Alright. In this video, we are going to start our coverage of endocrine system medications.
If you are following along with cards, I'm on card 99, which covers insulin, and there's a
lot to talk about when it comes to insulin, so this video will be dedicated to just insulin.
Insulin can be used by both type 1 and type 2 diabetic patients.
When we get into oral antidiabetic medications, those are just for type 2 diabetic patients.
There are four types of insulin to be familiar with. We have rapid-acting, short-acting,
intermediate-acting as well as long-acting. Alright, so let's start with our rapid-acting
insulins which include insulin lispro, or Humalog as well as insulin aspart, or Novolog.
These medications have a very rapid onset. So onset is going to be 15 minutes,
peak is going to happen around an hour, and duration occurs around 2 to 4 hours.
In terms of how I remember that these insulins that end in -log are rapid-acting
is I think of a log rolling rapidly down a hill. If you're going to give a patient a rapid-acting
insulin, you want to make sure their meal tray is right in front of them to prevent hypoglycemia.
Alright. Let's talk about short-acting insulins which include regular insulin,
which is Humulin R or Novolin R. These medications have a slighter longer
onset of action, so onset is about 30 minutes. Peak occurs around 2 to 3 hours,
and duration occurs between 3 and 6 hours. If you're going to give a patient some regular
insulin, you want to make sure those meal trays are at least on the floor.
It doesn't necessarily need to be in front of the patient, but you need to make sure
that meal's going to be delivered fairly soon - okay? - so we don't end up with hypoglycemia.
Then we have our intermediate-acting insulin, which is NPH.
So NPH has an onset of 2 to 4 hours. It has a peak between 4 and 12 hours and a duration
between 12 and 18 hours. So the way I remember
NPH is that Neil Patrick Harris, who's a famous actor, his initials are NPH,
and let's say that Neil Patrick Harris, he is of intermediate height, and he's a very hard-working
actor, so if you call him, he will be on set between 2 to 4 hours. He comes very quickly,
and he stays a pretty long time, too. He will stay up to 18 hours because he's so hard-working.
Okay. And then, lastly, we have our long-acting insulins, which include insulin glargine,
which is Lantus, or insulin detemir, which is Levemir. These medications have an onset
between 3 and 4 hours. There is no peak with these medications, and the duration is about 24 hours.
So the way I remember that insulin glargine is long-acting, I think of a comfy pair of jeans,
and they're so comfy that I want to wear them for 24 hours.
Okay. Let's talk about some important key points when it comes to insulin administration.
When you're administering insulin, you want to make sure that you rotate sites
to help prevent lipohypertrophy, which is the scar tissue you get if you inject that
insulin in the same spot over and over again. Also, the key adverse effect is hypoglycemia.
So if we bring down our sugar levels too low, we can end up with signs and symptoms
such as tachycardia, diaphoresis, shakiness, headache, and weakness. So we are definitely
going to want to monitor our patient for those signs and symptoms and also make them aware
of those signs and symptoms as well when the discharge from the hospital.
Other teaching, your patient may need extra doses of insulin during times of illness
or stress. They definitely should not skip their insulin when they're sick,
they actually might need a higher dose in order to adequately control their blood sugar levels.
If your patient does experience hypoglycemia and they are fully conscious, then you can provide
them with some orange juice or milk, basically something that contains about 15 grams of glucose.
So this could be like four ounces of juice or about eight ounces of milk.
If your patient is not fully conscious, then it is not safe to give them orange juice to drink.
You will need to administer glucagon, which we will be covering in a future video here.
Then, if you are trying to mix insulins - if you are mixing a short-acting insulin with,
say, an intermediate insulin, such as NPH - you always want to draw up clear before cloudy.
So how this works is, is you're going to inject air into the cloudy insulin,
okay? Remove your needle. Inject air into the clear, shorter-acting insulin.
Don't remove your needle. Draw up your short-acting insulin, which is your clear insulin,
and then come back over here and draw up your cloudy insulin. So those are the steps. We're
drawing up the clear before the cloudy. Another tip for remembering what you draw
up first is to think of registered nurse, or RN. You're drawing up regular before drawing up NPH.
So for insulin suspensions, you want to make sure you gently rotate the vial before administration.
And if a short-acting insulin looks cloudy or discolored, you're going to want to dispose of it.
So that is it for insulin. I know it's a lot of information. We will get into oral
antidiabetic medications in my next video. Thanks so much for watching!