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Insulin & Blood Glucose Monitoring

This self-study module was created for the Nursing 112 (Basic Nursing I Clinical) course at Lower Columbia College.
by

Merry Bond

on 14 April 2015

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Transcript of Insulin & Blood Glucose Monitoring

Blood Glucose Monitoring
Insulin &
Module Objectives
Following completion of this module
students will be able to
Describe the basic pathophysiology of both type 1 and type 2 diabetes mellitus
Recognize the symptoms of hypo- and hyperglycemia and their treatments
List reasons for insulin therapy, the various types of insulin, and patterns of administration
A Brief Review of
Endocrine Pancreas Function
A little more
depth...
Routine varies per patient and provider orders
Fasting capillary blood glucose (CBG) is generally drawn in the morning before breakfast
Elevation will be noted with glucose intolerance
Blood Glucose Monitoring
Normal range 70 – 110 mg/dL
Hypoglycemia
Greek Roots
Hypo- (gr. hypos) or "under"
+ glyc (gr. glykys) or "sweet"
+ emia (gr. haima) or "blood"
Literally - the blood isn't sweet enough!
Hyperglycemia's Roots
Hyper- meaning "over"
Hyperglycemia
+ glyc- meaning "sweet"
+ emia- meaning "blood"
Hyperglycemia means literally that the blood is too sweet!
View Video in
Films on Demand:
Diabetes: A Comprehensive Update
17. Part 2: Acute Complications
From the "library" link in the course room, click "databases," then "Films on Demand."
Which of the following is not considered a cause of hyperglycemia?
Overeating (particularly carbohydrates)
Missed doses of insulin or oral hypoglycemic agents
Infection
Increased activity levels
Stress

Knowledge Checkpoint
The correct answer is "increased physical activity" which can actually result in hypoglycemia
Knowledge Checkpoint
Which of the following groups of signs or symptoms can be related to hypoglycemia?
Sweating, tachycardia, and increased urination
Hunger, tachycardia, and irritability
Irritability, sweating, and increased thirst
Anxiety, drowsiness, and tingling pain in the extremities
Stress incontinence, thirst, and dizziness
Hunger, tachycardia, and irritability are all signs or symptoms or hypoglycemia
Knowledge Checkpoint
______________ is a hormone released from the pancreas that mediates the transport of glucose into target cells to be used for energy.
Glucagon
Aldosterone
Insulin
Triiodothyronine
Erythropoietin
The correct answer
is insulin
Types of Insulin
Image from JAMA Patient Page: Insulin
http://jama.ama-assn.org/content/289/17/2314.full

Rapid Acting
Humalog (Lispro)
NovoLog (Aspart)
Short Acting
Humulin R or Novolin R (Regular)
Intermediate Acting
Humulin N or Novolin N (NPH)
Long Acting
Glargine (Lantus)
Detemir (Levemir)
Peak
Duration
Onset
Combination
50/50 or 70/30 (Regular/NPH)
(Regular)
Knowledge Checkpoint
2 hours before a meal
Just after the meal
30 minutes before the meal
60 minutes after the meal
Just as the patient starts to eat
When would be the best time to give an ordered dose of regular insulin?
The correct answer is 30 minutes before the meal because the onset of regular insulin is between 30 and 60 minutes.
When is Insulin Given?
Basal
Bolus
Corrective
Typically long acting insulin (like Lantus), which is generally given once daily
May be intermediate insulin (such as NPH or combination, such as 70/30), which would be given twice daily
Meant to mimic the basal insulin usually present in the blood stream at all times to regulate blood sugar over the course of the day

Usually rapid acting (like Humalog)
May be short acting (like regular), but rapid acting is preferred
Given just prior to meals based on the amount of carbohydrates patient will be eating.
Meant to mimic the release of insulin that occurs in non-diabetics with intake of food
Usually rapid acting or short acting, as is bolus insulin
Given based on the patient’s pre-meal blood sugar reading
Meant to correct the blood sugar

Sample sliding scale

Blood sugar <150: give no additional insulin
Blood sugar 151-200: 2 units of regular insulin SQ
Blood sugar 201-250: 4 units of regular insulin SQ
Blood sugar 251-300: 6 units of regular insulin SQ
Blood sugar 301-350: 8 units of regular insulin SQ
Blood sugar 351-400: 10 units of regular insulin SQ
Blood sugar >400: Call provider for orders

Mrs. Brown has an order for 10 units of NPH insulin every morning before breakfast. She also has orders for a regular insulin sliding scale as follows:
<180, give no additional insulin
181-220, 2 units of regular insulin SQ
221-280, 4 units of regular insulin SQ
281-320, 6 units of regular insulin SQ
321-380, 8 units of regular insulin SQ
>381, call provider for orders
Mrs. Brown’s fasting blood sugar this morning was 234. How much of each type of insulin should she receive?
Knowledge Checkpoint
The correct answer is 4 units of regular insulin and 10 units of NPH
References
Films Media Group. (2005). Diabetes: A comprehensive update [H.264]. Retrieved from http://digital.films.com/PortalPlaylists.aspx?aid=6757&xtid=43835.
Hassan, E. (2007). Hyperglycemia management in the hospital setting. American Journal of Health-System Pharmacy, 64(Supplement), S9-S14. doi: 10.2146/ajhp070102
Johnston, J. A., & Van Horn, E. R. (2011). The effects of correction insulin and basal insulin on inpatient glycemic control. MEDSURG Nursing, 20(4), 187-193.
Kahn Academy. (2011, April 4). Glucose insulin and diabetes [Video file]. Retrieved from
National Diabetes Information Clearinghouse. (2012). Types of insulin. Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/medicines_ez/insert_C.aspx
References
Neurocirujo. (2007, December 8). Endocrine system, pancreas [Video file]. Retrieved from
Timby, B. K., & Smith, N. E. (2009). Introductory medical-surgical nursing (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Umpierrez, G. E., Smiley, D., Jacobs, S., Peng, L., Temponi, A., Mulligan, P. … Rizzo, M. (2011). Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care, 34(2). 256-261. doi: 10.2337/dc10-1407
Von Wartburg, L. (2007). Lantus and Levemir: What’s the difference? Retrieved from http://diabeteshealth.com/read/2007/07/17/5316/lantus-and-levemir--whats-the-difference/
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