Diabetes Mellitus Q 33

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Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of 563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What does the best evaluation of the nurse reveal? Select all that apply.

  

    A. The nurse could have given the insulin subcutaneously.

    B. The nurse should have contacted the physician.

    C. The nurse should have used regular insulin (Humulin R).

    D. The nurse used the correct insulin.

    E. The nurse could have given the insulin intramuscularly.

    

Correct Answer: B & C.

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Insulin lispro is an insulin analog that is FDA-approved for the treatment of patients with diabetes mellitus types 1 and 2 to control hyperglycemia. Regular insulin, short-acting human insulin, is a synthetic protein hormone, which, just as the naturally occurring endogenous insulin, exerts a wide range of physiologic effects.

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Option A: The nurse cannot give the insulin subcutaneously when it is ordered to be given intravenously (IV). Insulin, regular when administered subcutaneously, should be injected 30 to 40 minutes before each meal.

Option B: Contact the provider to clarify the order, regular insulin is the only insulin that can be given intravenously (IV). When administered intravenously, U-100 administration should be with close monitoring of serum potassium and blood glucose. Do not use it if the solution is viscous or cloudy; administration should only occur if it is colorless and clear.

Option C: Regular insulin is the only insulin that can be given intravenously (IV). The nurse did not use correct insulin as it was not regular insulin. Incorrect administration of insulin (e.g., too little, too much, or at wrong times) can result in transient and serious hypo- and hyperglycemia, wide glycemic excursions, and diabetic ketoacidosis.

Option D: The insulin ordered by the physician was an intravenous infusion. For intravenous infusions, to minimize insulin adsorption to plastic IV tubing, flush the intravenous tube with a priming infusion of 20 mL from a 100 mL-polyvinyl chloride bag insulin every time a new intravenous tubing is added to the insulin infusion container.

Option E: Insulin may be injected into the subcutaneous tissue of the upper arm and the anterior and lateral aspects of the thigh, buttocks, and abdomen (with the exception of a circle with a 2-inch radius around the navel). Intramuscular injection is not recommended for routine injections.

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