insulin lispro, rDNA origin

insulin lispro, rDNA origin

HumaLOG

insulin lispro protamine suspension/insulin lispro injection mixtures, rDNA origin

HumaLOG Mix 75/25

HumaLOG Mix 50/50

Indications

Action

Pharmacokinetics

Time/action profile (hypoglycemic effect)

Contraindications/Precautions

Adverse Reactions/Side Effects

Endocrinologic

• hypoglycemia (life-threatening)

Local

• lipodystrophy
• pruritus
• erythema
• swelling

Miscellaneous

• allergic reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess for symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait)and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst) periodically during therapy.
• Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.
• Lab Test Considerations:
  • Monitor blood glucose every 6 hr during therapy, more frequently in ketoacidosis and times of stress. A1C may be monitored every 3–6 mo to determine effectiveness.
Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.

Potential Nursing Diagnoses

Implementation

• high alert: Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation “u” for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional.
• Do not confuse Humalog with Humulin.
• Due to the short duration of action, insulin lispro must be used with a longer acting insulin, insulin infusion pump or in combination with oral sulfonurea agents.
• Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin’s units/mL. Special syringes for doses <50 units are available. Use only U-100 insulin syringes to draw up insulin lispro dose. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake.
  • When mixing insulins, draw insulin lispro into syringe first to avoid contamination of regular insulin vial.
  • Insulin should be stored in a cool place but does not need to be refrigerated.
• Subcutaneous: Administer insulin lispro within 15 min before a meal. Rotate injection sites. Do not administer IV.
  • May be administered via disposable external insulin pump. Do not administer solution that appears thickened, cloudy, discolored or contains particles. Store cartridges for pump in refrigerator. Do not mix with other insulins or solutions when used with pump. Choose a new infusion site and insertion site at least every 3 days. Discard cartridges after 7 days, even if solution remains.
• Syringe Compatibility: May be diluted with sterile diluent for Humalog, Humulin N, Humulin 50/50, Humulin 70/30, and NPH Ilentin to a concentration of 1:10 or 1:2.

• Intravenous Administration

• Continuous Infusion: Administer IV under medical supervision with close monitoring of blood glucose and potassium levels to avoid hypoglycemia and hypokalemia. Concentration: 0.1 unit/mL to 1.0 unit/mL. Diluent: 0.9% NaCl. Solutions of insulin lispro and 0.9% NaCl can be stored for 48 hrs in refrigerator, then used at room temperature for another 48 hr.

Patient/Family Teaching

• Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, external pumps, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen.
• Demonstrate technique for mixing insulins by drawing up insulin lispro first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).
• Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
• Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
• Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications or alcohol.
• Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
• Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled.
• Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
• Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding or planning to breastfeed.
• Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
• Emphasize the importance of regular follow-up, especially during first few weeks of therapy.

Evaluation/Desired Outcomes

• Control of blood glucose levels in diabetic patients without the appearance of hypoglycemic or hyperglycemic episodes.