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!

[Esme12, ASN, BSN, RN]

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.

Oh Lord....it doesn't "hurt " in the true sense of the word but they can feel the temperature difference and it's an odd feeling. Now potassium IV HURTS!

[txredheadnurse, BSN, RN]

A practical reason to store opened insulin at room temperature in the carts is increased efficiency during med passes. Constantly having to lock the cart, enter the med room, draw up the appropriate sliding scale doses or even routine doses, return syringe(s) to the cart multiplied by however many insulin injections adds a lot of time to a med pass. I recently pointed this out to a facility and the floor nurses were blown away when I showed them just how much time it took for them to each give 6 doses of insulin from the med room fridge. In addition they were working under the misunderstanding that refrigerating opened insulin prolonged its shelf life but it does not (per manufacturers recommendations).

[blondy2061h, MSN, RN]

Any insulin when given IV works instantly because all other insulins require subq injection to gain their long action. Therefore, but only allowing regular IV not benefit is lost, confusion is stopped (ie, someone giving Lantus IV not realizing it will have an action like Regular), and cost is saved since Regular is cheap. A newer insulin, Apidra, is also approved for IV use, but my understanding is that there is no advantage.

[Aurora77]

Oh Lord....it doesn't "hurt " in the true sense of the word but they can feel the temperature difference and it's an odd feeling. Now potassium IV HURTS!

Now that you put it that way, it seems really obvious. I just hadn't thought about the difference b/t the insulin temp and body temp. Thanks!

I did know about potassium. I've done the "play with fluid rates" dance to try to get the potassium in while not making my pt miserable. We even went so far as to get lidocaine into the bags of K for one pt--she just couldn't tolerate the K IV at all.

[SweetseRN]

I thought that since insulin is now made by recombinant DNA technology, and no longer comes from pork or beef, there is no longer much concern about lipidatrophy. I would still rotate sites just because but I don't believe it's as important as it used to be. Correct me if I am wrong.