ASSISTING CLIENTS ON INSULIN THERAPY
A. DEFINITON: Insulin therapy - is the administration of synthetically produced
insulin extract from the pancreas of slaughtered pigs and cows. It is given to persons
who do not have adequate indigenous insulin and administered through
subcutaneous route to lower blood glucose level.
B. RATIONALE
1. To lower the blood sugar level by facilitating the uptake and utilization of glucose
by body cells for energy production.
C. EQUIPMENT
prescribed bottle insulin
insulin syringe (units 40, 80, 100)
hypodermic needles (G 25,26, 1-2 cm (1/2 inch) long
alcohol swabs/sponge small tray for storage of supplies
D. PLANNING AND IMPLEMENTATION
ACTION RATIONALE
FOR ONE INSULIN SOLUTION
1. Check medication, injection site used To ensure correct administration of the
medication;previously as reflected in the medication; keep in mind the 5R's in
rotation chart. drug . therapy
2. Follow the usual procedure and
principles in giving injections in general.
a. Wash hands prior to preparation To prevent nosocomial infection.
b. Gather equipment, obtain specific Insulin syringes are calibrated in units of
insulin syringe for strength of insulin 40, 80, 100
being administered.
c. Rotate insulin bottle between hands. This brings the solution into suspension
for insulin other than regular.
d. Remember: Do not inject air directly Air bubbles in the solution can alter the
into insulin solution. actual dosage administered.
E. Double check the medication card, Accuracy in insulin administration is the
insulin bottle and dose with another - key to the client's recovery thus
RN. minimizing side effect of diabetes and
insulin itself.
F. Give insulin only by subcutaneous A suggested rotation chart is attached to
route. Position hand on a 45 angle and the client's chart to guide the nurse of
hold the subcutaneous tissue in place. the injection sites used.
g. Observe and teach client of what Involve client and family in his care.
specific signs and symptoms to watch Knowledge and cooperation is gained
while on insulin therapy. which contributes to better quality of
care.
FOR TWO INSULIN SOLUTIONS:
1. Follow the above guidelines and steps
in insulin administration
2. Keep in mind: Regular or clear insulin The technique generally prevents cloudy
is withdrawn into the insulin syringe first: insulin from contaminating the clear
Followed by the intermediate-acting insulin.
(NPH, Lente) of long acting (PZI,
ultralente) insulin which are cloudy in
preparation.
3. This can be avoided by putting gentle The total insulin dose will include the
"pullback" pressure on plunger with your amount of regular insulin already drawn
small finger when inserting needle into up into the syringe.
bottle.
4. Emphasize to the patient that he is Refer to table provided below.
receiving two insulin solutions with
different peak and duration effects in the
body.
VI. AFTER CARE
1. It is common practice to place an open insulin bottle ion the refrigerator
2. Dispose the insulin syringe and needle after use.
3. Chart medication and injection site in the nurse's notes.
TYPES ONSET PEAK DURATION
1. Rapid-acting
Regular 1/2 to 1 2-4 hours 6 to 8 hours
Semilente 1/2 to 1 4-8 hours 10 to 6 hours
Humulin R 1/2 to 1 2-4 hours 5 to 7 hours
2. Intermediate-acting 1 to 1 1/2 8 - 12 hours 24 hours
NPH 1 to 1 1/2 8 - 12 hours 24 hours
Lente 1 1/2 to 3 1/2 8 - 12 hours 18 to 24 hours
Humulin N
3. Long-acting 4 to 8 14 - 20 hours 24 - 36 hours
Protamine Zinc (PZI) 4 to 8 16 - 24 hours 36 hours
Ultralente
V EVALUATION I desired effect would be relief of pain, lowered blood sugar or
decreased urine glucose.
ASSISTING CLIENTS ON INSULIN THERAPY CHECKLIST
PROCEDURE 3 2 1 0
FOR ONE INSULIN SOLUTION
1. Check medication, injection site used medication;previously as
reflected in the rotation chart.
2.Follow the usual procedure and principles in giving injections in
general.
a. Wash hands prior to preparation
b. Gather equipment, obtain specific insulin syringe for strength of
insulin being administered.
c. Rotate insulin bottle between hands.
d. Remember: Do not inject air directly into insulin solution.
e. Double check the medication card, insulin bottle and dose with
another - RN.
f. Give insulin only by subcutaneous route. Position hand on a 45
angle and hold the subcutaneous tissue in place.
g. g. Observe and teach client of what specific signs and symptoms
to watch while on insulin therapy.
FOR TWO INSULIN SOLUTIONS:
1. Follow the above guidelines and steps in insulin administration
2. Keep in mind: Regular or clear insulin is withdrawn into the insulin
syringe first: Followed by the intermediate-acting (NPH, Lente) of long
acting (PZI, ultralente) insulin which are cloudy in preparation.
3. This can be avoided by putting gentle "pullback" pressure on
plunger with your small finger when inserting needle into bottle.
4. Emphasize to the patient that he is receiving two insulin solutions
with different peak and duration effects in the body.
Legend:
3 - Performed in the exact manner as stated in the procedure with in-depth explanation of rationale
2- Performed in the exact manner in the procedure but the rationale is unclear and less in-depth
1 - Performed the procedure without explanation of the rationale
0 - Not performed
Rating: __________
___________________________________________ _______________________
Signature of Clinical Instructor over Printed Name Signature of Student
