Insulina Regular

Insulina Regular

Indications

Control of hyperglycemia in patients with diabetes mellitus. Concentrated regular insulin U-500: Only for use in patients with insulin requirements >200 units/day. Unlabelled uses: Treatment of hyperkalemia.

Action

Lowers blood glucose by: stimulating glucose uptake in skeletal muscle and fat,, inhibiting hepatic glucose production.. Other actions of insulin: inhibition of lipolysis and proteolysis,, enhanced protein synthesis.. Therapeutic Effects: Control of hyperglycemia in diabetic patients.

Pharmacokinetics

Absorption: Rapidly absorbed from subcutaneous administration sites. U-100 regular insulin is absorbed slightly more quickly than U-500. Distribution: Identical to endogenous insulin. Metabolism and Excretion: Metabolized by liver, spleen, kidney, and muscle. Half-life: 30–60 min.

Time-Action Profile

(hypoglycemic effect)

ROUTE ONSET PEAK DURATION

Regular insulin IV 10–30 min 15–30 min 30–60 min

Regular insulin subcutaneous 30–60 min 2–4 hr 5–7 hr

Contraindications and Precautions

Contraindicated in: Hypoglycemia; Allergy or hypersensitivity to a particular type of insulin, preservatives, or other additives. Use Cautiously in: Stress or infection—may temporarily ↑ insulin requirements; Renal/hepatic impairment—may ↓ insulin requirements; Obstetric: Pregnancy may temporarily ↑ insulin requirements.

Adverse Reactions and Side Effects

Endo: hypoglycemia. Local: lipodystrophy, pruritus, erythema, swelling. Misc: allergic reactions including anaphylaxis.

Interactions

Drug-Drug: Beta blockers, clonidine, and reserpinemay mask some of the signs and symptoms of hypoglycemia. Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, and rifampinmay ↑ insulin requirements. Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates, may ↓ insulin requirements. Drug-Natural Products: Glucosaminemay worsen blood glucose control. Fenugreek, chromium, and coenzyme Q-10may produce additive hypoglycemic effects.

Route and Dosage

Dose depends on blood glucose, response, and many other factors

Ketoacidosis—Regular (100 units/mL) Insulin Only

Intravenous (Adults): 0.1 unit/kg/hr as a continuous infusion.

Intravenous (Children): Loading dose-0.1 unit/kg, then maintenance continuous infusion 0.05–0.2 unit/kg/hr, titrate to optimal rate of decrease of serum glucose of 80–100 mg/dL/hr.

Maintenance Therapy

Subcutaneous (Adults and Children): 0.5–1 unit/kg/day in divided doses. Adolescents during rapid growth—0.8–1.2 unit/kg/day in divided doses.

Treatment of Hyperkalemia

Subcutaneous, Intravenous (Adults and Children): dextrose 0.5–1 g/kg combined with insulin 1 unit for every 4–5 g dextrose given.

Availability

Insulin injection (regular insulin): 100 units/mL OTCRx

Regular (concentrated) insulin injection: 500 units/mLRx

In combination with: NPH insulins (Humulin 70/30, Novolin 70/30).

Nursing Implications

Assessment

• Assess patient periodically for symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst) during therapy.

• Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.

• Lab Test Considerations: Monitor blood glucose every 6 hr during therapy, more frequently in ketoacidosis and times of stress. A1C may be monitered every 3–6 mo to determine effectiveness.

• Toxicity and Overdose: Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.

Potential Nursing Diagnoses

Noncompliance (Patient/Family Teaching)

Implementation

• High Alert: Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation "u" for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting health care professional. Do not confuse regular concentrated (U-500) insulin with regular insulin.To prevent errors between regular U-100 insulin and concentrated U-500 insulin, concentrated U-500 insulin is marked with a band of diagonal brown strips and "U-500" is highlighted in red on the label and a conversion chart should always be available.

• Do not confuse Humulin with Humalog. Do not confuse Novolin with Novolog.

• Use only insulin syringes to draw up dose. The unit markings on the

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