulin. They are commonly discussed by the prescriber before the medication is prescribed.
One of these include allergy to animal products, as some types of insulin are sourced from pork or beef pancreas. Patients who are just starting on insulin are advised not to operate heavy machinery or drive as insulin may cause blurry vision, dizziness, or drowsiness.
Alcohol intake should be limited while on insulin as it can lower blood sugar levels even further. Blood sugar levels should be monitored regularly, especially before and after exercise or physical activity to prevent hypoglycemic episodes.
Women with diabetes should consult their doctor prior to breastfeeding, as insulin needs may change when breastfeeding. Insulin can be passed into breastmilk but research shows that it is highly unlikely to harm a nursing infant.
Drug Interactions with Insulin
Insulin may interact with other drugs and herbal medicines. These include:
- Beta blockers – may block the sympathetic nervous system which may hinder the patient to recognize the symptoms of hypoglycemia
- MAOIs, salicylates and alcohol – may put a patient at risk for hypoglycemia when taken with insulin
- Juniper, ginseng, garlic, berries, and other herbal therapies – may put a patient at risk for hypoglycemia when taken with insulin
Nursing Care Plan for Patients on Insulin
Possible Nursing Diagnoses
Risk for Unstable Blood Glucose Levels related to ineffective dosage of insulin
Imbalanced Nutrition: Less Than Body Requirements related to insulin use
|Check the patient’s diagnosis and how it relates to the administration of insulin. Assess the patient for signs and symptoms of hypoglycemia. Check the patient’s allergy status.||To confirm the indication and safety of administering insulin.|
|Conduct a review of current medications and history of alcohol intake.||Alcohol and some medications interact with insulin. Assess for the current use of beta blockers, MAOIs, salicylates, and herbal therapies.|
|Assess if the patient is pregnant and is planning to breastfeed.||Women with diabetes should consult their doctor prior to breastfeeding, as insulin needs may change when breastfeeding. Insulin can be passed into breastmilk but research shows that it is highly unlikely to harm a nursing infant|
|Check for the status of peripheral veins prior to cannulation and administration of intravenous insulin. If administering subcutaneous or intramuscular insulin, assess the skin for any breaks or abnormalities.||To check for any potential problems with administration, hydration, and absorption.|
To ensure that the right form of insulin is given through the right route.
|Check the patient’s medical history for the following:Kidney diseaseHeart disease and is on beta blocker therapy||Insulin should be prescribed with extreme caution in patients with the mentioned diseases. Patients with renal impairment are at a higher risk for hypoglycemia when on insulin therapy. On the other hand, a patient with history of heart disease and is on beta blocker therapy may have their sympathetic nervous system blocked, which may hinder the patient to recognize the symptoms of hypoglycemia|
Nursing Planning and Intervention
|Administer insulin through the appropriate route. It is ideal to give it at the same time of the day.||To ensure optimal absorption and therapeutic action by insulin.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking insulin. Instruct the patient on how to self-administer insulin.||To inform the patient on the basics of insulin, as well as to empower him/her to safely self-administer the medication.|
|Advise the patient to avoid operating heavy machinery and driving when starting insulin.||Patients who are just starting on insulin should avoid operating heavy machinery and driving due to the potential drowsiness, dizziness, or blurred vision. Once their body has adjusted to the insulin therapy and the patient feels safe, patient may proceed on their preferred physical activity with caution.|
|Rotate sites of injection.||To prevent damage to the muscles. Using the same site may cause subcutaneous atrophy.|
|Encourage the patient to avoid alcohol intake, or at least limit alcohol consumption to 1 to 2 units per day while taking insulin.||Alcohol may increase the risk of hypoglycemia or low blood sugar level while taking insulin.|
|During preparation, gently rotate the vial to mix the product inside and avoid vigorous shaking of the insulin vial.||To ensure uniform suspension of insulin inside the vial.|
|Prior to administration, verify the name of the insulin to be injected with the patient and his/her drug chart.||Insulin varies in types and speed. Some insulin pens have similar names which can be confusing to both the patient and nurse.|
|Store insulin in a cool, dry place, away from direct sunlight. Most insulin are stored in the fridge. Pre-drawn syringes can be stored in the fridge for 1 week.||Following proper storage instructions ensures effectiveness of insulin therapy.|
|Refer the patient to a diabetes dietitian.||A diabetes dietitian is a specialist in providing customized dietary regimen to patients with insulin to ensure proper nutrition.|
4. Nursing Evaluation
|Ask the patient to repeat the information about insulin.||To evaluate the effectiveness of health teaching on insulin.|
|Monitor the mental status of the patient.||To ensure that the insulin did not cause any drowsiness or dizziness to the patient.|
|Monitor the patient’s response to insulin in terms of side effects or adverse effects, particularly drowsiness, hypoglycemic episodes, dizziness, tingling or sensory loss (peripheral neuropathy), and blurry vision.||To check if the current insulin is effective, or the dose needs to be adjusted, or the drug should be stopped altogether and changed to an alternative treatment.|
|Monitor the patient’s blood sugar levels, food intake and physical activity.||To ensure that the patient receives the therapeutic benefit of insulin therapy and to avoid hypoglycemic episodes.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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