Why regular insulin iv

Regular insulin typically starts to work within 30 minutes to 1 hour of an injection. It takes about 2—4 hours before the medication reaches peak effectiveness, and the total effects should last for about 6—8 hours. The amount of insulin that a person takes can influence these estimates. A larger dosage may start to work more quickly but take longer to reach peak effectiveness. Regular insulin comes in three forms, and a doctor will advise about the best option, taking specific factors into account.

People injecting Humulin R or Novolin R should do so approximately 30 minutes before meals. This will give the insulin time to start working. Humulin R and Novolin R have similar dosages and instructions.

They come in concentrations of units per milliliter ml , and both are clear liquids. A person should only mix the intermediate acting insulin called neutral protamine Hagedorn — or NPH — with Humulin R or Novolin R if a doctor recommends it.

To inject the medication, a person draws their dose from the vial and administers the shot to their:. Rotating injection sites may help reduce the risk of lipodystrophy, which involves problems producing and maintaining healthy fat tissue. Regular insulin is available by IV, but a person should not attempt to self-administer it.

Receive IV insulin only under direct supervision at a medical facility. Low blood sugar is another common side effect of regular insulin, and anyone taking this treatment should be aware of the symptoms.

Low levels of potassium in the blood can cause weakness, muscle cramps, constipation , and tiredness , among other symptoms. A serious allergic reaction can cause a fast heartbeat, a rash that covers the body, trouble breathing, sweating, and a feeling of faintness, among other symptoms.

Some symptoms of severe low blood sugar include confusion or delirium, sleepiness, seizure, and loss of consciousness. Some symptoms of heart failure include swelling in feet and ankles, trouble breathing, and sudden weight gain. A person should receive medical attention for any of these severe symptoms.

In an emergency, call or seek immediate medical aid. Doctors also advise about other potential negative effects of regular insulin. Some of these warnings involve:. Lien Abstract The transition from intravenous IV to subcutaneous SQ insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care.

Introduction Intravenous IV insulin is used in the hospitalized patient to control blood sugars for patients with and without diabetes who may exhibit uncontrolled hyperglycemia or for those who need close glycemic attention.

Indications that It Is Not Safe to Transition from IV to SQ Insulin Problems that can be encountered in an IV to SQ transition fall into two major categories including discontinuing the infusion when it is not yet safe to occur or discontinuing at a safe time but making logistical errors that allow the transition to fail. Table 1. Examples of these situations include the following: The patient on several days of high-dose steroids.

Common examples of this include the management of transplant rejection bursts of high-dose solumedrol , managing CNS lesions and neurologic surgery high-dose decadron , and managing oncologic patients whose chemotherapy regimen includes steroids. Because of the high corticosteroid doses associated, as well as frequent adjustments in dosing, these cases are often safely managed with IV insulin for a limited period of time days.

In some of these cases, especially with transplant recipients, the patient may feel well enough to be consuming three meals daily. A patient in DKA with slowly resolving acidosis.

Many patients are kept NPO until this occurs, though some patients may be allowed to eat small meals if the process of gap closure is prolonged. Highly insulin-resistant patients. A patient with profound insulin resistance, seen now more commonly given the growing obesity and type 2 diabetes epidemic, may undergo an episode of HHS and require very high rates of IV insulin to re-attain glycemic control.

Significant insulin resistance is also frequently seen with acute episodes such as myocardial infarction or pancreatitis [27]. The patient may be able to consume PO intake even when rates of IV insulin are still so high that a direct IV to SQ transition could be considered dangerous i.

Examples of subcutaneous orders in addition to IV insulin for a patient who is eating include the following: Infuse IV regular Novolin or Humulin insulin. Hold if patient is NPO nothing by mouth [3]. Section 2: The Process of Transition Once it has been decided that it is indeed safe and appropriate to transition the patient from IV to SQ insulin, the actual process of transition must be planned and carried out systematically.

Proper Calculation of the Total Daily Insulin Requirement A safe transition requires careful analysis of the clinical situation of the patient in addition to a numerical assessment of IV insulin requirements.

The following circumstances need to be considered: Potential instability of the IV insulin infusion rates. For example, many patients who present with DKA or HHS will have extremely high rates in the first few hours on IV insulin, and then the rates will become variable, before finally settling down to a more stable pattern.

This is why it is recommended that a weight based weight based dose calculation be used in both of these clinical scenarios to optimize safety [11]. If a full 24 h of data is not available, a cautious evaluation of the patient and insulin use must be considered.

If one chooses to use less than 24 h of data, it is recommended that only basal requirements from the IV drip be used for transitioning.

It is generally not recommended to transition the patient when too few data are available; at least 6 h of data is seen as a minimum requirement [6,30,31].

Options may include adding prandial insulin to the IV drip for patients eating, considering extenuating factors such as corticosteroid dosing , and evaluating nursing adherence to the insulin drip protocol or mechanical problems with IV insulin infusion delivery. Therefore: The average rate during this time is 2. Therefore: Final order: 19 units of NPH insulin administered twice daily, once in the morning and once at bedtime Transition to Regular q 6 h From Table 2, the final h SQ insulin requirement was determined to be 38 units This can then be split up into 4 equal doses of SQ Regular insulin to cover the basal requirements Furnary and Braithwaite [6]; Clement [53] 38 divided by 4 equals approximately 10 units with rounding.

Next, to determine the prandial requirement, use a weight-based calculation Given the possibility of decreased appetite, a conservative estimate in this patient with DM-2 is 0.

Assistance with the Transition Process—Institution-Specific and Computer Protocols Given the complexity of IV insulin and the transition to SQ insulin as described above, there is growing interest in tools that can help the practitioner complete the process safely and effectively.

Institution-Specific Protocols One such protocol is described by Furnary and Braithwaite [6], with a particular focus on the care of cardiac and cardiothoracic surgery patients. Computerized Protocols Computerized protocols such as EndoTool [63, 64] and Glucommander [65] focus on glycemic management and adjustment of blood sugars while the patient is on an IV insulin infusion to achieve desired targets.

Review of the — Literature There is significant opportunity for knowledge expansion in the area of transitioning from IV to SQ insulin. Conclusions and Areas for Future Research With the expansion of computerized algorithms to direct clinical care, more research is needed into the development of computerized glucose control systems which can achieve more individualized patient transitions, i.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. Clinical practice. Management of hyperglycemia in the hospital setting.

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Glycemic control in the hospitalized patient: a comprehensive clinical guide. New York: Springer; Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. Implementing an intravenous insulin protocol in your practice: practical advice to overcome clinical, administrative, and financial barriers.

Semin Thorac Cardiovasc Surg. Effects of outcome on in-hospital transition from intravenous insulin infusion to subcutaneous therapy. Am J Cardiol. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.

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Transitioning postoperative cardiovascular surgery patients from intravenous to subcutaneous insulin: an improvement project. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. These guidelines approach IV management for the critically ill patient comprehensively, including the transition to SQ.

Understanding the needs of this population is essential for safe IV insulin transitions. Insulin infusion protocols for critically ill patients: a highlight of differences and similarities. Endocr Pract. Intravenous insulin infusion therapy: indications, methods, and transition to subcutaneous insulin therapy. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control.

Transition from intravenous to subcutaneous insulin: effectiveness and safety of a standardized protocol and predictors of outcome in patients with acute coronary syndrome. Rush university guidelines and protocols for the management of hyperglycemia in hospitalized patients: elimination of the sliding scale and improvement of glycemic control throughout the hospital.

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This article describes the safe use of NPH insulin a special population of patients. The use of NPH may be considered in patients who are requiring enteral tube feedings and can be dosed safely to match the tube feeding regimen. In-hospital management of type 2 diabetes mellitus. Med Clin N Am. Insulin therapy for the management of hyperglycemia in hospitalized patients. Endocrinol Metab Clin N Am.

A quadruplyasymmetric sigmoid to describe the insulin-glucose relationship during intravenous insulin infusion. J Healthc Eng. Pharmacy management of postoperative blood glucose in open heart surgery patients: evaluation of an intravenous to subcutaneous insulin protocol.

Hosp Pharm. This article highlights the importance hospital adherence to SCIP measures and the importance of effective transitions for cardiac patients to avoid sternal wound infections. PubMed Google Scholar. Accessed 17 May Moneim Shalash, A. Abdel Rahim, K. Rohoma, A. Andrade-Castellanos, L. Colunga-Lozano, N.

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Indian J. Cahn, E. Roitman, G. Aharon-Hananel et al. Continuous subcutaneous insulin infusion—an opportunity for better care but not a magic pill. Endocrine 56 , 4 Hedeker, R. Longitudinal Data Analysis. Wiley, New Jersey, Kutner, C. Nachtsheim, J. Applied Linear Regression Models. Chapter 9. Download references. This paper was extracted from a Ph.

The authors would like to thank all pediatric senior residents at Besat Hospital for their accuracy and cooperation in data entry and management of children with diabetic ketoacidosis. They also appreciate Miss Nasim Ansari member of the research center of Hamedan Besat Hospital for her skillful assistance in completion of this work.

We gratefully acknowledge the patients and their families for their invaluable cooperation. Insulin syringes should be readily available in all patient care units, and steps should be taken to separate insulin syringes from other parenteral syringes so they cannot be inadvertently mixed-up.

Dispense from pharmacy. To preserve an independent double-check, wherever possible, pharmacy should prepare, label, and dispense insulin doses to treat hyperkalemia. Some organizations dilute the IV insulin dose and dispense it in a minibag. Hyperkalemia is a medical emergency, yet the administration of insulin, in most circumstances, can wait until a pharmacy prepares a stat dose.

In general, pharmacy should also prepare all insulin infusions using a standard concentration e. If the pharmacy does not provide hour services, consider stocking a night cabinet with a pharmacy-mixed insulin infusion and diluted insulin in a syringe for hyperkalemia treatment that are discarded and replaced when necessary e. There are also 3 mL vials of regular insulin available, which can be provided to lessen the risk exposure.

Insulin or any other additive should never be added to IV solutions that are already hanging or infusing. Pharmacy should dispense a newly mixed infusion if new additives e. Provide reminders. Conduct an independent double-check. Require an independent double-check of all doses before dispensing and administering IV insulin. Include a double-check of the blood glucose result if the dose of insulin being administered is based on that result.

Build the double-check into daily work processes so it can be accomplished without disruption.