C H A P T E R 3 8
Agents to control blood glucose levels
583
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Assess activity level, including amount and degree
of exercise,
which could alter anticipated response
to insulin therapy.
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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.
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Obtain blood glucose levels as ordered
to monitor
response to insulin and need to adjust dose as
needed.
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Monitor the results of laboratory tests, including
urinalysis,
for evidence of glucosuria.
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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.
Implementation with rationale
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Ensure the person is following a dietary and
exercise regimen and using good hygiene practices
to improve the effectiveness of the insulin and
decrease adverse effects of the disease.
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Gently rotate the vial containing the agent
and avoid vigorous shaking
to ensure uniform
suspension of insulin.
■
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Select a site that is free of bruising and scarring
to
ensure good absorption of the insulin.
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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.
■
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Monitor response carefully
to avoid adverse
effects
; blood glucose monitoring is the most
effective way to evaluate insulin dose.
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■
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.
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Always verify the name of the insulin being given
because each insulin has a different peak and
duration, and the names can be confused.
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■
Use caution when mixing types of insulin;
administer mixtures of regular and isophane or
regular and lente insulins within 15 minutes after
combining them
to ensure appropriate suspension
and therapeutic effect.
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■
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.
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■
Monitor during times of trauma or severe stress
for
potential dose adjustment needs.
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■
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.
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■
Monitor the person’s sensory losses
to
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.
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■
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.
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■
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 response to the drug
(stabilisation of blood glucose levels).
■
■
Monitor for adverse effects (hypoglycaemia,
ketoacidosis, injection-site irritation).
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■
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).
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■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
