Page 355 - Critical Care Nursing Demystified

340 CRITICAL CARE NURSING DeMYSTIFIED

Insulin Therapy Insulin cannot be taken orally because it will be destroyed by
gastric juices. When exercise, diet, and oral agents can no longer maintain sat-
isfactory blood glucose levels, insulin must be administered. The patient is no
longer producing his or her own insulin to meet the patient’s metabolic needs.
Insulin is also required for the management of Type 1 diabetes.
Pramlintide (Symlin) Acts as a synthetic analog of amylin, which is an endogenous
pancreatic hormone that aides in the control and management of postprandial
hyperglycemia. Used with mealtime insulin, not in place of insulin. Preferrable
to inject into the thigh or abdomen because absorption rates vary if injected
into the arm. Never inject near an insulin injection site. Can be used with met-
formin and sulfonlyureas.

Exenatide (Byetta) This drug has been approved for Type 2 diabetes uncontrolled by
metformin or a sulfonylurea. Mimics the action of incretin to control blood glucose
levels. Injected twice a day within 1 hour before breakfast and dinner. It is not a
substitute for insulin in patients who require insulin to control their diabetes.

Liraglutide (Victoza) This drug was recently approved for management of Type 2
diabetes. It is given as a once-daily injection and is not recommended for initial
therapy. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Sample Guidelines to Control Glucose Levels With Regular Insulin
151–200 mg/dL: 6 U of regular insulin

201–250 mg/dL: 8 U of regular insulin
251–300 mg/dL: 10 U of regular insulin
301–400 mg/dL: 12 U of regular insulin

NURSING ALERT

Most commercial insulin is available as U 100, which means that 1 mL contains 100 U
of insulin. U 100 must be used with a U 100–marked syringe. U 50 syringes may be
used for doses of 50 U or less.

Alternate Insulin Delivery Methods
An insulin pen is a compact needle and syringe preloaded with insulin carried
by the user in the event of an emergency (e.g., Novo Pen Insulin).
Insulin pump continuously infuses insulin subcutaneously and promotes the
potential for tighter glucose control. It is a small battery-operated device
worn on the belt and connected by a small plastic tube to a catheter inserted
into the subcutaneous tissue of the abdominal wall (e.g., InDuo).