Nursing 212

Health Differences Across the Lifespan 2 Study Guide Instructions for insulin: Store insulin in the refrigerator and keep it away from direct sunlight. Note the expiration date and replace after four weeks. Discard the vial and use a new one if regular insulin appears cloudy. Do not shake the vial as this may inactivate insulin and form bubbles that lead to dosage errors. Roll non-regular insulin gently between hands to evenly disperse suspended particles; draw regular (clear) insulin first when mixing it with other types of insulin. Only mix insulins of same concentrations (U100 regular and U100 NPH) and from same source. Rotate injection sites to prevent lipoatrophy and lipodystrophy. Medications: Insulin therapy is used to treat type 1 DM. Different insulin preparations are available to maintain near normal blood glucose levels. Insulin is classified according to source, onset, peak, and duration of action. Human insulin has a faster onset of action, a shorter peak, and a shorter duration. Rapid acting insulin includes Humalog, Novolog, and Apidral. Short acting insulins are Humulin R and Novolin R. Intermediate acting insulin is Lantus, a mixture of NPH and regular, buffered insulin (Humulin BR). Buffered preparations are used for external insulin pumps. Humalog is a rapid acting onset of 15-30 minutes, peaks in 1 1/2-2 hours, with a duration of 3-6 hours. Regular insulin has an onset 30 minutes-1 hour, peaks in 2-3 hours, with a duration of 5-6 hours. NPH Lente has an onset of 1-2 hours, peaks in 8-12 hours, with a duration of 18-24 hours. Insulin preparations can be combined to mimic pancreatic response to variations in BG levels; for example, rapid and short acting insulins are usually given to cover mealtimes, while intermediate and long acting insulins maintain basal insulin requirements between meals. Insulin regimens combine short acting, intermediate acting, and long acting preparations to maintain target BG levels. Regular insulin may be given with an IV. Insulin preparations are usually given SQ; a continuous SQ insulin infusion (insulin pump) is also available to deliver a basal rate of insulin and allow for additional bolus doses based on requirements (before a meal). Hypoglycemia is caused by too much insulin, inadequate intake, missed meals, or strenuous exercise without increased intake. Blood glucose levels drop below normal. The patient exhibits diaphoresis, tremors, hunger, weakness, pallor, dizziness, somnolence, coma, seizures, and death. Treatment depends on the severity of symptoms but involves replacement of glucose. Mild or moderate symptoms give juice or milk, graham crackers, or glucose tablets. If severe, give glucose paste and possible administration of glucagon SQ. Hyperglycemia is caused by insufficient insulin, infection, or other illness. The BG is greater than 250 mg/dL, blood pH less than 7.2, and HCO3- less than 15 mEq/L. Symptoms include glycosuria, ketonuria, acetone breath, dehydration, Kussmaul’s respirations, weight loss, tachycardia, flushed facial skin, hypotension, decreased level of consciousness, and death. The patient will have elevated serum potassium and chloride and decreased serum sodium, calcium, magnesium, and phosphate. The patient may report stomach ache or chest pain (common symptoms); some may present with vomiting. Non-insulin dependent diabetes mellitus (type II) is a deficit in insulin release or an insulin- receptor defect in peripheral tissues. It usually develops after age 30. Exercise increases insulin sensitivity, improves glucose tolerance, and promotes weight loss. It may require oral antidiabetic

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