2. Categories Of Insulin
Time Course
Rapid Acting
Agent
Lispro
Humalog
Aspart
Novolog
Onset
10-15
min
10-15
min
Peak
1 hour
40-50
min
Duratio
n
3h
4-6
hours
Indications
Used for rapid
reduction of
glucose level, to
treat postprandial
hyperglycemia,
and / to prevent
nocturnal
hypoglycemia
Short Acting Regular
(Humalog
R, Novolin
R)
½
hour –
1h
2-3 h 4-6 h Usually
administered 20-30
mins before a meal;
may be taken alone
or in combination
w/ longer action
insulin

3. Categories Of Insulin
Time
Course
Interme
diate
Insulin
Agent
NPH - Neutral
protamine Hagedorn
Humulin N,
Iletin II Lente,
Ileten II NPH,
Novolin I
(lente)
Novolin N (NPH)
Onset
2-4h
3-4h
Peak
6-12h
6-12
Durat
ion
16-
20h
16-20
Indications
Usually taken
after food
intake
Long
Acting
Very
Long-
Acting
Ultra Lente
Glargine (Lantus)
6-8h
1h
12-16h
Conti
nuous
(no
peak)
20-
30h
24h
Used primarily
to control fasting
glucose level
Used for basal
dose

4. Preparing Insulin InjectionsPreparing Insulin Injections
Equipment :Equipment :
• Insulin(s)
• 100-unit or 50-unit insulin
syringe
with needle
• alcohol wipes
• medication card

5. ProcedureProcedure
1. Check medication orders. Gather equipment.1. Check medication orders. Gather equipment.
Wash your hands.Wash your hands.
(Insulin does not need to be refrigerated)(Insulin does not need to be refrigerated)
2. Rotate intermediate or long-acting insulin bottle2. Rotate intermediate or long-acting insulin bottle
between hands.between hands.
(Rationale: This brings cloudy insulin solution(Rationale: This brings cloudy insulin solution
into suspension.into suspension. RegularRegular insulininsulin (rapid acting)(rapid acting)
isis clearclear and requiresand requires NO rotationNO rotation.).)
For One Insulin Solution

6. 3. Wipe top of insulin bottle with alcohol swab. Take
off needle guard and place on tray.
4. Pull plunger of syringe down to desired amount of
medication (e.g.,30 units). Inject amount of air into
air space, not solution.
(Rationale: Injecting air directly into insulin solution
causes bubbles. Bubbles can confuse drug
amount withdrawn).
5. Draw up ordered amount of insulin into syringe.
6. Remove needle from vial, and expel air from syringe.
7. Replace needle guard. Take medication to client’s
room.

7. 8. Follow protocol for administration of medications
by subcutaneous injections.
For Two Insulin Solutions
1. Check medication orders & injection site. Wash hands.
Gather equipment. Insulin does not need to be
refrigerated.
2. Rotate intermediate or long-acting insulin bottle
between hands.
(Rationale: This brings cloudy solution into suspension
for insulins other than regular).
3. Wipe top of insulin bottles with alcohol. Take needle
guard off and place on tray.

8. 4. Pull plunger of syringe down to desired units of
intermediate or long-acting insulin.
5. Bottle N : Insert needle and inject prescribed amount
of air into intermediate-acting or long-acting bottle.
Do not touch insulin with the needle.
(Rationale: This method prevents contamination of the
second bottle (R).
6. Bottle R (regular insulin) : Inject air into insulin, invert
bottle, and withdraw medication.
(Rationale : Withdrawing regular insulin first prevents
inadvertent injection of intermediate-acting insulin
into the regular insulin bottle, which would
inactivate its rapid action).

9. 7. Withdraw needle from bottle and expel all air bubbles.
8. Invert bottle N and insert needle. Take care not to push
any regular insulin into bottle. This can be avoided by
holding steady pressure on plunger with you small finger
when inserting needle into bottle.
9. Pull back on plunger to obtain exact prescribed amount
of intermediate or long-acting insulin. The total insulin
dose now includes both the regular insulin (previously
drawn up into syringe), and the intermediate or long-acting
insulin you have just drawn up. (Do not rotate syringe to
mix insulins).
10. Expel air from syringe. Replace needle guard. Follow
protocol for administration of medications by subcutaneous
injections.

10. Complications of Insulin Therapy
1. Local allergic reactions - redness, swelling, tenderness,
induration or a 2 to 4 cm wheal) may appear at injection
site 1 to 2 hrs. after insulin administration.
2. Systemic allergic reactions – rare; immediate local skin
reaction that gradually spreads into generalized urticaria.
3. Insulin Lipodystrophy – localized reaction occuring at the
site of the insulin injections.
• Lipoatrophy – loss of sub Q fats and appears as slight
dimpling of sub Q fats.
• Lipohypertrophy – dev’t. of fibrofatty masses at the injection
site.

11. 4. Insulin Resistance – defined as a daily insulin requireme
of 200 units or more (due to obesity).
Immune bodies develop and bind the insulin, decreasing
the insulin available for use.
5. Morning Hyperglycemia - elevated bld. Glucose upon
arising in the morning may be due to :
-Dawn Phenomenon – characterized by normal bld. Glucose
level until 3 a.m., when blood Glucose levels begin to
rise.
-Somogyi effect - nocturnal hypoglycemia followed by
rebound hyperglycemia.
-Insulin waning – progressive increase in bld. Glucose from
bedtime to morning.

12. Nursing Considerations
• Rotating injection areas is not recommended due to
variation in insulin absorption and action. A body area
should be used consistently. Give injections consecu-
tively at points 1 to 8, then move to another site.
• The injection site should be 1 inch from the previous
injection site. Absorption is most predictable in the
abdomen.
• Avoid injection into area to be actively used because
absorption is enhanced.
• Wait for 30 seconds after slowly injecting insulin before
withdrawing needle to prevent insulin leakage. Hold
alcohol wipe over injection site for several seconds. This
hastens absorption and drug action.

13. • Aspirating before and massaging after injecting the
insulin are NOT recommended due to potential for
tissue damage.
• Insulin type and brand should remain consistent for
an individual client.

14. Nasal Spray Insulin
• Intranasal insulin may soon replace regular insulin
boluses for mealtimes. A single puff of 30 units replaces
8 units sub Q.
• Advantages : It has rapid physiologic action and can be
be either before or after meals.
• Disadvantages : It requires higher doses and thus be
more expensive. A potential side effect might be nasal
irritation.

15. Education is a progressive discovery of our
Ignorance……………………..
God Bless……………