two Qs about administering insulin

[neurontin]

Actually there are three questions.

1. Does a nurse administer room temperature insulin only?

2. Is it because that regular insulin is clear so that it can be administered IV?

3. The reason why lipidatrophy occurs is because of cold insulin or because of not rotating the injection site?

Thanks in advance!

[ktliz]

I'm just a student nurse so I can't confidently answer your questions... but I do know that that was THREE Qs, not 2. :)

Edit: Doh! I'm an idiot. You said that in your post.

[RNBearColumbus, BSN]

1:Yes. Insulin should be administered at room temperature, to make the injections more comfortable for the patient. (Unopened insulin vials should still be stored in the refrigerator, while opened insulin can be stored at room temperature for up to 28 days after being opened.)

2: Not sure that the color has anything to do with any thing as far as IV administration. Short acting insulins are clear, while long acting ( ex: 70/30) are cloudy.

3: Lipid atrophy could be caused by not rotating the injection site.

[Nurse Fancypants]

2: Not sure that the color has anything to do with any thing as far as IV administration. Short acting insulins are clear, while long acting ( ex: 70/30) are cloudy.

This is true to some degree, however, Lantus (long acting insulin) is clear.

[RNBearColumbus, BSN]

True, as is Levamir. (Neither of which should be mixed with any other type of insulin.)

[RN58186]

1. Insulin can be given straight out of the fridge but trust me it hurts. Even more so for some of the newer insulins like Lantus (different pH)

2. I was taught (back in the dark ages when I was in Nsg School) that only regular insulin is given IV because it's action is more predictable and easier to monitor for.

3. Lipodystrophy comes from not rotating sites. That's why I was taught (again, back in the dark ages) to inject insulin in places where pts couldn't give it to themselves (such as in the back below the shoulder blades) as long as there is enough sc tissue to inject it into.

[agldragonRN]

actually there are three questions.

1. does a nurse administer room temperature insulin only?

2. is it because that regular insulin is clear so that it can be administered iv?

3. the reason why lipidatrophy occurs is because of cold insulin or because of not rotating the injection site?

thanks in advance!

1. yes. cold insulin hurts!

2. good question. i forgot what my teacher said why only regular insulin can be given iv. fyi, there are many clear insulins that cannot be given iv, such as, lantus, novolog, levemir, etc...

3. yes not rotating sites.

fyi, if you have a patient that has a really high blood sugar, you may want to give the insulin in the abdomen (sub-q) because it is absorbed faster there therefore lowering the bs faster.

[Esme12, ASN, BSN, RN]

general advice on insulins

• parenteral insulins
  
• regular insulin is for subcutaneous, im, or iv administration only. not for intradermal, intra-arterial, or oral administration.
  
• long-acting insulins are for subcutaneous administration only. not for intradermal, im, iv, intra-arterial, or oral administration.
  
• administer direct subcutaneous injections into abdominal wall, thigh, or deltoid. rotate injection sites within same region.
  
• do not use regular insulin if cloudy, thickened, discolored, or contains particulate matter.
  
• do not use long-acting insulin if white material (insulin) remains at bottom of bottle after mixing or if there are clumps.
  
• if mixing regular insulin with long-acting insulin, draw regular insulin into syringe first.
  
• if using insulin pen, mix contents by rolling between the palms 10 times then inverting 180° 10 times, then prime the pen before each dose. do not administer if white material (insulin) remains visibly separated from the liquid after mixing, if clumps are noted, or if solid white particles stick to walls of cartridge.
  

storage/stability

parenteral insulins

store in refrigerator (36° to 46°f). protect from freezing. discard insulin that has been frozen. if refrigeration is not possible, store unrefrigerated at temperature below 86°f, away from heat and light for 1 mo. store unopened pens in refrigerator. store in-use pens at room temperature away from heat and light do not refrigerate. discard in-use pen after 10 days, even if pen still contains insulin.

drug interactions

ace inhibitors, anabolic steroids, clofibrate, disopyramide, fibrates, fluoxetine, guanethidine, maois, oral antidiabetics, propoxyphene, salicylates, sulfinpyrazone, sulfonamide antibiotics, tetracyclines

may increase hypoglycemic effects of insulin.

alcohol, beta-blockers, clonidine, lithium salts

may increase or decrease the blood glucose-lowering effect of insulin.

atypical antipsychotics, corticosteroids, danazol, diazoxide, diltiazem, glucagon, isoniazid, oral contraceptives, phenothiazines, protease inhibitors, somatropin, sympathomimetics, thyroid hormone

may decrease hypoglycemic effects of insulin.

beta-blockers, clonidine, guanethidine, reserpine

signs and symptoms of hypoglycemia may be reduced or absent.

pentamidine

may cause hypoglycemia, which may be followed by hyperglycemia.

http://www.globalrph.com/rapid-acting-analogues.htm

http://pi.lilly.com/us/humalog-pen-pi.pdf

http://dermnetnz.org/dermal-infiltrative/lipodystrophy.html

.....:)

[xtxrn, ASN, RN]

General Advice on insulins

Parenteral insulins

Store in refrigerator (36° to 46°F). Protect from freezing. Discard insulin that has been frozen. If refrigeration is not possible, store unrefrigerated at temperature below 86°F, away from heat and light for 1 mo. Store unopened pens in refrigerator. Store in-use pens at room temperature away from heat and light Do not refrigerate. Discard in-use pen after 10 days, even if pen still contains insulin.

.....:)

Some pens are good for 28 days after opening (Lantus and NovoLog.... the package inserts will indicate specifics for each insulin). :)

[Rob72, ASN, RN]

Regular insulin is the only (pre-recombinant)insulin that will not substantially precipitate due to passage through the IV tubing, and has a duration that lends itself to administration in solution.

I.e., Humalog/Novalog are only suitable for subQ pump infusion, and the ultra-long actings (while they might sustain in solution) have such long duration that individual metabolism, site patency, etc., makes them unsuitable. I believe they also precipitate, tho'.

[mqnurse36]

My facility stores all of our insulin in the refrig. I dont like it but its policy. As soon as I get into work I take it out of the refrig and let it sit for an hour before using it.

[Aurora77]

Insulin right out of the fridge hurts? How on earth did I not know that? Two years of nursing school and 4 months on the job and I've never heard that. Does it warm up relatively quickly when it's drawn up? I hate to think I've been hurting my patients unneccessarily.