Insulin: Nursing Pharmacology

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*High Alert Medications*
insulin aspart (Humalog), insulin lispro (NovoLog), insulin glulisine (Apidra)
regular insulin (HumuLIN R, NovoLIN R)
NPH insulin (HumuLIN N)
insulin glargine (Basaglar, Lantus), insulin detemir (Levemir)
insulin degludec (Tresiba)
Rapid-acting insulins
Short-acting insulins
Intermediate-acting insulins
Long-acting insulins
Ultra long-acting insulins
  • Bind insulin receptors on cells of adipose tissue and skeletal muscles  → stimulates glucose uptake from the blood into these cells
  • Stimulate glycogenesis, lipogenesis, amino acids uptake and protein synthesis
  • Stimulate Na+/K+ pump → potassium uptake into cells
  • Type 1 diabetes mellitus
  • Type 2 diabetes mellitus
  • Gestational diabetes
  • Diabetic complications (e.g., diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic coma)
  • SubQ
  • SubQ
  • IV
  • SubQ

  • SubQ

  • SubQ

  • Hypoglycemia
  • Lipodystrophy
  • Hypoglycemia
  • Elderly clients
  • Hepatic or renal disease
  • Vomiting or diarrhea
  • Infection
  • Fever
  • Surgery
  • Current weight, recent weight loss
  • Symptoms of diabetes: polyuria, polydipsia, polyphagia
  • Laboratory test results: blood glucose, hemoglobin A1C, urinalysis, renal and hepatic function; potassium

IV administration
  • Verify name and dose of medication with second nurse
    • Potassium level before and during treatment
  • Monitor for side effects
  • Therapeutic effect: improved glucose control; decreased symptoms of hyperglycemia
  • Purpose of medication: to help maintain blood glucose level within a normal range
  • Medication used along with antidiabetic regimen; e.g., glucose monitoring, regular activity, low-carbohydrate and high-fiber diet
  • Correct method of blood glucose monitoring; frequency of monitoring
    • Adjustments with insulin, meals, snacks, activity
    • Review sick day plan
  • Correct self-administration technique
    • Injection sites, including the posterior arm, abdomen, thigh
    • Inspect site for bruising, broken skin, or tenderness
    • Rotate site
  • Proper storage: unopened vials of insulin in refrigerator, vial in use at room temperature away from heat or direct sunlight
  • Wear medical alert identification
  • Recognize and respond to symptoms of hypoglycemia; e.g., hunger, fatigue, tremors, headache, dizziness,  confusion
    • Check blood glucose level
    • Consume half cup of fruit juice, three glucose tablets, or approximately 15 grams of sugar
    • Check blood glucose again in 15 minutes
  • Recognize and respond to symptoms of hyperglycemia; e.g., fatigue, blurred vision, increased thirst, appetite, and urination
    • Diabetic ketoacidosis, extremely high blood glucose level, nausea, excessive thirst, dry mouth, frequent urination, drowsiness, fruity-scented breath, confusion
    • Seek medical assistance


Insulin is a medication used to treat clients with diabetes mellitus. Now, there are two main types of diabetes mellitus. Type 1 diabetes mellitus arises when the pancreas is unable to produce insulin in order to maintain normal blood glucose levels.

On the other hand, type 2 diabetes mellitus is characterized by insulin resistance, which is when tissue cells have trouble responding to insulin in order to use glucose from the blood; as a result, tissue cells starve for energy despite having high blood glucose levels, which is called hyperglycemia.

Insulin is also used in the management of gestational diabetes, diabetic complications, like diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic coma, as well as in hyperkalemia.

Now, there are five main categories of insulin based on their onset of action and duration of effect. These include rapid-acting, short-acting or regular, intermediate-acting, long-acting, and ultra long-acting insulins.

All categories of insulin can be given subcutaneous injection or through an insulin pump, while the short-acting insulin can also be given intravenously.

Now the short-acting, or regular, insulin starts working 30 minutes after administration, with a peak effect at 2 to 3 hours, and can last between 6 to 8 hours.

Next, there’s rapid acting insulins which include insulin aspart, lispro, and glulisine. These medications begin working within 5 to 15 minutes of administration, with a peak effect at 30 minutes, and may last for 3 to 5 hours. Another rapid acting insulin is inhaled insulin, which can only be used as an adjunct to therapy with injected insulins, and never by itself.


  1. "Insulin" undefined (2021)
  2. "Focus on Nursing Pharmacology" LWW (2019)
  3. "Pharmacology" Elsevier Health Sciences (2014)
  4. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  5. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  6. "Giving an insulin injection" undefined (2020)

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