Diabetes Mellitus and Insulin

• Diseases characterized by high blood glucose, or hyperglycemia, are known as Diabetes Mellitus.

Types of Diabetes

• Type 1 diabetes means the body does not produce insulin.
• Type 2 diabetes means the body does not use insulin properly, resulting in insulin resistance.
• Initially with type 2 diabetes, the pancreas compensates by producing more insulin.
• Over time with type 2 diabetes, insulin production declines, leading to high blood glucose levels.

Insulin Basics

• U-100 insulin concentration is 100 units per mL solution.
• Insulin is a naturally occurring hormone secreted by the pancreas.
• Insulin transports glucose from the bloodstream into cells for energy.
• Insulin therapy is required when the body does not produce insulin (Type 1 diabetes) or does not effectively use insulin (advanced Type 2 diabetes).

Types of Insulin

• Onset is the time before insulin starts lowering blood glucose.
• Peak tells us when insulin is at its maximum strength.
• Duration indicates how long insulin remains effective in lowering blood glucose.

Rapid-Acting Insulin

• Onset: 15 minutes
• Peak: ~1 hour
• Duration: 2-4 hours
• Examples include insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog), with Humalog and NovoLog being MOST used.

Short-Acting (Regular) Insulin

• Onset: 30 minutes
• Peak: 2-3 hours
• Duration: 3-6 hours
• Examples include Humulin R and Novolin R.
• Regular insulin is the only insulin that can be given intravenously (IV).

Intermediate-Acting Insulin

• Onset: 2-4 hours
• Peak: 4-12 hours
• Duration: 12-18 hours
• Examples include NPH (Humulin N, Novolin N).

Long-Acting Insulin

• Onset: Several hours
• Duration: 24 hours (steady effect)
• Examples include insulin detemir (Levemir) and insulin glargine (Lantus).

Inhaled Insulin

• Onset: 12-15 minutes
• Peak: 30 minutes
• Duration: ~3 hours
• The technosphere insulin-inhalation system (Afrezza) is an example.

Afrezza

• Introduced in 2015 in the U.S.
• It is a rapid-acting insulin taken before meals.
• Afrezza is not a replacement for long-acting insulin.
• Type 1 diabetics must use it with long-acting insulin.

Insulin Combination Therapy

• Some patients require a mix of short-acting and intermediate-acting insulin for sustained glucose control.
• An example of pre-mixed insulin is 70/30 insulin (70% NPH, 30% regular insulin).
• Follow the "Clear to Cloudy" rule when mixing in one syringe: draw short-acting (clear) insulin first, then intermediate-acting (cloudy) insulin.

Insulin Pens

• Some insulin types come in pens for easier dosing.

Insulin Administration Principles

• Insulin is ordered in specific doses at set times.
• Sliding Scale Insulin (Correction Insulin): Adjusts insulin dose based on the patient's blood glucose level.
• Sliding Scale Insulin (Correction Insulin) is not a long-term solution but used for short-term corrections.

Blood Glucose Testing Methods

• A1C Test measures average blood glucose over 2-3 months.
• Fasting Plasma Glucose Test (FPG) checks blood glucose after an 8-hour fast.
• Random Plasma Glucose Test (FSBS) involves a blood glucose test taken at any time.

Important Considerations in Insulin Administration

• Do NOT mix insulin with any other medications or diluents unless approved by a provider.
• Do NOT mix long-acting insulins (Glargine (Lantus) or Detemir (Levemir)) with other insulin types.
• Administer rapid-acting insulin mixed with NPH within 15 minutes before a meal.
• Always verify insulin doses with another nurse when preparing the injection.
• Use the "Clear to Cloudy" rule when mixing insulins; NPH IS CLOUDY.