University of Cebu - Banilad

College of Nursing
Banilad, Cebu City

INSULIN AND INSULIN ADMINISTRATION: SINGLE DOSING AND DOUBLE

DOSING

Submitted by:
Fionah Retuya
BSN 3 - D

Submitted to:
Rachel A. Bajarias, MAN, RN
Clinical Instructor

March 2023
 “An Overview of Insulin”
(Article)

What is insulin?

Insulin is a chemical messenger that allows cells to absorb glucose, a sugar, from the
blood. The pancreas is an organ behind the stomach that is the main source of insulin in
the body. Clusters of cells in the pancreas called islets produce the hormone and
determine the amount based on blood glucose levels in the body. The higher the level of
glucose, the more insulin goes into production to balance sugar levels in the blood.

Insulin also assists in breaking down fats or proteins for energy. A delicate balance
of insulin regulates blood sugar and many processes in the body. If insulin levels are too
low or high, excessively high or low blood sugar can start to cause symptoms. If a state
of low or high blood sugar continues, serious health problems might start to develop.

Insulin Problems

In some people, the immune system attacks the islets, and they cease to produce
insulin or do not produce enough. When this occurs, blood glucose stays in the blood and
cells cannot absorb them to convert the sugars into energy. This is the onset of type 1
diabetes, and a person with this version of diabetes will need regular shots of insulin to
survive.

In some people, especially those who are overweight, obese, or inactive, insulin is
not effective in transporting glucose into the cells and unable to fulfill its actions. The
inability of insulin to exert its effect on tissues is called insulin resistance. Type 2
diabetes will develop when the islets cannot produce enough insulin to overcome insulin
resistance.

Since the early 20th century, doctors have been able to isolate insulin and provide it
in an injectable form to supplement the hormone for people who cannot produce it
themselves or have increased insulin resistance.
Types of Insulin

A person can take different types of insulin based on how long they need the effects of
the supplementary hormone to last.

People categorize these types based on several different factors:

 speed of onset, or how quickly a person taking insulin can expect the effects to
start.

 peak, or the speed at which the insulin reaches its greatest impact

 duration, or the time it takes for the insulin to wear off

 concentration, which in the United States is 100 units per milliliter (U100)

 the route of delivery, or whether the insulin requires injection under the skin,into
a vein, or into the lungs by inhalation.

People most often deliver insulin into the subcutaneous tissue, or the fatty tissue located
near the surface of the skin. Three main groups of insulin are available.

Fast-acting insulin

The body absorbs this type into the bloodstream from the subcutaneous tissue extremely
quickly. People use fast-acting insulin to correct hyperglycemia, or high blood sugar, as
well as control blood sugar spikes after eating.

This type includes:

 Rapid-acting insulin analogs: These take between 5 and 15 minutes to have an

effect. However, the size of the dose impacts the duration of the effect. Assuming
that rapid-acting insulin analogs last for 4 hours is a safe general rule. Examples:
Aspart (Novolog), Lispro (Humalog).

 Regular human insulin: The onset of regular human insulin is between 30

minutes and an hour, and its effects on blood sugar last around 8 hours. A larger
 dose speeds up the onset but also delay the peak effect of regular human insulin.
Examples: Humulin R, Novolin R

Intermediate-acting insulin

This type enters the bloodstream at a slower rate but has a longer-lasting effect. It is most
effective at managing blood sugar overnight, as well as between meals.

Options for intermediate-acting insulin include:

 NPH human insulin: This takes between 1 and 2 hours to onset, and reaches its
peak within 4 to 6 hours. It can last over 12 hours in some cases. A very small
dose will bring forward the peak effect, and a high dose will increase the time
NPH takes to reach its peak and the overall duration of its effect. Examples:
Humulin N, Novolin N.

 Pre-mixed insulin: This is a mixture of NPH with a fast-acting insulin, and its
effects are a combination of the intermediate- and rapid-acting insulins. The
mixtures can be in various combinations from 50:50 to 75:25 or 70:30. An
example includes Novolog 70/30.

Long-acting insulin

While long-acting insulin is slow to reach the bloodstream and has a relatively low peak,
it has a stabilizing “plateau” effect on blood sugar that can last for most of the day.
Glargine (Lantus) is an example. It is useful overnight, between meals, and during fasts.
Long-acting insulin analogs are the only available type, and these have an onset of
between 1.5 and 2 hours. While different brands have different duration, they range
between 12 and 24 hours in total.

Retrieved from:
Felman, A. (2023, January 31). An overview of
insulin. https://www.medicalnewstoday.com/articles/323760#takeaway
 SUMMARY

Insulin is a peptide hormone that helps to control blood sugar levels. It is produced

by the β cells in the pancreatic islets of Langerhans and helps to take in energy from food,

regulate carbohydrate, lipid, and protein metabolism, and promote cell division and

growth. As the immune system attacks the islets, insulin issues arise, and type 1 diabetes

develops. When the islets are unable to produce enough insulin to combat insulin

resistance, type 2 diabetes begins to form.

People use fast-acting insulin to control their blood sugar levels when they are

having a high blood sugar or when their blood sugar levels go up after eating. The insulin

works quickly to lower the blood sugar levels, and it is different from regular human

insulin in that it takes longer for it to work and it has a longer lasting effect.

Intermediate-acting insulin works a little bit slower but has a longer lasting effect, and is

best for managing blood sugar overnight. Long-acting insulin takes a bit longer to work

but it has a longer lasting effect, and it can keep your blood sugar levels stable most of

the day.

This also provides that the kind of insulin is based on the insulin's quick onset, peak,

duration, concentration, delivery method, and inhalation. There are three primary

categories of insulin.
 REFLECTION

In this article, we explore what happens when the pancreas doesn't produce enough

insulin, as well as the different types of insulin that people can use to help regulate their

blood sugar levels.

Insulin is a hormone that helps the body to absorb energy and to break down food. In

people with insulin resistance, there are fewer cells in the pancreas that produce insulin,

which means that the body is not able to use energy as efficiently. Cells can take up

glucose, a sugar, from the blood thanks to the chemical messenger insulin. The hormone

is produced by groups of cells in the pancreas, and the quantity is decided by blood

glucose levels. Excessively high or low blood sugar can start to create symptoms if

insulin levels are excessively low or high.

Some people have trouble controlling their blood sugar, which can lead to type 1

diabetes. Type 2 diabetes happens when people have trouble using their insulin correctly

and their body doesn't produce enough of the hormone to control their blood sugar. Some

people can take shots of insulin to help them control their blood sugar. There are three

types of insulin: fast, intermediate, and long-acting. Each one works differently in how

quickly it causes a person's blood sugar to go down and how long it lasts.
 Insulin Administration

Insulin
Insulin is obtained from pork pancreas or is made chemically identical to human
insulin by recombinant DNA technology or chemical modification of pork insulin.
Insulin analogs have been developed by modifying the amino acid sequence of the insulin
molecule.
Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be
injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin
lispro and insulin aspart) are available, and other analogs are in development. Regular is a
short-acting insulin. Intermediate-acting insulins include lente and NPH. Ultralente and
insulin glargine are long-acting insulins. Insulin preparations with a predetermined
proportion of intermediate-acting insulin mixed with short- or rapid-acting insulin (e.g.,
70% NPH/30% regular, 50% NPH/50% regular, and 75% NPL/25% insulin lispro) are
available.
Different companies have adopted different names for the same short-, intermediate-,
or long-acting types of insulin or their mixture. Human insulins have a more rapid onset
and shorter duration of activity than pork insulins.
Insulin is commercially available in concentrations of 100 or 500 units/ml (designated
U-100 and U-500, respectively; 1 unit equals ∼ 36 μg of insulin). U-500 is only used in
rare cases of insulin resistance when the patient requires extremely large doses. U-500,
insulin lispro, insulin aspart, insulin glargine, and 75% NPL/25% insulin lispro require a
prescription. Insulin preparations are sometimes formulated individually for use in infants
(e.g., U-10) with diluents provided by the manufacturer. In these instances, special care
must be taken to ensure that the correct dose of the diluted insulin is administered with an
ordinary insulin syringe.
Different types and species of insulin have different pharmacological properties.
Human insulin is preferred for use in pregnant women, women considering pregnancy,
individuals with allergies or immune resistance to animal-derived insulins, those
initiating insulin therapy, and those expected to use insulin only intermittently. Insulin
type and species, injection technique, insulin antibodies, site of injection, and individual
patient response differences can all affect the onset, degree, and duration of insulin
activity. Changing insulin species may affect blood glucose control and should only be
done under the supervision of a health professional with expertise in diabetes. Human
insulin manufactured using recombinant DNA technology is replacing insulin isolated
from pigs. Future availability of animal insulin is uncertain.
Pharmacists and health care providers should not interchange insulin species or types
without the approval of the prescribing physician and without informing the patient of the
type of insulin change being made. If an individual is admitted to a hospital, the type of
insulin he or she has been using should not be changed inadvertently. If there is doubt
about the principal species, human insulin should be administered until adequate
information is available. When purchasing insulin, the patient should make sure that the
type and species are correct and that the insulin will be used before the expiration date.
In the event that a patient’s specific brand of insulin is temporarily unavailable, the same
insulin formulation from another manufacturer may be substituted. Changing insulin
types (e.g., long, intermediate, short, and rapid acting) from one formulation to another
should always be done under medical supervision. The patient should be fully informed
as to the reason for any change in insulin and the potential need for additional glucose
monitoring.
Storage
Vials of insulin not in use should be refrigerated. Extreme temperatures (<36
or >86°F, <2 or >30°C) and excess agitation should be avoided to prevent loss of potency,
clumping, frosting, or precipitation. Specific storage guidelines provided by the
manufacturer should be followed. Insulin in use may be kept at room temperature to limit
local irritation at the injection site, which may occur when cold insulin is used.
The patient should always have available a spare bottle of each type of insulin used.
Although an expiration date is stamped on each vial of insulin, a loss in potency may
occur after the bottle has been in use for >1 month, especially if it was stored at room
temperature.
The person administering insulin should inspect the bottle before each use for
changes (i.e., clumping, frosting, precipitation, or change in clarity or color) that may
signify a loss in potency. Visual examination should reveal rapid- and short-acting
insulins as well as insulin glargine to be clear and all other insulin types to be uniformly
cloudy. The person with diabetes should always try to relate any unexplained increase in
blood glucose to possible reductions in insulin potency. If uncertain about the potency of
a vial of insulin, the individual should replace the vial in question with another of the
same type.
Mixing Insulin
Administration of mixtures of rapid- or short- and intermediate- or long-acting
insulins will produce a more normal glycemia in some patients than use of a single
insulin. The formulations and particle size distributions of insulin products vary. On
mixing, physicochemical changes in the mixture may occur (either immediately or over
time). As a result, the physiological response to the insulin mixture may differ from that
of the injection of the insulins separately. When rapid-acting and ultralente insulins are
mixed, there is no blunting of the onset of action of the rapid-acting insulin. A slight
decrease in the absorption rate, but not the total bioavailability, is seen when rapid-acting
and protamine-stabilized insulin (NPH) are mixed. In clinical trials, however, the
postprandial blood glucose response was similar when rapid-acting insulin was mixed
with either NPH or ultralente. Mixing of short-acting and lente insulins is not
recommended, except for patients already adequately controlled on such a mixture. Upon
mixing, Zn2+ present in lente insulins) (e.g., lente and ultralente) will bind with the
short-acting insulin and delay its onset of action. The degree and rate of binding varies
with the ratio and species of the two insulins; binding equilibrium may not be reached for
24 h. Phosphate-buffered insulins (e.g., NPH insulin) should not be mixed with lente
insulins. Zinc phosphate may precipitate, and the longer-acting insulin will convert to a
short-acting insulin to an unpredictable extent.
Mixing of insulins should follow these guidelines:

 Patients who are well controlled on a particular mixed-insulin regimen should

maintain their standard procedure for preparing their insulin doses.
 No other medication or diluent should be mixed with any insulin product unless
approved by the prescribing physician.
 Insulin glargine should not be mixed with other forms of insulin due to the low pH of
its diluent.
 Use of commercially available premixed insulins may be used if the insulin ratio is
appropriate to the patient’s insulin requirements.
 Currently available NPH and short-acting insulin formulations when mixed may be
used immediately or stored for future use.
 Rapid-acting insulin can be mixed with NPH, lente, and ultralente.
 When rapid-acting insulin is mixed with either an intermediate- or long-acting
insulin, the mixture should be injected within 15 min before a meal.
 Mixing of short-acting and lente insulins is not recommended except for patients
already adequately controlled on such a mixture. If short-acting and lente mixtures
are to be used, the patient should standardize the interval between mixing and
injection.
 Phosphate-buffered insulins (e.g., NPH) should not be mixed with lente insulins.
 Insulin formulations may change; therefore, the manufacturer should be consulted in
cases where its recommendations appear to conflict with the American Diabetes
Association guidelines.
Syringes
Conventional insulin administration involves subcutaneous injection with syringes
marked in insulin units. There may be differences in the way units are indicated,
depending on the size of the syringe and the manufacturer. Insulin syringes are
manufactured with 0.3-, 0.5-, 1-, and 2-ml capacities. Several lengths of needles are
available. Blood glucose should be monitored when changing from one length to another
to assess for variability of insulin absorption. Regulations governing the purchase of
syringes vary greatly from one state to another.
Many different medical devices have been developed to reduce the risk of needle
sticks and other sharps injuries using current OSHA standards. These devices incorporate
features designed to reduce injury. Use of some currently available insulin syringes with
engineered sharps injury protection (ESIP) may present barriers to effective insulin
self-administration training. Use of a device for training that is different from the device
to be used in practice is inconsistent with teaching/learning principles, and may
compromise the success of the training process. Individualized patient assessment should
guide the use of an ESIP insulin syringe during insulin self-administration instruction.
(See AADE, Diabetes Educ 28:730, 2000).
Syringes must never be shared with another person because of the risk of acquiring a
blood-borne viral infection (e.g., acquired immune deficiency syndrome or hepatitis).
Travelers should be aware that insulin is available in a strength of U-40 outside of the
U.S. To avoid dosing errors, syringes that match the concentration of U-40 insulin must
be used.
Disposal
Recapping, bending, or breaking a needle increases the risk of needle-stick injury
and should be avoided. Insulin syringes and pens, needles, and lancets should be disposed
of according to local regulations. Some areas may have special needle disposal programs
to prevent sharps from being in the main waste disposal stream. When community
disposal programs are unavailable, used sharps should be placed in a puncture-resistant
container. Local trash authorities should be contacted for proper disposal of filled
containers. Care should be taken to keep these filled containers away from containers to
be recycled. In areas with container-recycling programs, placement of containers of used
syringes, needles, and lancets with materials to be recycled is prohibited.
Needle Reuse
Manufacturers of disposable syringes and pen needles recommend that they only be
used once. One potential issue, which arises with reuse of syringes or needles, is the
inability to guarantee sterility. Most insulin preparations have bacteriostatic additives that
inhibit growth of bacteria commonly found on the skin. Nevertheless, syringe/needle
reuse may carry an increased risk of infection for some individuals. Patients with poor
personal hygiene, an acute concurrent illness, open wounds on the hands, or decreased
resistance to infection for any reason should not reuse a syringe or pen needle.
Another issue has arisen with the advent of newer, smaller (30 and 31 gauge) needles.
Even with one injection, the needle tip can become bent to form a hook which can
lacerate tissue or break off to leave needle fragments within the skin. The medical
consequences of these findings are unknown but may increase lipodystrophy or have
other adverse effects.
 Some patients find it practical to reuse needles. Certainly, a needle should be
discarded if it is noticeably dull or deformed or if it has come into contact with any
surface other than skin. If needle reuse is planned, the needle must be recapped after each
use. Patients reusing needles should inspect injection sites for redness or swelling and
should consult their healthcare provider before initiating the practice and if signs of skin
inflammation are detected.
Before syringe reuse is considered, it should be determined that the patient is capable
of safely recapping a syringe. Proper recapping requires adequate vision, manual
dexterity, and no obvious tremor. The patient should be instructed in a recapping
technique that supports the syringe in the hand and replaces the cap with a straight
motion of the thumb and forefinger. The technique of guiding both the needle and cap to
meet in midair should be discouraged, because this frequently results in needle-stick
injury.
The syringe being reused may be stored at room temperature. The potential benefits
or risks, if any, of refrigerating the syringe in use or of using alcohol to cleanse the needle
of a syringe are unknown. Cleansing the needle with alcohol may not be desirable,
because it may remove the silicon coating that makes for less painful skin puncture.
SYRINGE ALTERNATIVES
Insulin can be given with jet injectors that inject insulin as a fine stream into the skin.
These injectors offer an advantage for patients unable to use syringes or those with needle
phobias. A potential advantage may be a more rapid absorption of short-acting insulin.
However, the initial cost of these injectors is relatively high, and they may traumatize the
skin. They should not be viewed as a routine option for use in patients with diabetes.
Several pen-like devices and insulin-containing cartridges are available that deliver
insulin subcutaneously through a needle. In many patients (e.g., especially those who are
neurologically impaired and those using multiple daily injection regimens), these devices
have been demonstrated to improve accuracy of insulin administration and/or adherence.
Low-dose pens that can deliver insulin in half-unit increments are also available.
Insulin delivery aids (e.g., nonvisual insulin measurement devices, syringe
magnifiers, needle guides, and vial stabilizers) are available for people with visual
impairments. Information about these products is available in the American Diabetes
Association’s annual diabetes resource guide.
INJECTION TECHNIQUE
- Dose preparation
Before each injection, the insulin label should be verified to avoid injecting an
incorrect insulin. The hands and the injection site should be clean. For all insulin
preparations, except rapid- and short-acting insulin and insulin glargine, the vial or pen
should be gently rolled in the palms of the hands (or shaken gently) to resuspend the
insulin. An amount of air equal to the dose of insulin required should first be drawn up
and injected into the vial to avoid creating a vacuum. For a mixed dose, putting sufficient
air into both bottles before drawing up the dose is important. When mixing rapid- or
short-acting insulin with intermediate- or long-acting insulin, the clear rapid- or
short-acting insulin should be drawn into the syringe first.
After the insulin is drawn into the syringe, the fluid should be inspected for air
bubbles. One or two quick flicks of the forefinger against the upright syringe should
allow the bubbles to escape. Air bubbles themselves are not dangerous but can cause the
injected dose to be decreased.
Injection procedures
Injections are made into the subcutaneous tissue. Most individuals are able to lightly
grasp a fold of skin, release the pinch, then inject at a 90° angle. Thin individuals or
children can use short needles or may need to pinch the skin and inject at a 45° angle to
avoid intramuscular injection, especially in the thigh area. Routine aspiration (drawing
back on the injected syringe to check for blood) is not necessary. Particularly with the use
of insulin pens, the needle should be embedded within the skin for 5 s after complete
depression of the plunger to ensure complete delivery of the insulin dose.
Patients should be aware that air bubbles in an insulin pen can reduce the rate of
insulin flow from the pen; under delivery of insulin can occur when air bubbles are
present, even if the needle remains under the skin for as long as 10 s after depressing the
plunger. Air can enter the insulin pen reservoir during either manufacture or filling if the
needle is left on the pen between injections. To prevent this potential problem, avoid
leaving a needle on a pen between injections and prime the needle with 2 units of insulin
before injection.
If an injection seems especially painful or if blood or clear fluid is seen after
withdrawing the needle, the patient should apply pressure for 5–8 s without rubbing.
Blood glucose monitoring should be done more frequently on a day when this occurs. If
the patient suspects that a significant portion of the insulin dose was not administered,
blood glucose should be checked within a few hours of the injection. If bruising, soreness,
welts, redness, or pain occur at the injection site, the patient’s injection technique should
be reviewed by a physician or diabetes educator. Painful injections may be minimized by
the following:
 Injecting insulin at room temperature.
 Making sure no air bubbles remain in the syringe before injection.
 Waiting until topical alcohol (if used) has evaporated completely before injection.
 Keeping muscles in the injection area relaxed, not tense, when injecting.
 Penetrating the skin quickly.
 Not changing direction of the needle during insertion or withdrawal.
 Not reusing needles.
Some individuals may benefit from the use of prefilled syringes (e.g., the visually
impaired, those dependent on others for drawing their insulin, or those traveling or eating
in restaurants). Prefilled syringes are stable for up to 30 days when kept in a refrigerator.
If possible, the syringes should be stored with the needle pointing upward or laying flat,
so that suspended insulin particles do not clog the needle. The predrawn syringe should
be rolled between the hands before administration. A quantity of syringes may be
premixed and stored. The effect of premixing of insulins on glycemic control should be
assessed by a physician, based on blood glucose results obtained by the patient. When
premixing is required, consistency of technique and careful blood glucose monitoring are
especially important.
Injection site
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. Rotation of the injection site is important to prevent lipohypertrophy or
lipoatrophy. Rotating within one area is recommended (e.g., rotating injections
systematically within the abdomen) rather than rotating to a different area with each
injection. This practice may decrease variability in absorption from day to day. Site
selection should take into consideration the variable absorption between sites. The
abdomen has the fastest rate of absorption, followed by the arms, thighs, and buttocks.
Exercise increases the rate of absorption from injection sites, probably by increasing
blood flow to the skin and perhaps also by local actions. Areas of lipohypertrophy usually
show slower absorption. The rate of absorption also differs between subcutaneous and
intramuscular sites. The latter is faster and, although not recommended for routine use,
can be given under other circumstances (e.g., diabetic ketoacidosis or dehydration).
Other considerations
Whenever possible, insulin should be self-administered by the patient. In the case of
children, the proper age for initiating this depends on the individual developmental level
of the child as well as family and social circumstances. It should not be delayed beyond
adolescence. In the case of the visually impaired, mechanical aids are available to ensure
accuracy. Where this is insufficient, the syringes may be prefilled periodically by a
relative, friend, home health aide, or visiting nurse and the dose may be self-injected. The
latter strategy can also be applied to some individuals with borderline dexterity or
arithmetical skills. For patients who are completely independent in insulin administration,
it is still advisable to have a family member knowledgeable in the technique in case of
emergency.
DOSING
The appropriate insulin dosage is dependent on the glycemic response of the
individual to food intake and exercise regimens. For virtually all type 1 patients and
many type 2 patients, the time course of insulin action requires three or more injections
per day to meet glycemic goals. Type 1 patients and some type 2 patients may also
require both rapid- or short- and longer-acting insulins. A dosage algorithm suited to the
individual’s needs and treatment goals should be developed with the cooperation of the
patient. The timing of the injection depends on blood glucose levels, food consumption,
exercise, and types of insulin used. Variables in insulin action (e.g., onset, peak, and
duration) must be considered.
Rapid-acting insulin analogs should be injected within 15 min before a meal or
immediately after a meal. The most commonly recommended interval between injection
of short-acting (regular) insulin and a meal is 30 min. Eating within a few minutes after
(or before) injecting short-acting insulin is discouraged because it substantially reduces
the ability of that insulin to prevent a rapid rise in blood glucose and may increase the
risk of delayed hypoglycemia. Guidelines should be set by the physician for the
suggested interval between insulin injection and meal time based on factors such as blood
glucose levels, site of injection, and anticipated activity during the interval.

Self-monitoring

Whenever possible, insulin-using patients should practice self-monitoring of blood

glucose (SMBG). Insulin dosage adjustments should be based on blood glucose
measurements. SMBG is extremely valuable in patients who take insulin because they
experience day-to-day variability in blood glucose levels. This variability is influenced by
differences in insulin absorption rates, insulin sensitivity, exercise, stress, rates of food
absorption, and hormonal changes (e.g., puberty, the menstrual cycle, menopause, and
pregnancy). Illness, traveling, and any change in routine (e.g., increased exercise and a
different diet during vacation) may require more frequent SMBG under the guidance of a
physician. Travel through three or more time zones requires special advice regarding
insulin administration. During illness, it is important that insulin be continued even if the
patient is unable to eat or is vomiting. When accompanied by hyperglycemia, a positive
urine or blood test for ketones during illness indicates a need for extra, not less, insulin.
Health professionals should obtain information regarding blood glucose values whenever
patients need assistance in handling illness or stress.

Hypoglycemia

Excess insulin is a common cause of hypoglycemia. Hypoglycemia may also result from
a delayed or missed meal, decreased carbohydrate content of a meal, increased physical
activity, or increased insulin absorption rates (e.g., as a result of increased skin
temperature due to sunbathing or exposure to hot water). All insulin-requiring individuals
should be instructed to carry at least 15 g carbohydrate to be eaten or taken in liquid form
in the event of a hypoglycemic reaction. Family members, roommates, school personnel,
and coworkers should be instructed in the use of glucagon in those with type 1 for
situations when the individual cannot be given carbohydrate orally. All insulin users
should carry medical identification (e.g., a bracelet or wallet card) that alerts others to the
fact that the wearer uses insulin.

Retrieved from:
Insulin Administration. (2003). Diabetes Care, 27(suppl_1),
s106–s107. https://doi.org/10.2337/diacare.27.2007.s106
 SUMMARY

Insulin is important for the body to use different types of food properly. People with

type 1 diabetes have a problem with not producing enough insulin, and so they need to

take extra insulin to control their blood sugar. But people with type 2 diabetes don't

always have a problem with insulin production, and they don't need extra insulin to

control their blood sugar. Sometimes, over time, people with type 2 diabetes will lose the

ability to produce enough insulin on their own, and then they'll need to take insulin to

stay in control.

The route of administration usually depends on the patient's condition and setting.

The route of administration usually depends on the patient's condition and setting. So,

insulin is a hormone that helps control blood sugar levels. It can be administered via

subcutaneous, intravenous, and intramuscular routes.

Patients with type 2 diabetes may require intermittent or continuous glycemic control,

while individuals with type 1 diabetes must inject insulin in order to be managed. The

type and amount of insulin used should always be constant, and the diabetes care team

should regularly examine the patient's injection technique. Understanding the duration of

action of the various types of insulin and the relationship between blood glucose levels

and exercise, food intake, concurrent illness, certain medications, and stress are all

necessary for the effective use of insulin to achieve the best metabolic control. SMBG is

also necessary, as is learning how to adjust insulin dosage to meet the unique target goals

agreed upon by the patient, family, and diabetes care team.

 REFLECTION

In reflection, there are numerous insulin dosage regimens, and no single one is

suitable for all patients. When deciding which approach is appropriate for a particular

person, patient characteristics such as education, motivation, diabetes management, and

resources must all be taken into account. The danger of hypoglycemia is typically the

greatest concern when starting insulin therapy in patients. In order to reduce the risk, it is

important to monitor blood sugar more frequently and educate all patients on the

symptoms, signs, and treatment of hypoglycemia.

Insulin is a medication that helps control blood sugar levels. It comes in different

forms, including regular insulin (R), isophane insulin (NPH), and insulin zinc (L). The

dosage of insulin is based on a person's weight and blood sugar levels. Blood sugar levels

dictate the dose of human isophane/human regular insulin and isophane insulin (NPH),

which are injected under the skin 30 to 60 minutes before meals and/or nocturnal snacks.

Semilenteinsulin (prompt insulin zinc) is given intravenously prior to meals or bedtime

snacks. The doctor could recommend using various insulin types for both.

Based on what I have understood, the insulin dosage must always be tailored to the

individual and balanced with medical nutrition therapy and exercise in all situations when

insulin is used. Most importantly, the statement concerns the use of conventional insulin

administration (such as using a syringe or pen with a needle and cartridge) by people with

diabetes themselves. We think this type of insulin administration is important and we

want people with diabetes to be able to use it as easily as possible.

 References:

Felman, A. (2023, January 31). An overview of

insulin. https://www.medicalnewstoday.com/articles/323760#takeaway

Insulin Administration. (2003). Diabetes Care, 27(suppl_1),

s106–s107. https://doi.org/10.2337/diacare.27.2007.s106