ADDITIONAL SLIDES FOR ASSIST WITH COMPREHENSION OF LAB CONTENT-MODULE FIVE-DM DENISE TURNER, MS-N.ED, RN, CCRN

SIGNS AND SYMPTOMS ELEVATED FASTING BLOOD GLUCOSE (HIGHER THAN 126 MG/DL) OR A HEMOGLOBIN A1C (A1C) LEVEL GREATER THAN OR EQUAL TO 6.5% 515 POLYURIA POLYDIPSIA POLYPHAGIA GLYCOSURIA UNEXPLAINED WEIGHT LOSS FATIGUE BLURRED VISION DIABETES MELLITUS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.2

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TYPE 1 INSULIN THERAPY TYPE 2 LIFESTYLE CHANGES ORAL DRUG THERAPY INSULIN WHEN THE ABOVE NO LONGER PROVIDE GLYCEMIC CONTROL TREATMENT FOR DM Copyright © 2014 by Mosby, an imprint of Elsevier Inc.5

INSULINS ORAL HYPOGLYCEMIC DRUGS BOTH AIM TO PRODUCE NORMAL BLOOD GLUCOSE STATES TYPES OF ANTIDIABETIC DRUGS Copyright © 2014 by Mosby, an imprint of Elsevier Inc.6

FUNCTION AS A SUBSTITUTE FOR THE ENDOGENOUS HORMONE EFFECTS ARE THE SAME AS NORMAL ENDOGENOUS INSULIN RESTORES THE DIABETIC PATIENT’S ABILITY TO: METABOLIZE CARBOHYDRATES, FATS, AND PROTEINS STORE GLUCOSE IN THE LIVER CONVERT GLYCOGEN TO FAT STORES INSULINS Copyright © 2014 by Mosby, an imprint of Elsevier Inc.7

HUMAN INSULIN DERIVED USING RECOMBINANT DNA TECHNOLOGIES RECOMBINANT INSULIN PRODUCED BY BACTERIA AND YEAST GOAL: TIGHT GLUCOSE CONTROL TO REDUCE THE INCIDENCE OF LONG-TERM COMPLICATIONS INSULINS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.8

RAPID-ACTING MOST RAPID ONSET OF ACTION (5 TO 15 MINUTES) SHORTER DURATION PATIENT MUST EAT A MEAL AFTER INJECTION INSULIN LISPRO (HUMALOG) SIMILAR ACTION TO ENDOGENOUS INSULIN INSULIN ASPART (NOVOLOG) INSULIN GLULISINE (APIDRA) MAY BE GIVEN SUBCUTANEOUSLY OR VIA CONTINUOUS SUBCUTANEOUS INFUSION PUMP (BUT NOT IV) INSULINS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.9

SHORT-ACTING REGULAR INSULIN (HUMULIN R) ONSET 30 TO 60 MINUTES THE ONLY INSULIN PRODUCT THAT CAN BE GIVEN BY IV BOLUS, IV INFUSION, OR EVEN IM INSULINS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.10

INTERMEDIATE-ACTING INSULIN ISOPHANE SUSPENSION (ALSO CALLED NPH) CLOUDY APPEARANCE SLOWER IN ONSET AND MORE PROLONGED IN DURATION THAN ENDOGENOUS INSULIN INSULINS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.11

LONG-ACTING GLARGINE (LANTUS), DETEMIR (LEVEMIR) CLEAR, COLORLESS SOLUTION USUALLY DOSED ONCE DAILY REFERRED TO AS BASAL INSULIN INSULINS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.12

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.13

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.14

SUBCUTANEOUS SHORT-ACTING OR REGULAR INSULIN DOSES ADJUSTED ACCORDING TO BLOOD GLUCOSE TEST RESULTS TYPICALLY USED IN HOSPITALIZED DIABETIC PATIENTS OR THOSE ON TOTAL PARENTERAL NUTRITION (TPN) OR ENTERAL TUBE FEEDINGS SUBCUTANEOUS INSULIN IS ORDERED IN AN AMOUNT THAT INCREASES AS THE BLOOD GLUCOSE INCREASES DISADVANTAGE: DELAYS INSULIN ADMINISTRATION UNTIL HYPERGLYCEMIA OCCURS; RESULTS IN LARGE SWINGS IN GLUCOSE CONTROL SLIDING-SCALE INSULIN DOSING Copyright © 2014 by Mosby, an imprint of Elsevier Inc.15

ORAL FORMS OF CONCENTRATED GLUCOSE BUCCAL TABLETS, SEMISOLID GEL 50% DEXTROSE IN WATER (D 50 W) GLUCAGON GLUCOSE-ELEVATING DRUGS Copyright © 2014 by Mosby, an imprint of Elsevier Inc.16

WHEN INSULIN IS ORDERED, ENSURE: CORRECT ROUTE CORRECT TYPE OF INSULIN TIMING OF THE DOSE CORRECT DOSAGE INSULIN ORDER AND PREPARED DOSAGES ARE SECOND-CHECKED WITH ANOTHER NURSE Copyright © 2014 by Mosby, an imprint of Elsevier Inc.17 NURSING IMPLICATIONS (CONT’D)

INSULIN CHECK BLOOD GLUCOSE LEVEL BEFORE GIVING INSULIN ROLL VIALS BETWEEN HANDS INSTEAD OF SHAKING THEM TO MIX SUSPENSIONS ENSURE CORRECT STORAGE OF INSULIN VIALS ONLY USE INSULIN SYRINGES, CALIBRATED IN UNITS, TO MEASURE AND GIVE INSULIN ENSURE CORRECT TIMING OF INSULIN DOSE WITH MEALS NURSING IMPLICATIONS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.18

INSULIN (CONT’D) WHEN DRAWING UP TWO TYPES OF INSULIN IN ONE SYRINGE, ALWAYS WITHDRAW THE REGULAR OR RAPID-ACTING INSULIN FIRST (CLEAR) PROVIDE THOROUGH PATIENT EDUCATION REGARDING SELF-ADMINISTRATION OF INSULIN INJECTIONS, INCLUDING TIMING OF DOSES, MONITORING BLOOD GLUCOSE LEVELS, AND INJECTION SITE ROTATIONS NURSING IMPLICATIONS (CONT’D) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.19