Components And Importance Of Insulin Medication: Diabetes Care In The Hospital

Components of Insulin Medication

Components of insulin medication

1. date and the time when the order is written
2. name of the drug
3. dosage of drug
4. dosage strength
5. dosage form
6. route of administration of the drug
7. The angle of the injection
8. Frequency and duration of drug administration
9. Duration of therapy
10. Indication for use
11. Signature of physician

Importance of these components

• To avoid any confusion related to the drug administration
• To prevent the medication errors
• To provide the right medication to the right patient  (Steineck, Cederholm, Eliasson, Rawshani, Eeg-Olofsson, Svensson, & Gudbjörnsdóttir, 2015)

As discussed in the case study that the patient admitted to the emergency department due to severe hypoglycaemia which occurs due to imbalanced insulin or insulin resistant. Aspart injected subcutaneously helps to decrease the blood glucose level and takes only 10 to 20 minutes to act after injected. Lantus Solostar is the long acting medicine that starts to work several hours after delivering and it keeps working for around 24 hours. The two medicines help to act immediately and exhibit long lasting effects. Therefore prescribing these medicines to Bens was a good idea.

Diabetes type 1 is the result of autoimmune destruction of beta cells that produce insulin in the pancreas. Insulin Aspart binds to the beta subunits consisting of receptors on the fat and muscle cells and inhibits the secretion of glucose out of the liver. The primary action of insulin Glargine (Lantus) is regulating glucose metabolism. It lowers blood glucose levels by triggering peripheral glucose uptake by muscles and inhibiting the hepatic glucose uptake. (Haidar, Elleri, Kumareswaran, Leelarathna, Allen, Caldwell, & Dunger, 2013) 

The onset of action of Aspart insulin occurs within ten to twenty minutes of injection. The duration of action of is three to five hours. Peak time is 15 minutes. This insulin should be administered after or shortly before or shortly after eating to control the levels of blood glucose after a meal. This is because the levels of insulin disturbed after meal. Taking Novorapid 15 to 20 minutes before eating can provide a significant improvement in after-meal control (Slattery, Amiel, & Choudhary, 2018)

Hypoglycaemia (low blood sugar) is the condition which occurs when insulin levels are high and glucose (sugar) levels are low in the blood. Causes of hypoglycaemia includes Excessive use of insulin or other medications that increase insulin levels, disturbed eating habits after taking medications, Skipping meals, Exercising vigorously without proper nutrition, and Excess consumption of alcohol when on medications, especially if it replaces food.

Symptoms

Symptoms of hypoglycaemia includes Excessive sweating, Shakiness, Dizziness, Moodiness and irritability, Drowsiness, and Confusion (Kalra, Mukherjee, Venkataraman,  Bantwal, Shaikh, Saboo, & Ramachandran, 2013).

Treatment

The patient with hypoglycaemia needs to eat or drink juices or fruits that can rise blood sugar level immediately for example, sugar tablets, fruit juice and carbohydrate snack. In severe case of hypoglycaemia the patient may be prescribed glucagon hormone. (International Hypoglycaemia Study Group, 2015). 

Understanding the medication before administration is very important for every nurse or register nurse to avoid any medication errors like wrong medicine, wrong doses, wrong time, route of administration and concentration. Understanding the medication also helps the nurse to have information about the possible side effects of a particular medication and any allergies that the patient has related to a specific type of medicine (Athanasakis, 2015).

The five rights of medication administration include

1. The right patient
2. Right time
3. Right Dose
4. The right route of administration
5. Right drug

Why it is important to follow these rights

• The right drug at right time with right doses helps to achieve the goal already set for the patient. Avoiding these rights may cause health issues and the patient might take legal issues against the health provider (Kim & Bates, 2013).  

The insulin pen needle size should be used in case of Ben is 4 mm which is the standard length. It was also found that needles with long size cause more pain to compare to short needles. 4 mm needle is enough to deliver the drug in subcutaneous tissues of the body and fear might be there when administrating the medication (Frid, Kreugel, Grassi, Halimi, Hicks, Hirsch, & Kalra, 2016).

Importance of These Components

Nursing Assessment

• The patient should be examined for any allergy to insulin Novorapid or any other contents of this medicine. Because the allergies can impact the beneficial effects of the medicine (American Diabetes Association, 2016).
• A nurse should use new needle, already used needle may spread infection (Heise, Hövelmann, Brøndsted, Adrian, Nosek, & Haahr, 2015).

The best site for injecting Novorapid is abdomen in case of Ben because this part of the body is easy to reach and the insulin is absorbed more quickly. The skin should be folded 1 or 2 inches to reduce the risk of reaching the injection to muscles. The medicine should be injected at 90-degree angle as it is the easiest angle to inject in the folded skin and ben may feel less pain in this way (Frid, Kreugel, Grassi, Halimi, Hicks, Hirsch, & Kalra, 2016).  

The documentation should be done inpatient data sheet or EMAR (electronic medication administration record) and it will include information of:

• The timing of injection and understanding of insulin action
• Site for injection
• Needle length
• Correct dose selection
• Evidence of damaged injection site with size and location of damage
• Issues like physical deficit or psychological issues
• And any side effects

Keeping records is necessary to ensure that the right medicine has been administered to the right patient art right time and in a prescribed quantity (Australian Commission on Safety and Quality in Health Care, 2014).

• After administration insulin to ben nurse should examine the blood glucose level. This is because checking the levels confirms that the medication worked for him
• Ben should be checked for blood ketone level to ensure that the ketone levels are controlled.
• He should also be assessed for any side effects (Adhikari, Poudel, Rajbanshi, & Shrestha, 2018)

• The patient may feel continue fatigue and this may result in a lack of exercise
• He may also have gastroparesis which means delayed emptying the food material from the stomach. This may leads to bloating, nausea, heartburn.  
• Kidneys damage may also occur over time due to reduced blood filtration.
• Decreased blood flow to the routine can cause eye damage or blindness (Freeborn, Dyches, Roper, & Mandleco, 2013).

• The patient may feel tired due to regular testing of blood glucose
• Ben may also face a problem in remembering to take the medication on time
• Stress may be there
• Sometimes the patients develop “why me” thoughts and feeling alone with their diabetes
• He likes to play football, being tired due to fatigue may not allow him to do exercise and this may affect him.
• Diabetes may also cause behavioral changes (Nicolucci, Kovacs Burns, Holt, Comaschi, Hermanns, Ishii, & Tarkun, 2013).

References:

Adhikari, S., Poudel, R. S., Rajbanshi, L., & Shrestha, S. (2018). Assessment of Insulin Injection Practice of Nurses Working in a Tertiary Healthcare Center of Nepal. Nursing Research and Practice, 2018. 6

American Diabetes Association. (2016). 13. Diabetes care in the hospital. Diabetes Care, 39(1), S99-S104.

Athanasakis, E. (2015). The method of checking medications prior to administration: an evidence review. International Journal of Caring Sciences, 8(3), 801.

Australian Commission on Safety and Quality in Health Care (2014). User guide for nursing and care staff. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/SAQ123_NursesUserGuide_V6.pdf

Freeborn, D., Dyches, T., Roper, S. O., & Mandleco, B. (2013). Identifying the challenges of living with type 1 diabetes: child and youth perspectives. Journal of clinical nursing, 22(13-14), 1890-1898.

Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., & Kalra, S. (2016). New insulin delivery recommendations. In Mayo Clinic Proceedings, 91(9), 1231-1255

Haidar, A., Elleri, D., Kumareswaran, K., Leelarathna, L., Allen, J. M., Caldwell, K., & Dunger, D. B. (2013). Pharmacokinetics of insulin Aspart in pump-treated subjects with type 1 diabetes: reproducibility and effect of age, weight, and duration of diabetes. Diabetes Care, 36(10), e173-e174.

Heise, T., Hövelmann, U., Brøndsted, L., Adrian, C. L., Nosek, L., & Haahr, H. (2015). Faster?acting insulin Aspart: earlier onset of appearance and greater early pharmacokinetic and pharmacodynamics effects than insulin Aspart. Diabetes, Obesity and Metabolism, 17(7), 682-688.

Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.

Nicolucci, A., Kovacs Burns, K., Holt, R. I., Comaschi, M., Hermanns, N., Ishii, H., & Tarkun, I. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking of diabetes?related psychosocial outcomes for people with diabetes. Diabetic medicine, 30(7), 767-777.

Slattery, D., Amiel, S. A., & Choudhary, P. (2018). The optimal prandial timing of bolus insulin in diabetes management: a review. Diabetic Medicine, 35(3), 306-316.

Steineck, I., Cederholm, J., Eliasson, B., Rawshani, A., Eeg-Olofsson, K., Svensson, A. M., & Gudbjörnsdóttir, S. (2015). Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18 168 people with type 1 diabetes: observational study. BMJ, 350, h3234.

International Hypoglycaemia Study Group. (2015). Minimizing hypoglycemia in diabetes. Diabetes Care, 38(8), 1583-1591.

Kalra, S., Mukherjee, J. J., Venkataraman, S., Bantwal, G., Shaikh, S., Saboo, B.,  & Ramachandran, A. (2013). Hypoglycemia: The neglected complication. Indian journal of endocrinology and metabolism, 17(5), 819.