- Body system
- Endocrine
- Drug cards
- 4 in this guide
Drugs in this class
- Regular insulinHumulin R, Novolin R, Myxredlin
- Insulin lisproHumalog, Admelog, Lyumjev
- Insulin glargineLantus, Basaglar, Semglee, Toujeo, Rezvoglar
- NPH insulin (isophane)Humulin N, Novolin N
Other examples: Insulin aspart (NovoLog), Insulin glulisine (Apidra), Insulin detemir (Levemir), Insulin degludec (Tresiba), 70/30 premixed insulin.
How insulins work
Insulin moves glucose into cells, promotes glycogen and fat storage, and shifts potassium into cells.
Uses
- Type 1 diabetes (always required)
- Type 2 diabetes when other drugs are not enough
- Gestational diabetes
- Diabetic ketoacidosis and hyperglycemic hyperosmolar state
- Hyperkalemia (IV regular insulin with dextrose)
Adverse effects
- Hypoglycemia
- Hypokalemia
- Weight gain
- Lipodystrophy at overused injection sites
Nursing considerations
- Check blood glucose before giving and match the dose to the order and the meal.
- Approximate profiles (subcutaneous): rapid-acting onset 15 min, peak 1 h, duration 3 to 5 h; regular onset 30 to 60 min, peak 2 to 4 h, duration 5 to 8 h; NPH onset 1 to 2 h, peak 4 to 12 h, duration 12 to 18 h; long-acting basal insulins have no pronounced peak and last about 24 hours.
- Only regular insulin is routinely given IV. Never mix glargine with other insulins; when mixing regular and NPH, draw up clear before cloudy.
- High-alert medication: independent double check per policy.
Patient teaching
- Know the signs of low blood sugar (shaking, sweating, confusion, hunger) and treat with 15 g of fast-acting carbohydrate, then recheck in 15 minutes.
- Rotate injection sites. Opened vials and pens are usually good for 28 days at room temperature (check the product).
- Follow sick-day rules: do not stop basal insulin when ill.
Insulins NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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When mixing regular and NPH insulin in one syringe, which insulin is drawn up first?
Show answer
Answer A: Regular (clear) Clear before cloudy: draw up regular first so that NPH (which contains protamine) does not contaminate the regular insulin vial.
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A patient received NPH insulin at 0700. At what time is hypoglycemia most likely?
Show answer
Answer A: Early to mid-afternoon NPH peaks about 4 to 12 hours after injection, so a morning dose peaks in the afternoon.
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Which insulin can be given by continuous IV infusion?
Show answer
Answer D: Regular Regular insulin is the insulin routinely used for IV infusions. Glargine, NPH and premixed insulins are subcutaneous only.
Frequently asked questions
What are insulins?
Insulins are grouped by how fast and how long they work: rapid, short, intermediate and long-acting. Hypoglycemia is the main risk, and knowing the peak tells you when it is most likely.
How do insulins work?
Insulin moves glucose into cells, promotes glycogen and fat storage, and shifts potassium into cells.
What are examples of insulins?
Regular insulin, Insulin lispro, Insulin glargine, NPH insulin (isophane), Insulin aspart (NovoLog), Insulin glulisine (Apidra), Insulin detemir (Levemir) and Insulin degludec (Tresiba).
What are the nursing considerations for insulins?
Check blood glucose before giving and match the dose to the order and the meal. Approximate profiles (subcutaneous): rapid-acting onset 15 min, peak 1 h, duration 3 to 5 h; regular onset 30 to 60 min, peak 2 to 4 h, duration 5 to 8 h; NPH onset 1 to 2 h, peak 4 to 12 h, duration 12 to 18 h; long-acting basal insulins have no pronounced peak and last about 24 hours.