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INTRODUCTION

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HIGH ALERT

insulin, regular (injection, concentrated) (in-su-lin)

Humulin R, Image not available.Insulin-Toronto, Novolin R, Iletin II Regular, Velosulin BR, Humulin R Regular U-500 (Concentrated)

Classification

Therapeutic: antidiabetics, hormones

Pharmacologic: pancreatics

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Indications
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Control of hyperglycemia in patients with diabetes mellitus. Concentrated regular insulin U-500: Only for use in patients with insulin requirements >200 units/day. Unlabeled Use: Treatment of hyperkalemia.

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Action
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Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. Other actions of insulin: inhibition of lipolysis and proteolysis, enhanced protein synthesis. Therapeutic Effects: Control of hyperglycemia in diabetic patients.

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Adverse Reactions/Side Effects
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Endo: HYPOGLYCEMIA. Local: lipodystrophy, pruritus, erythema, swelling. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of hypoglycemia, especially during and after exercise. Common neuromuscular symptoms include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.

  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

  • Assess blood pressure periodically (see Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management, and should be reported to the physician.

  • Assess body weight periodically. Changes in weight may necessitate changes in insulin dose.

  • Assess injection site for redness, swelling, or other reactions. Make sure patient understands the need to rotate injections sites to prevent local damage and lipodystrophy.

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Interventions
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  • Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).

  • Provide a source of oral glucose (fruit juice, glucose gels/tablets, etc.) to treat mild hypoglycemia. Call for emergency assistance if symptoms persist or in cases of severe hypoglycemia. Emergency treatment typically consists of IV glucose, glucagon, or epinephrine.

  • Do not apply physical agents (heat, cold, electrotherapeutic modalities) or massage at or near the injection site; these interventions will alter insulin absorption from subcutaneous tissues.

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Patient/Client-Related Instruction
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  • Encourage patient to monitor blood glucose before and after exercise and to adjust insulin dose accordingly based on exercise duration and intensity.

  • Emphasize the importance of adhering to nutritional guidelines and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) throughout the management of diabetes mellitus.

  • Advise patient about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; ...

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