Diabetes & Introduction to Parenteral Medications Teresa Stone, 2004

Diabetes & Introduction to Parenteral Medications Teresa Stone, 2004 Diabetes Blood Glucose Monitoring Insulin

Diabetes Type I & Type II • Most common metabolic disorder • Currently no cure • Either pancreas produces no insulin or very little • Also body may be insulin resistant (loss of sensitivity of receptor sites)

Hyperglycemia • High blood sugar > 10.0 mmol/L • Usual gradual onset • Fruity breath with ketosis • Slow & sluggish

Signs & Symptoms • Fatigue & Lethargy- unable to use glucose • Polyuria – kidneys • Irritable & pruritis • Glycosuria – as unable to reabsorb • Polyphagia (hunger) - sense of starvation • Polydipsia (thirst) - blood tonicity & fluid loss • Ketosis – fat metabolism

Hypoglycemia • Below 4.0 mmol/L • S & S related to parasympathetic stimulation & sympathetic response • Hunger, nausea, sweating, weakness, headache, confusion, shaking, irritability • Can be sudden onset – appear drunk

Blood Glucose Monitoring • Before meals or 2 hrs after meals • Normal range 3.9 – 6.1 mmol/L ac • < 7.8 mmol/L 1-2 hr pc • Capillary sample • Quick & easy • Monitors progress of treatment

Specimen Collection • Wash site with soap & water • Warm hand and dangle arm • Lance side of finger or heel • Stroke finger from base to tip • Choose a new site

Documentation • Date & time of blood specimen • Results of Blood glucose reading • On diabetic record with insulin

BGM Care Standards • For all clients with diagnosis of diabetes • Values 2.2 or < , and 19.4 or > contact lab for stat serum glucose • Compare values • Assess, report to physician • Treat hypoglycemia!

Hypoglycemia Treatment Protocol • Mild to moderate 2.8-3.9 treat (3). • Retest in 15 min. Retreat (1) if < 4.0 • Severe conscious < 2.8 treat (4) and retest as before. Retreat (1) if <4.0. • Severe unconscious < 2.8 Need IV glucose • Assess possible cause & discuss with Dr.

Insulin – What is it & Why do we need it? • A hormone to promote storage of glucose • Replacement insulin required by those with diabetes mellitus • Must be given by injection • Various available with differing onsets, peaks & durations

Types of Insulin

Methods of Administration - How? • Subcutaneous injection • Insulin jet injector • Insulin Pen • Insulin pump • Long acting insulin • Transdermal (coming) • Inhalant (coming) • IV

Injection of a medication into body tissues Invasive procedure Must use aseptic technique Variety of syringes & needles Methods Subcutaneous Intramuscular Intravenous Intradermal What are Parenteral Medications?

Safe Practice with Injections • Do not recap used needle (or one hand method) • Take sharps disposal receptacle to bedside • Aseptic technique • Never force a needle into a full receptacle • Use of clean gloves

Syringe Barrel with tip Plunger .5 – 50 ml 2-3 ml usual for SQ Needles Hub, Shaft & Bevel Gauge 29 – 19 Depends upon viscosity of fluid Vary in length 3/8-5/8” for SQ Syringes & Needles

Needle gauge- 27-29 Unique as in units U -100 = 100 units/1 ml U 100 strength insulin May have luer lok or attached needle Needle length - ½ depth of skin fold Insulin Syringes

Insulin facts • Good for 28 days after opening • Store in refrigerator • Room temp for administration • Temp extremes Loss of potency • Dose adjusted according to BG • Lantus not to be mixed with other insulins

Routine BID, QID, ac or with meal Regular plus sliding scale Sliding Scale Short acting according to BG result Typical Orders

Sliding scale • Monitor BG QID • Humulin R or Toronto • Low, normal & high scale • Example of part of high scale

Drawing up your dose • Select correct syringe • Cleanse stopper • Inject air same volume as medication • Withdraw correct volume • Always double check dose with RN – college policy

Mixing Insulin • Examine vials R should be clear, N will be cloudy but not clumpy. • Gently rotate vials • Should be at room temperature • Always mix clear to cloudy • Clear air from syringe before injection • Have accurate number of units of each insulin

Mixing Insulin

Absorption best in abdomen, arm & thigh Site rotation To aspirate or not to aspirate? Inject slowly Do not massage area after injection Injection Sites

Injecting • Inject dart like for best insertion • Pinch up tissue or pull flat • 45 or 90 degree angle

Subcutaneous injection • 45 degrees if needle > than ½ inch • 90 degrees if < ½“ • Between muscle- skin Into fat + connective tissue • Avoid inflammation, edema, lesions, irritations, marks, impaired coagulation

The fold/hold of skin • Pick up skin • Don’t take muscle • Keep hold until finished injecting • Heparin – don’t move needle

Insulin Pens & Jet Injectors • Easy to use and less discomfort • Decrease risk of error in dose • Must roll pen with intermediate acting insulin • Just dial dose & inject!

Insulin Pumps • Can deliver basal & bolus • Mimics natural release of insulin • Better control for some • Flexible for lifestyle • Still must monitor BG

Documentation • June 30/04 Mrs. Sweet Thang • 0740 - CBG 5.8mmol/L - TS RN • 0745 -Humulin N 23 units with Humulin R 10 units s/c R upper arm - TS RN • Utilize documentation record.

Diabetes & Introduction to Parenteral Medications Teresa Stone, 2004