INSULIN TYPES

PROFILES

1. Rapid acting (analogues) - clear in appearance

• Humalog (insulin lispro)

• NovoRapid (insulin aspart)

• Apidra (insulin glulisine)

• Fiasp (insulin aspart)

• A rapid acting insulin prescribed for the meal/carbohydrate load, or for correction hyperglycaemia.

• Rapid acting insulin prescribed for supplementary sliding scale before bed and four hourly if nil by mouth.

• Onset of action  10 - 15 minutes (fiasp = 5 minutes).

• Peak action 1-3 hours.

• Duration 3-5 hours.

• Administer humalog, novorapid or apidra 15 - 5 minutes prior to the meal.

• Administer fiasp with meal - at first bite or within 20 minutes after the start of the meal.

2. Short acting-clear in appearance

Actrapid (neutral insulin)

• Onset of action 30 minutes.

• Peak action 2.5-5 hours.

• Duration 8 hours.

• Administer 30 minutes before meals.

3. Intermediate Acting - cloudy in appearance

Humulin NPH (isophane)

• Protaphane (isophane)

Must be gently mixed by inverting device at least 10 times before use

• Onset of action 1.5 hours.

• Peak action 4-12 hours.

• Duration16-18 hours, up to 24 hours.

• Administer at the same time each day.

4.  Long acting (basal) - clear in appearance

• Optisulin (insulin glargine)

• Levemir (insulin detemir)

• Toujeo (insulin glargine 300units/ml)

DO NOT mix with any other insulin

• Once daily insulin with up to twenty-four hours duration. It may be used twice a day if required.

• Must be given at the same time each day.

Optisulin (glargine)

• Onset of action 1-2 hours.

• Peak action no peak.

• Duration 24 hours.

• Inject in separate sites from other insulin.

Levemir (detemir)

• Onset of action 1 hour.

• Peak action 3-14 hours.

• Duration between 12 and 20 hours.

Toujeo (glargine) 300 units/ml

• Onset of action initial dose up to 6 hours.

• Peak action no peak.

• Duration up to 36 hours.

Note the concentration Toujeo = 300 units/ml. Must not be injected with syringe. Only administer via solostar pen device

Toujeo is not indicated for children under the age 18.

Seek specialist advice before mixing insulin detemir with insulin aspart (Novorapid). These are physically compatible if administered immediately after mixing, however the effect of the insulin aspart will be altered (reduced and/or delayed maximum effect). The expected profile of insulin detemir may also be altered. Frequent monitoring and review of BGLs is required.

5. Pre-mixed long acting insulin with rapid acting insulin  - cloudy in appearance

• Humalog Mix 25 and Humalog Mix 50 (insulin lispro and protamine insulin)

• Novo Mix 30/70 (insulin aspart and protamine insulin)

Must be gently mixed by rotating before use

• Mix of rapid acting and long acting insulin.

• Onset of action 10 - 20 minutes.

• Peak action 1-4 hours.

• Duration 16-18 hours, up to 24 hours.

• Must be administered as the meal is served due to the presence of rapid acting insulin.

6.    Pre-mixed long acting insulin with short acting insulin  - cloudy in appearance
Humulin   30/70   (neutral insulin/isophane)               

Mixtard 30/70 or 50/50 (neutral insulin/isophane)

Must be gently mixed by rotating before use

• Administered half an hour before the prescribed meal.

• Onset of action 30 minutes.

• Peak action 2-12 hours 30/70.

• Peak action 4-8 hours 50/50.

• Duration 16-24 hours.

7.Pre mixed ultra long acting insulin with short acting

insulin -

Ryzodeg 70/30 (Insulin degludec and insulin aspart)

Administer once or twice daily with carbohydrate containing main meal.

Not indicated in paediatrics.

• Onset of action 10-20 minutes.

• Peak action 1-3 hours.

• Duration greater than 24 hours.

PROCESS STANDARDS:

KEYPOINTS:

ADMINISTRATION

Give insulin at specific times according to medical order. Take note of type of insulin to ensure correct time and preparation.

• Dose must be ordered in units, not U to avoid dosage errors

• Route of administration should be documented as subcutaneous not s/c

• Doses should be prescribed in words; for example ten units

• Many insulins have similar names and/or have numbers in the trade name. Beware confusing the name of the insulin with the prescribed dosage

• Query any unclear insulin orders prior to administration

Blood glucose level must be taken within 15 minutes before insulin is administered

• Insulin is a time critical medication and must be administered at the prescribed time.

• Treat hypoglycaemia as per CPP0268 Hypoglycaemia- Management of the Conscious and Unconscious Person

• Insulin dose may need to be reviewed in the setting of hypoglycaemia

• Basal insulin must not be omitted for patients with type 1 diabetes

• Basal insulin administration is not dependent on oral intake

Follow checking process for insulin in accordance with Grampians Health requirements

•  Ensure three approved patient identifiers are double checked at the bedside

• All insulin must be double checked at the bedside by nursing staff who are endorsed to administer insulin. The checking process to include insulin type, dose, time and expiry

Check expiry date and date of opening of insulin.

• Insulin should be discarded one month after opening regardless of the amount used
  

If a cloudy insulin is to be given, mix by gently rotating vial or pen with an up and down motion.

• Discard if the insulin does not fully re-suspend.

If a clear insulin is to be given, check that the insulin is not discolored and that no foreign matter is present.

• Discard if insulin is discolored or has foreign matter

The needle needs to be primed to clear it of air and check its function

• A 2 unit air shot is required to prime the needle for all insulin except Toujeo. If insulin is not expelled from the needle tip repeat step until insulin emerges from needle

• Prime Toujeo with 3 units insulin

• If a 4 or 8 units prime does not see insulin expelled from the tip, change the needle, device or syringe

Draw up correct dose as ordered and written on the medication chart by Doctor.

• Patients are encouraged to use their own insulin devices if able to self inject without any assistance. The attending nurse will need to confirm the correct dose, type of insulin, expiry and injection technique against the medical order. Patients are required to dispose of sharps into a sharps bin when self administering insulin

• If patients are unable to perform self injection adequately without assistance, a registered nurse needs to administer insulin dose

• Do not use a single use syringe for Toujeo as the concentration is 300 units/ml.

• If a registered nurse is using a pen device then a BD Auto Shield Duo Size 5 mm pen needle must be used. BD Duo Auto Shield must only be used for patients who cannot independently inject, attach and remove needle

Ensure site for injection is clean.

Inject subcutaneously, wait ten seconds and then withdraw needle. Discard syringe and needle in sharps container after each use.

Record nurse initials checking and time of injections on the medication chart.

If the patient is self administering, annotate the chart with "S" (for self administration) and initial that patient has been supervised throughout process.