McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 3 8 Agents to control blood glucose levels

■ ■ Assess activity level, including amount and degree of exercise, which could alter anticipated response to insulin therapy. ■ ■ Inspect skin areas that will be used for injection of insulin; note any areas that are bruised, thickened or scarred, which could interfere with insulin absorption and alter anticipated response to insulin therapy. ■ ■ Obtain blood glucose levels as ordered to monitor response to insulin and need to adjust dose as needed. ■ ■ Monitor the results of laboratory tests, including urinalysis, for evidence of glucosuria. ■ ■ Assess level of cognitive ability and dexterity in planning for education related to the condition. Refer to the Critical thinking scenario for a full discussion of care for a person with type 1 diabetes mellitus. exercise regimen and using good hygiene practices to improve the effectiveness of the insulin and decrease adverse effects of the disease. ■ ■ Gently rotate the vial containing the agent and avoid vigorous shaking to ensure uniform suspension of insulin. ■ ■ Select a site that is free of bruising and scarring to ensure good absorption of the insulin. ■ ■ Give maintenance doses by the subcutaneous route only (see Focus on safe medication administration under Pharmacokinetics for insulin), and rotate injection sites regularly to avoid damage to muscles and to prevent subcutaneous atrophy. Give regular insulin intramuscularly or intravenously in emergency situations. ■ ■ Monitor response carefully to avoid adverse effects ; blood glucose monitoring is the most effective way to evaluate insulin dose. ■ ■ Monitor the person for signs and symptoms of hypoglycaemia, especially during peak insulin times, when these signs and symptoms would be most likely to appear, to assess the response to insulin and the need for dose adjustment or medical intervention. ■ ■ Always verify the name of the insulin being given because each insulin has a different peak and duration, and the names can be confused. administer mixtures of regular and isophane or regular and lente insulins within 15 minutes after combining them to ensure appropriate suspension and therapeutic effect. ■ ■ Use caution when mixing types of insulin; Implementation with rationale ■ ■ Ensure the person is following a dietary and

■ ■ Store insulin in a cool place away from direct sunlight to ensure effectiveness . Pre-drawn syringes are stable for 1 week if refrigerated; they offer a good way to ensure the proper dose for people who have limited vision. ■ ■ Monitor during times of trauma or severe stress for potential dose adjustment needs. ■ ■ Monitor food intake; ensure that the person eats when using insulin to ensure therapeutic effect and avoid hypoglycaemia. ■ ■ Monitor exercise and activities; ensure that the person considers the effects of exercise in relationship to eating and insulin dose to ensure therapeutic effect and avoid hypoglycaemia. ■ ■ Protect the person from infection, including good skin care and foot care, to prevent the development of serious infections and changes in therapeutic insulin doses. incorporate his or her needs into safety issues, as well as potential problems in drawing up and administering insulin . ■ ■ Help the person to deal with necessary lifestyle changes, including diet and exercise needs, sensory loss and the impact of a drug regimen that includes giving injections, to help encourage compliance with the treatment regimen. ■ ■ Instruct people receiving beta-blockers about ways to monitor glucose levels and signs and symptoms of glucose abnormalities to prevent hypoglycaemic and hyperglycaemic episodes when SNS and warning signs are blocked. ■ ■ Provide thorough teaching, including diet and exercise needs; measures to avoid adverse effects, including proper food care and screening for injuries; warning signs of problems, including signs and symptoms of hypoglycaemia and hyperglycaemia; the importance of increased screening when ill or unable to eat properly; proper administration techniques and proper disposal of needles and syringes; and the need to monitor disease status, to enhance knowledge about drug therapy and promote compliance. Evaluation ■ ■ Monitor the person’s sensory losses to ■ ■ Monitor the person’s response to the drug (stabilisation of blood glucose levels). ■ ■ Monitor for adverse effects (hypoglycaemia, ketoacidosis, injection-site irritation). ■ ■ Evaluate the effectiveness of the teaching plan (person can name drug, dosage, adverse effects to watch for, specific measures to avoid them and proper administration technique). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen.