RN

Understanding Insulin Administration

By Lindsey Ryan, MSN, RN, CCRN-K, ACNS-BC, Contributor


It is well known that the prevalence of diabetes is rapidly escalating throughout the United States. From 1980 through 2014, the number of Americans diagnosed with diabetes increased from 5.5 million to 22.0 million (CDC, 2015). Of those diagnosed with diabetes, approximately 85% reported taking medication, either pills or insulin (CDC, 2013). Currently there are more than 20 varieties of insulin sold in the United States (ADA, n.d.). While it can be difficult to memorize the pharmacodynamic properties of each insulin, they can be broken down into categories by their “action” to aid in recollection. Below is a table outlining many of the frequently administered insulins:

Insulin Chart: Types of Insulin

INSULIN ADMINISTRATION

Insulin Syringes
Traditionally insulin had been administered with a single use, 100-unit syringe. Now that insulin is available in 500-unit vials, it is critical to ensure the appropriate syringe is being used. If applicable, combining the short- or rapid-acting, and long-acting insulins may be necessary. This is an important procedure and requires close attention to prevent an error from occurring:

Insulin Administration Process Chart

Insulin Pens
Some insulin products come in the shape of a writing pen and are typically less painful than a typical syringe. There are two different types of insulin pens: The first contains a refillable cartridge of insulin and the second contains a pre-filled cartridge which is discarded completely once empty. Each pen is filled with only one type of insulin, therefore two separate injections must be given if two types of insulin are required. To use the device, the dose of insulin is dialed on the pen, and the insulin is injected through a needle, much like using a syringe (ADA, 2015A).


Insulin Pumps
Insulin pumps deliver rapid- or short-acting insulin throughout the day via a subcutaneous catheter (ADA, 2015B). The insulin doses are separated into:
• Basal rates
• Bolus doses to cover carbohydrate in meals
• Correction or supplemental doses

Insulin pumps have many benefits including accurate delivery of programmed doses, more stable blood glucose levels improving HbA1C, less pain related to injections, and the ability to exercise without having to carb load upfront.

NOTE: It is important to review your facility’s policies and procedures to become familiar with your role in caring for a patient with an insulin pump.

Verification
Prior to administering insulin (regardless of delivery method) it is critical to have a colleague perform an independent double check. Multiple studies have validated the effectiveness that independent double checks can play, detecting up to 95% of errors (ISMP, 2013). An independent double check requires that two RNs separately check each component of the work process. Two RNs are unlikely to make the same mistake if they work independently. If they collaborate or affect the review process by influencing what the checker should find, an error could be overlooked. In other words, holding up a syringe and a vial in front of a colleague and saying, “This is 8 units of insulin, do you agree?” is not of value. The primary RN asking for verification must not influence the second RN in any way (ISMP, 2013).

CONCLUSION
Caring for a diabetic patient can be complex, and at times, overwhelming. Becoming familiar with institutional policies and utilizing your resources will help get you started in delivering safe, effective care. For more information check out the American Diabetes Association at http://www.diabetes.org.

For more information on diabetes check out these courses on RN.com: Diabetes: Overview, Diagnosis & Management for Healthcare Professionals or Management of Type 2 Diabetes & the Role of the Certified Diabetic Educator



References:
American Diabetes Association (ADA). (n.d). Insulin and Other Injectables. Retrieved from
http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/

American Diabetes Association (ADA). (2015A). Insulin Routines. Retrieved from
http://www.diabetes.org/living-with- diabetes/treatment-and-care/medication/insulin/insulin-routines.html

American Diabetes Association (ADA). (2015B). How do Insulin Pumps Work? Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/how-do-insulin-pumps-work.html?referrer=http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/

Centers for Disease Control (CDC). (2015). Number (in Millions) of Civilian, Non-Institutionalized Persons with Diagnosed Diabetes, United States, 1980-2014. Retrieved from http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm

Centers for Disease Control (CDC). (2013). Crude and Age-Adjusted Percentage of Adults with Diabetes Using Any Diabetes Medication, United States, 1997–2011. Retrieved from http://www.cdc.gov/diabetes/statistics/meduse/fig3.htm

Institute for Safe Medication Practices (ISMP). (June 13, 2013). Acute Care ISMP Medication Safety Alert, Independent Double Checks: Undervalued and Misused: Selective Use Of This Strategy Can Play An Important Role In Medication Safety. Retrieved from https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=51

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Biography:
Lindsey Ryan graduated from Point Loma Nazarene University in San Diego, California with both her BSN and MSN. Lindsey’s clinical experience ranges from Acute to Critical Care where she has functioned in the roles of frontline staff and CNS. Most recently, Lindsey has been responsible for leading efforts associated with new knowledge and innovation including interdisciplinary quality initiatives, evidence-based practice projects and clinical research. Lindsey is a member of the American Association of Critical Care Nurses (AACN) and National Association of Clinical Nurse Specialists (NACNS).