Insulin Delivery Techniques
It is important to note that insulin delivery is primarily conducted through injection, which is why it is of paramount importance to be able to properly operate the given procedure. The main reason for the unavailability of oral delivery is the fact that insulin is easily digestible by enzymes, and thus, the hormone needs to be transferred directly into the bloodstream. Before the procedure, a person needs to wash his or her hands with soap in order to make the process as sterile as possible. The technique of injections begins with the preparation of one’s insulin supplies and a fresh syringe, where the premixed or intermediate insulin is gently stirred. Then, it is important to remove the cap from the syringe and pull the plunger to fill the syringe with air equivalent to the dose. After, one needs to insert the needle into the vial and push the plunger until the air is emptied into the syringe because it helps to balance the draw up of insulin due to pressure stabilization. The syringe needs to be filled with insulin to the desired amount, and newly formed air bubbles in the syringe need to be removed by pushing the plunger until there are no air bubbles left. It is of paramount importance to avoid contaminating the needle by not letting it touch anything besides the area of injection. Insulin can also be delivered through a pen, where one needs to follow the manufacturer’s specific instructions for usage.
Injection Process
The injection technique includes folding of the skin in the area of injection, but it is important to note that one should not fold the skin too tightly or too loosely. The area of injection needs to be sterilized and cleaned with alcohol prior to injection. The skin needs to be pinched with one’s first finger and thumb, where either pen or syringe needs to be inserted at a 90-degree angle with one quick motion. It is important that the needle of a syringe is inserted fully, after which the plunge needs to be pushed gradually with a steady pace until it is empty, where the whole delivery process after insertion needs to take 10 seconds for a pen and 5 seconds for a syringe. The needle needs to be also removed at a 90-degree angle, and the site of injection needs to be pressed with one’s finger for a few seconds in order to prevent leakage of insulin. The syringe or the needle of a pen needs to be disposed of appropriately in thick plastic containers.
Injection Area
In the case of areas of injections, it is important to conduct rotations of these sites because continuous use of one site can lead to an unpleasant experience, pain, discomfort, inflammation, and lipodystrophy, which is a fat tissue breakdown (American Association of Diabetes Educators, n.d.). Although insulin can be injected in any location, the most preferred sites are the abdomen, buttocks, thighs, and arms. The rotation process needs to be systematic, where, for example, in the case of the abdomen, the insertions can follow various patterns. The recommended pattern resembles an S-pattern, where one starts injecting insulin in his or her abdomen in the upper right corner and moves to the upper left corner of the abdomen injection area, after which he or she moves to the lower middle left area and moves to the right middle area. Then, one begins injections in the bottom right corner and gradually moves to the bottom left corner.
Medication Properties
Insulin is a hormone, which regulates a wide range of internal processes, but primarily focuses on lowering blood glucose levels by inducing the uptake of glucose by cells. In the case of diabetes, the cells are either insensitive to insulin, or the body does not generate the hormone, which means that glucose regulation is disrupted. In both cases, insulin injections increase the overall insulin concentration or supply the absent insulin, which leads to the lowering of glucose in the bloodstream. There are generally four types of insulin medications, which can be categorized as rapid-acting, short-acting or regular, intermediate-acting, and long-acting, and they last for 2 to 4 hours, 2 to 6 hours, 12 to 18 hours, and 24 hours, respectively (NIDDK, n.d.). Insulin needs to be stored in fridges or at room temperature, and one needs to keep it from direct sunlight and heat. In addition, one also needs to avoid freezing insulin, in which case, it becomes unusable even if it is thawed. The insulin expiration date needs to be checked on the medicine itself, but generally, after opening insulin, it needs to be discarded after 14 – 42 days depending on the injection device (“How to store insulin,” 2021). Therefore, a user needs to be attentive to the guidelines described by a manufacturer.
Injection Devices
In the case of choices in regards to injection devices, the most common involve needles and syringes as well as insulin vials. Pens are easier to use, and they come in reusable or one-use forms. Insulin pumps allow a person to deliver insulin at a steadier and gradual pace throughout the day because it remains attached to the body through a needle for longer durations. Insulin can also be delivered through an inhaler, where the hormone is transferred to the bloodstream through the lungs. Injection ports are useful devices, which allow a person to avoid repetitive skin puncturing, where a short tube is inserted into the skin, which can be used for several insulin deliveries, and these ports usually last for a few days (NIDDK, n.d.). Jet injectors spray insulin into the skin at higher levels of pressure and can be an alternative to a needle.
Timing
Insulin intake or injection schedule is verified and approved by a doctor, but usually, insulin is taken twice a day, and in some cases, thrice or four times per day. Short-acting insulin is usually taken ten minutes before a meal, whereas long-acting variants are taken around 30 minutes before a meal (AAFP, 2020). In either case, one should consult his or her doctor in order to design an appropriate schedule for insulin delivery.
Nursing Care Plan
The selected nursing care plan is at risk for unstable blood glucose, where the nursing diagnosis is evidenced by “inadequate blood glucose monitoring, inability to follow diabetes management” (Vera, 2021). The first intervention is an administration of prandial and basal insulin because normal range levels prevent or slow down microvascular issues. The second intervention revolves around being watchful for morning hyperglycemia signs, such as the dawn phenomenon. The third intervention focuses on educating a patient on performing a glucose monitoring process, where the measurements are taken at bedtime and prior to meals, and these values determine the dosage. The fourth intervention is centered around reporting blood pressure changes because diabetes is strongly linked to hypertension. If systolic pressure of 160 mm Hg is exceeded, it needs to be reported.
References
AAFP. (2020). Diabetes: How to use insulin. Web.
American Association of Diabetes Educators. (n.d.). Insulin injection know-how.Web.
How to store insulin. (2021). Web.
NIDDK. (n.d.). Insulin, medicines, & other diabetes treatments. Web.
Vera, M. (2021). 17 diabetes mellitus nursing care plans.Web.