Endocrine System-Long-Acting Insulin Drugs

Name of the Long-Acting Insulin Drugs

• Insulin glargine
• Insulin detemir

1.Insulin glargine

Mechanism of Action

Long-acting insulin form. Promotes glucose transport, which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where it’s converted to glycogen. Directly affects fat and protein metabolism, stimulates protein

Pharmacokinetics

• Bioavailability: Delayed absorption from SC site
• Metabolism: Adipose tissue/muscle
• Excretion: Urine

Administration

• Be aware that insulin is a highalert drug.
• Give by subcutaneous route only, at same time each day.
• Don’t mix in solution with other drugs, including other insulins.
• Before drawing up insulin into syringe, roll vial between hands to ensure uniform dispersion; don’t shake.
• Rotate injection sites to prevent lipodystrophy

Contraindications

•   Hypersensitivity to drug or its components
•   Hypoglycemia

Precautions:

• Pregnant or breastfeeding patients
• Children.

Adverse reactions

• Metabolic: rebound hyperglycemia (Somogyi effect), hypoglycemia
• Skin: urticaria, rash, pruritus, redness, stinging, or warmth at injection site
• Other: edema, lipodystrophy, lipohypertrophy, allergic reactions including anaphylaxis

Patient monitoring

• Monitor blood glucose level frequently to assess drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
• Check for signs and symptoms of hypoglycemia (such as CNS changes). Keep glucose source at hand.

Administration

• Be aware that insulin is a high alert drug.
• Given by subcutaneous route only, at same time each day.
• Don’t mix in solution with other drugs, including other insulins.
• Before drawing up insulin into syringe, roll vial between hands to ensure uniform dispersion; don’t shake.
• Rotate injection sites to prevent lipodystrophy

Contraindications

•   Hypersensitivity to drug or its components
•   Hypoglycemia

Precautions:

• Pregnant or breastfeeding patients
• Children.

Adverse reactions

• Metabolic: rebound hyperglycemia (Somogyi effect), hypoglycemia
• Skin: urticaria, rash, pruritus, redness, stinging, or warmth at injection site
• Other: edema, lipodystrophy, lipohypertrophy, allergic reactions including anaphylaxis

Patient monitoring

• Monitor blood glucose level frequently to assess drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
• Check for signs and symptoms of hypoglycemia (such as CNS changes). Keep glucose source at hand.
• Monitor for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (blood and urine ketones, metabolic acidosis, extremely elevated glucose level, hypovolemia).
• Monitor for glycosuria.
• Closely monitor kidney and liver function test results in patients with renal or hepatic impairment.

Patient teaching

• Instruct patient how to administer insulin subcutaneously.
• Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to always carry glucose source.
• Advise patient to rotate subcutaneous injection sites and keep a record of sites used.
• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
• Inform patient that changes in diet, activity, and stress level can affect blood glucose level and insulin requirements.
• Advise patient to wear medical identification stating that he is diabetic and takes insulin.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above

2.Insulin detemir

Mechanism of Action

Regulates glucose metabolism

Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production; insulin inhibits lipolysis and proteolysis and enhances protein synthesis; targets include skeletal muscle, liver, and adipose tissue

Pharmacokinetics

• Bioavailability: 60% SC; well absorbed
• Protein bound: 98% bound to albumin
• Half-life: 5-7 hr (dose dependent)

Administration

• Be aware that insulin is a high alert drug.
• Give by subcutaneous route only, at same time each day.
• Don’t mix in solution with other drugs, including other insulins.
• Before drawing up insulin into syringe, roll vial between hands to ensure uniform dispersion; don’t shake.
• Rotate injection sites to prevent lipodystrophy

Contraindications

•   Hypersensitivity to drug or its components
•   Hypoglycemia

Precautions:

• Pregnant or breastfeeding patients
• Children.

Adverse reactions

• Metabolic: rebound hyperglycemia (Somogyi effect), hypoglycemia
• Skin: urticaria, rash, pruritus, redness, stinging, or warmth at injection site
• Other: edema, lipodystrophy, lipohypertrophy, allergic reactions including anaphylaxis

Patient monitoring

• Monitor blood glucose level frequently to assess drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
• Check for signs and symptoms of hypoglycemia (such as CNS changes). Keep glucose source at hand.
• Monitor for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (blood and urine ketones, metabolic acidosis, extremely elevated glucose level, hypovolemia).
• Monitor for glycosuria.
• Closely monitor kidney and liver function test results in patients with renal or hepatic impairment.

Patient teaching

• Instruct patient how to administer insulin subcutaneously.
• Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to always carry glucose source.
• Advise patient to rotate subcutaneous injection sites and keep a record of sites used.
• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
• Inform patient that changes in diet, activity, and stress level can affect blood glucose level and insulin requirements.
• Advise patient to wear medical identification stating that he is diabetic and takes insulin.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above

REFERENCES

1. Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
2. McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
3. April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
4. Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
5. Nursebro.com, Search – Nursebro

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