Understanding Aspart (NovoRapid) Insulin And Type-1 Diabetes Mellitus

1. Explain the 11 components of a valid routine subcutaneous insulin medication order and why this is important. Support your answer with academic or clinical guideline references.

2.Explain why Ben has been prescribed this medication.Relate to pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid insulin. Support your answer with academic references.

3. What is the onset, peak and durationof action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administeredin relation to food intake and why.Support your answer with academic references.

Aspart (NovoRapid) insulin and its mode of action

Aspart (NovoRapid) insulin is rapid acting insulin. It gets quickly absorbed within the body fluid and starts working within 10 to 20 minutes post injection.. Ben was given Aspart (NovoRapid) in order to control his high blood glucose level (BGL: 26.0mmol/L). The family history of Ben indicates that he has genetic pre-disposition of autoimmune disease with his mother have hyperthyroidism and Graves’s disease. When type-1diabetes is an autoimmune disease, there occurs an autoimmune destruction of the beta cells of Islet of Langerhans. Beta cells of Islet of Langerhans is the main cite if insulin production in the pancreas (Paschou, Papadopoulou-Marketou, Chrousos & Kanaka-Gantenbein, 2018). So, when beta cells are destroyed no insulin is produced within the body in order to respond to glucose uptake. Hence Aspart (NovoRapid) insulin was provided, which will immediately act as a substitute of pancreatic insulin and will promote uptake of glucose by the hepatic cells (Paschou, Papadopoulou-Marketou, Chrousos & Kanaka-Gantenbein, 2018).

1. What is the onset, peak and durationof action for NovoRapid insulin according to Bullock and Manias (2017)? Explain when NovoRapid should be administeredin relation to food intake and why.Support your answer with academic references. (5 marks)

According to Bullock and Manias (2013) Insulin aspart (novorapid) is ultra short acting insulin with onset time: 0 to 0.25 hours; peak effect: 1 to 3 hours; duration: 3.5 to 5 hours. NovoRapid must be given in relation to food intake. When consumption of carbohydrate or sugar is high blood glucose content of the body increases immediately. Under this condition in order to avoid hyperglycemia shock in type-1 diabetes patients, NovoRapid is given (Bullock & Manias, 2013).

2. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a common adverse effect of NovoRapid.Support your answer with academic references. (5 marks)

Definition: Hypoglycemia occurs when the blood sugar level drops below the normal (Seaquist et al., 2013).

Cause: Hypoglycemia mainly arises from the side effects of insulin or other types of anti-diabetic medication. However, other type of anti-diabetic medications do not directly cause hypoglycemia, they only increase the chances of developing hypoglycemia when given along with insulin (Seaquist et al., 2013).

Symptoms: The symptoms of hypoglycemia vary from person to person. Common mild to moderate symptoms include headache, confused or disoriented, sweating, blurred vision, tired, shaky or jittery, fast or irregular heartbeat, difficulty in concentrating and changed behavior or personality. Severe symptoms include unable to eat or drink, seizures and jerky movements (convulsions) and unconsciousness (Seaquist et al., 2013).

Treatment: Immediate intake of sugar or glucose when the blood glucose level drops below the normal range can help to prevent the consequences of hypoglycemia. Other procedures, which must be used to prevent hypoglycemia, include proper monitoring of blood glucose level and regulation of the diet plan (Seaquist et al., 2013).

Impact of Type-1 Diabetes Mellitus on individuals

3. Discuss the importance of understanding the medication prior to administration. Support your answer with academic references. (5 marks)

It is important to understand the medication before administration. Understanding of the medication mainly include proper knowledge of the mode of action of the medication, route of administration, dosage requirement based on height, weight and age of the patient and the possible side-effects of the medication (World Health Organization, 2013). Proper knowledge about the medication helps in proper medication management. This helps to avoid post medication complications and thereby helping to increase patient’s safety (World Health Organization, 2013).

4. Discuss the 5 rights of medication administration and why it is important for nurses to follow this procedure. Support your answer with academic references. (5 marks)

Five rights for medication administration include right patient, right drug, right time, right dose and right route. These five rights are principle standards for the safe medication practice by the nursing professionals (Institute for Healthcare Improvement, 2018). It is important for the nursing professionals to follow these five different rights for medication administration in order to avoid the chances of the medication error. Medication error are fatal and apart from endangering the life of the patients, also increases the overall healthcare cost (Kim & Bates, 2013).

5. What is the most appropriate insulin pen needle length for Ben and why? Support your answer with academic references. (5 marks)

Appropriate insulin pen needle in case of Ben will be less than 4 mm. This is because; Ben is prescribed for subcutaneous insulin. The average thickness of skin less than 2.8mm and hence the needle length must be smaller than 4mm. Needle length higher than 4 mm might increase the chance of getting intramuscular injection (Hirsch, Byron & Gibney, 2014).

6. What diabetes specific nursing assessment would you conduct prior to administration of NovoRapid insulin to Ben and why? Support your answer with academic references. (5 marks)

The diabetic specific nursing assessment for Ben before administration of NovoRapid will be assessment of the patient knowledge about the disease and medication. This will help to draft the care plan in order to manage emergency like hypoglycemia or hyperglycemic shock (Tallis et al., 2013).

7. Identify the site and angle you would inject the NovoRapid insulin and explain why this was selected for Ben. Discuss infection control considerations. Support your answer with academic references.  

Angle: 45-degree angle from the body

Rationale: Ensures proper support of the wrist while injecting medication

Site: Abdomen (avoiding 2-inch radius around umbilicus)

Rationale: Because the layer of skin is of medium thickness surrounding the stomach with more surface area (Home, 2015)

Infection control consideration

(i) Use of sterile needle or single use needle

(ii) Observance of proper hand hygiene before and after injection via using hand disinfectant

(iii) Disinfection of the site of the injection (Frid et al., 2016) 

8. What would you document and where? Why is documentation important? Support your answer with academic or clinical guideline references.  

Documentation must be done in patient records (Marcum, Sevick & Handler, 2013)

Points to be documented include

• Name of the medication with brand name
• Dosage of the medication
• Time of administration
• Route of administration
• BGL before and after medication administration
• Time of breakfast, lunch and dinner (Marcum, Sevick & Handler, 2013)

Proper documentation helps to increase patient’s safety and avoiding the chances of medication error (Marcum, Sevick & Handler, 2013). 

9. Explain the diabetes specific nursing assessment you would provide for Ben post administration of insulin, when you would provide it and why. Support your answer with academic references. (5 marks)

Checking blood glucose level of Ben: 3 hours after the subcutaneous administration of insulin (NovoRapid). The time span is selected 3 hours because the half-life of NovRapid is 3 hours. Proper monitoring of blood glucose post insulin administration will help to avoid the chances of hypoglycemia shock (Blair, 2016). 

Symptoms, causes, and treatment of hypoglycemia

Discuss the potential impact of type 1 diabetes on Ben. 

1. Discuss the daily physical challenges of living with type 1 diabetes that Ben may face.Support your answer with academic references.  

Daily physical challenges of living with diabetes include frequent urination (diabetes insipidus), difficulty in concentrating, fatigue, headache, increase in hunger and thrust (Zimmet, Magliano, Herman & Shaw, 2014). These physical challenges will prevent Ben from concentrating in his studies and playing football. Moreover, while playing football hi hunger will increase further and he might end up in consuming more food and thereby increasing his glycemic index (Zimmet, Magliano, Herman & Shaw, 2014). 

2. Discuss potential emotional impacts of living with type 1 diabetes that Ben may face.Support your answer with academic references. (5 marks) 

Emotional impact of diabetes over Ben includes constant concern over the potential threat of hypoglycemia and feeling depressed while having a diabetic meal with other friends who are enjoying their normal meal. Ben might also feel diabetic burnout resulting from stress of managing everyday demands of diabetes. This will hamper Ben’s mental health well-being (Zimmet, Magliano, Herman & Shaw, 2014). 

Reference list

Australian Commission on Safety and Quality in Health Care. (2012) User Guide to National Subcutaneous Insulin Form. Access date: 28^th August 2018. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2012/11/Attachment-2-National-Insulin-Subcutaneous-Form-User-Guide-Nov-2012.pdf

Blair, M. (2016). Diabetes Mellitus Review. Urologic nursing, 36(1). Retrieved from: https://web.b.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=1053816X&AN=113452049&h=405M5CorSyHhjJZw2RvJm5%2fnziD2A%2fjFzMcVxOQvjGQPIOZH%2fXNtXDboHxWzT9RtEfkUDAGBLvhVkPpJhv5WMw%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d1053816X%26AN%3d113452049

Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education AU. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=ODjiBAAAQBAJ&oi=fnd&pg=PP1&dq=Fundamentals+of+Pharmacology,+8th,+Bullock,+Shane+%26+Manias&ots=WJccN9Fb5V&sig=XQvMvqd9L8A0_zIACS_HjUYLrOg#v=onepage&q=NovoRapid%20insulin%20&f=false

Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., ... & Kalra, S. (2016, September). New insulin delivery recommendations. In Mayo Clinic Proceedings (Vol. 91, No. 9, pp. 1231-1255). Elsevier. https://doi.org/10.1016/j.mayocp.2016.06.010

Hirsch, L., Byron, K., & Gibney, M. (2014). Intramuscular risk at insulin injection sites—measurement of the distance from skin to muscle and rationale for shorter-length needles for subcutaneous insulin therapy. Diabetes technology & therapeutics, 16(12), 867-873. https://doi.org/10.1089/dia.2014.0111

Home, P. D. (2015). Plasma insulin profiles after subcutaneous injection: how close can we get to physiology in people with diabetes?. Diabetes, Obesity and Metabolism, 17(11), 1011-1020. https://doi.org/10.1111/dom.12501

Institute for Healthcare Improvement. (2018). The Five Rights of Medication Administration. Access date: 28^th August 2018. Retrieved from:  https://www.ihi.org/resources/Pages/ImprovementStories/FiveRightsofMedicationAdministration.aspx

Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), 590-598. https://doi.org/10.1111/j.1365-2702.2012.04344.x

Marcum, Z. A., Sevick, M. A., & Handler, S. M. (2013). Medication nonadherence: a diagnosable and treatable medical condition. Jama, 309(20), 2105-2106. doi:10.1001/jama.2013.4638

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine connections, 7(1), R38-R46. doi:  10.1530/EC-17-0347

Seaquist, E. R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., ... & Vigersky, R. (2013). Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes care, DC_122480. https://doi.org/10.2337/dc12-2480

Tallis, A., Motley, T. A., Wunderlich, R. P., Dickerson Jr, J. E., Waycaster, C., Slade, H. B., & Collagenase Diabetic Foot Ulcer Study Group. (2013). Clinical and economic assessment of diabetic foot ulcer debridement with collagenase: results of a randomized controlled study. Clinical therapeutics, 35(11), 1805-1820. https://doi.org/10.1016/j.clinthera.2013.09.013

World Health Organisation. (2013). Improving medication safety. Access date: 28^th August 2018. Retrieved from: https://www.who.int/patientsafety/education/curriculum/who_mc_topic-11.pdf

Zimmet, P. Z., Magliano, D. J., Herman, W. H., & Shaw, J. E. (2014). Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology, 2(1), 56-64.