This document provides information about different types of insulin, including their classification, mechanisms of action, indications, routes of administration, side effects, contraindications, assessment and monitoring considerations, and important points for patient education. It discusses rapid-acting, short-acting, intermediate-acting, and long-acting insulins. The key points are that insulin works by stimulating glucose uptake and use, is used to treat diabetes and its complications, is administered via subcutaneous injection or intravenous routes, and careful monitoring and education of patients is important to safely manage insulin therapy and avoid hypoglycemia or hyperglycemia.

1. By
Dr. Dinesh Kumar G
Pharm. D

33. INSULIN
DRUG NAME & CLASS
insulin aspart (Humalog), insulin lispro
(NovoLog), insulin glulisine (Apidra)
regular insulin
(HumuLIN R, NovoLIN
R)
NPH insulin
(HumuLIN N)
insulin glargine (Basaglar,
Lantus), insulin detemir
(Levemir)
insulin degludec
(Tresiba)
Rapid-acting insulins Short-acting insulins Intermediate-
acting insulins
Long-acting insulins Ultra long-acting
insulins
MECHANISM OF ACTION
•Bind insulin receptors on cells of adipose tissue and skeletal muscles → stimulates glucose uptake from the blood into these cells
•Stimulate glycogenesis, lipogenesis, amino acids uptake and protein synthesis
INDICATIONS
•Type 1 diabetes mellitus and Type 2 diabetes mellitus
•Gestational diabetes
•Diabetic complications (e.g., diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic coma)
ROUTE(S) OF ADMINISTRATION
SubQ SubQ, IV SubQ SubQ SubQ
SIDE EFFECTS
•Hypoglycemia and Lipodystrophy
CONTRAINDICATIONS AND CAUTIONS
•Hypoglycemia
•Elderly clients
•Hepatic or renal disease
•Vomiting or diarrhea, Infection, Fever,
•Surgery

34. ASSESSMENT AND MONITORING
Current weight, recent weight loss
•Symptoms of diabetes: polyuria, polydipsia, polyphagia
•Laboratory test results: blood glucose, hemoglobin A1C, urinalysis, renal and hepatic function; potassium
IV administration
Verify name and dose of medication with second nurse
•Monitor for side effects
•Therapeutic effect: improved glucose control; decreased symptoms of hyperglycemia
CLIENT EDUCATION
•Purpose of medication: to help maintain blood glucose level within a normal range
•Medication used along with antidiabetic regimen; e.g., glucose monitoring, regular activity, low-carbohydrate and high-fiber diet
•Correct method of blood glucose monitoring; frequency of monitoring
• Adjustments with insulin, meals, snacks, activity
•Correct self-administration technique
• Injection sites, including the posterior arm, abdomen, thigh
• Inspect site for bruising, broken skin, or tenderness
• Rotate site
•Proper storage: unopened vials of insulin in refrigerator, vial in use at room temperature away from heat or direct sunlight
•Recognize and respond to symptoms of hypoglycemia; e.g., hunger, fatigue, tremors, headache, dizziness, confusion
• Check blood glucose level
• Consume half cup of fruit juice, three glucose tablets, or approximately 15 grams of sugar
• Check blood glucose again in 15 minutes
•Recognize and respond to symptoms of hyperglycemia; e.g., fatigue, blurred vision, increased thirst, appetite, and urination
• Diabetic ketoacidosis, extremely high blood glucose level, nausea, excessive thirst, dry mouth, frequent urination, drowsiness,
fruity-scented breath, confusion
• Seek medical assistance