09.04 Insulin

Okay, so, in this video, we gonna talk about the insulin, different types of insulin, what is the peak time, what is the onset of action time and how long they will last. We really need to know all those 3 things only. We don’t really need to go in detail about the mechanism of action because it is at a cellular level. And, as nurses, we don’t really need to know. Now, NCLEX questions on insulin are focused usually on like, let’s say, for example, talk about the rapid acting insulin. If you give this patient rapid acting insulin at 8 o’clock and the onset of action is within 15-20 minutes but its peak time is 1-3 hours after you give. So, when will you look for the hypoglycemia symptoms? So, when you give it at 8 o’clock, look for the hypoglycemia symptoms between 9 o’clock to 11. So, that’s what it actually ask for, doesn’t go in detail. And there’s also one question they like to ask about the insulin is how do you mix a clear insulin and a cloudy insulin, for example, regular insulin and NPH. Regular is clear and NPH is cloudy. And we’ll go in detail about that one too in this video how to mix those. And the only one insulin we cannot mix with any other insulin is the long acting. So, we can’t really mix any any any insulin with long acting or it cannot be mixed with any other as well.

Alright, so, the first one. Rapid Acting. We got three different types of rapid acting insulin. Insulin Aspart, Insulin Lispro and Insulin Glulisine. This one is not really been used very often. I have seen Insulin Aspart and Insulin Lispro all the time, so we gotta cover only those two on this video.

Let’s talk about the Insulin Aspart. Rapid acting insulin. Insulin Aspart, also known as a Novolog. The onset of action is 10-20 minutes and the peak time is 1-3 hours after you give it. So, let’s say you give this medication, this insulin at 9 o’clock to the patient. Then, it will start working from 9:10 to 9:20, anytime between that, and its peak time will be from 10 o’clock to 12 o’clock. So, the symptom for hypoglycemia, as a nurse, you’ll look for, you’ll be looking between 10-12 because its its peak time is between 1-3 hours after you give it. And duration is 3-5 hours it will last. It is clear, so if you have a rapid acting insulin aspart, if it is cloudy, then don’t use it, that’s supposed to be clear. And, it can be mixed with the NPH.

Rapid acting, another type is Insulin Lispro. The onset of action is a little bit faster, Lispro has 5-15 minutes. The peak time which is 1 - 1.5 hours. So, if you give it at 9 o’clock, you’ll be looking for the hypoglycemia symptoms between 10 - 10:30. Okay. Duration is 3-4 hours and the color is clear.

The next category is short acting. It includes the Insulin Regular also known as Humulin R or Novolin R. The onset of action is 30-60 minutes, the peak time is 1-5 hours, so, this is like a little bit long range to look for the hypoglycemic symptoms. So, if you give it at 9 o’clock, you wanna look for signs and symptoms of hypoglycemia between 10 o’clock all the way to (10, 11, 12, 1, 2, 3) so, 1500. I believe so. No, my mistake. 0900 to 1400, because this is 9 o’clock. Could be 10 o’clock and 5 hours will be 1400. So, you’ll be looking for hypoglycemic symptoms in between these hours. And last it a little bit longer, it has a longer duration of action, 6 - 10 hours. It is clear. The only difference with this insulin compared to other ones, this insulin, you can give IV. This is the only insulin you can give in IV. It’s a really important thing to remember. You cannot give any other insulin through IV, only the regular. So, probably, if you have studied about the DKA, diabetes ketoacidosis or hyperosmolar hyperglycemia syndrome, HHS or DKA, blood sugar is really really high like DKA,I believe it’s more than around like 400 - 600. HHS is really even higher like 800 blood sugar. Then, you would start them on IV insulin drip which will be Insulin Regular. Because you cannot give any other insulin by IV, all other insulins are given subq. This one, it can be given as a subq or IV. It’s an important thing to remember. And you can mix it with sterile water and normal saline. So, you will mix it with a normal saline and put in a bag and give as a drip. Okay.

The next one is Intermediate Acting Isophane Suspension also known as NPH or Humulin N. The onset of action is 1-2 hours. The peak time is 6-14 hours, it lasts a little bit longer like 16-14 hours and the color of this insulin is cloudy. This is the difference, okay? Now, as we talk, like NCLEX may ask you a question how to mix. Let’s say you have a, this is a bottle, this is Regular Insulin and this is NPH and you wanna mix regular insulin and NPH. Clear, cloudy, okay? So, how do you mix these? You wanna mix 3 units of regular with 2 units (let’s say, I’m just drawing some numbers) of NPH. How do you mix it? Do you take NPH first and then go to regular or do you take regular first and go to the NPH? Let’s think about it. If you take some insulin out of the NPH, so, you have a cloudy insulin in your syringe, now if you try, and then if you put the same syringe in the regular, try to draw a regular which is clear. What if, by mistake, you draw some cloudy insulin in the regular? The solution will become cloudy. It’s not bad, but it will become cloudy, that means, you cannot use that insulin anymore. That’s why, when you are mixing insulin, you do not want to go from cloudy to clear at all. You wanna go from clear to cloudy. So, let’s talk about mixing 3 units of Regular Insulin with 2 units of NPH. Well, you have a syringe, let’s say this is a syringe, a plunger, now, 5 units (1,2,3,4,5) because you want 3 + 2, 5 units. So, you gonna pull out up to here and have that 5 this much air, you gotta put a needle in the regular insulin, you gonna insert about 3 units of air into this regular unit and draw 3 units out of it. Then you gonna go into NPH, put the remaining 2 units of amount of air and then draw the NPH. So, draw regular first, NPH. So, that’s the order. Like, pull this plunger back up to the 5 units, so, you can put that much here, that’s 3 + 2. Take out, insert air to the regular unit, take out 3 units, go to the NPH and take NPH. Okay, that’s a really important question and have seen NCLEX ask me this question, or generally ask me, like in exams, in nursing school exams. This is an important question to remember.

Then, Rapid Acting is, I think I mix this one right here. We gonna cover on this one like, I think, as we talk about the rapid acting insulin. There are 3 types of insulin, aspart, lispro and glulisine and this is a rapid acting. 15-30 minutes. Peak time is 1 hour. Duration is 3-4 hours. It’s clear. It can be mixed with NPH.

The long acting, the last one, is long acting and it’s Insulin Detemir, also known as Levemir. The peak time is 6-8 hours and duration is up to 24 hours. This one is clear. It cannot be mixed with any other insulin. Long acting insulin cannot be mixed with any other insulin.

There’s another type of insulin, long acting, it’s Insulin Glargine. The onset of action is 1 hour, there’s no peak, just the same level for 24 hours. There’s no peak. Color is clear. And the same, do not mix long acting insulin with any other insulin.

Okay, that was a video about the insulin. If you have any questions about the insulin, let us know and thank you for watching.