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(bright music)

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- Now as far as diabetic treatments, guys

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we're gonna cover all[br]the diabetic pharmacology

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including the seven rules of insulin.

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So write these down.

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These are the most tested.

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So remember, Type One

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we have none or no insulin.

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The body destroyed the pancreas

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so they are insulin dependent for life.

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And Type Two, the[br]problem is you, your diet

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and a little bit of genetics.

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So remember Type Two, we have[br]few insulin receptors working.

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So the first treatment is[br]to fix you, your habits.

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So we focus on diet

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and exercise to help repair[br]those broken receptors

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aka increase insulin sensitivity.

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Then we give drugs like[br]oral meds and insulin

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but only if diet and exercise,[br]don't manage it alone.

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So for our seven insulin[br]rules, peaks equals plate guys.

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Typically we give food during[br]a peak since the greatest risk

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for low sugar is during[br]those insulin peaks.

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Guys, the number one[br]way to kill your patient

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is not giving food during the peaks.

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So know your peak times.

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During peaks we monitor for[br]that low sugar, sugar below 70.

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Now number two, if you[br]get low sugar below 70

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or if your patient looks shaky

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or trembly, the classic[br]signs pale, cool, sweaty

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or even clammy, give that[br]patient some sugary candy.

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The priority key terms again,[br]are the A's and the S's.

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If your patient is awake

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ask them to eat, always[br]sugary food here guys.

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So soda, juices, crackers,[br]and low fat milk.

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Not high fat milk or peanut butter.

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Guys, fat will slow the[br]sugar absorption here.

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And if they're sleeping, then[br]we stab them with IV D50.

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Sleeping means unresponsive[br]or unarousable,

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responsive only two painful stimuli.

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So don't just go stabbing[br]sleeping diabetics here, guys

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always assess the sugar[br]and symptoms first.

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And after you give sugar, always[br]reassess 15 minutes later,

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we always follow up after any intervention

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always checking the[br]sugar and the symptoms.

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Now the third rule, insulin[br]with no peaks and no mixes.

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It's our long acting dudes.

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Guys, the memory trick is the old dudes

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like grumpy old men who have[br]been here for a long time

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they're past their peak and[br]they never mix well with others.

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They're basically antisocial.

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So the keywords, draw up[br]in two separate syringes.

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So remember, Detemir lasts all year

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and Glargine is large, lasting

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and Lantus is like a[br]lanturn, it burns all night.

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Now number four here guys,[br]a big NCLEX favorite.

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They're gonna try and trick you.

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So the IV only insulin is regular insulin.

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So remember a memory trick here.

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Regular insulin is ready to go IV

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or regular is right in the vein.

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Not NPH, not Lispro, not Lantus guys.

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No one except regular.

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He's the VIP for the IV.

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Now number five, we draw up[br]insulin always clear to cloudy.

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Guys, just think you want clear days

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before you want cloudy ones.

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So draw up regular insulin first

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the clear and then NPH the cloudy second.

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Six, we rotate locations[br]every two or three weeks

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and the best location is[br]always on the abdomen.

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Keywords here near the[br]Umbilicus, naval or belly button.

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And guys, we never aspirate.

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Basically never draw back on that plunger.

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It'll cause scar tissue and swelling.

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And also we never massage

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or add heat after sub-Q injections.

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Now lastly, number seven, DKA

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the extreme high sugar[br]condition in type one diabetes.

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Guys, we have a separate video for that

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but here's the big NCLEX question here.

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Do we give insulin on sick days?

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What if the patient's not eating

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or basically too nauseous to eat?

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Well, yes, we give insulin without food

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we just monitor that glucose closely.

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So remember, we always[br]increase the insulin

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during the Ss, like stress, like surgery

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sepsis or infection, and[br]even sickness and steroids.

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Now, as far as insulin types

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who put sugar and[br]potassium into the cells.

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Now these are must knows[br]for the NCLEX specifically

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the peak times, coming up 60%

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of the time and all endocrine questions.

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And a little FYI for the NCLEX guys

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we're not using brand names anymore.

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Only generic.

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So no more Novolog or Novolin.

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If your school's still using this

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then they're behind on the times.

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So again, for reinforcement

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our first group is the long acting guys

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our antisocial old dudes, guys

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they have no peak and[br]never mix with others.

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Big NCLEX keyword again

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draw up in separate syringes, never mix.

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These guys have no peaks,[br]so they require no plates

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or basically they're not food dependent

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and hence they have a minimal risk

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for that hypo low sugar.

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So the brain is pretty safe here.

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Again, our memory trick here[br]is Detemir lasts all year.

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It's long lasting and[br]Glargine is large lasting.

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Now NPH are cloudy,[br]dude, always being mixed.

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So remember the Ns intermediate insulin

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and we never give it IV drip or bag.

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Guys never put anything[br]cloudy in an IV bag.

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Now when we do mix it[br]always mix clear to cloudy,

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clear days before cloudy.

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So we usually give NPH two times per day

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not four times a day.

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So don't let the NCLEX trick you.

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Now the peak time is[br]between four and 12 hours

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but most dangerous in the[br]middle, around five to six hours.

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So make sure you have a[br]plate of food with that peak.

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Next is regular insulin,[br]that's ready to go IV.

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Guys again, he's the only dude[br]allowed IV push or IV bag.

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If you haven't wrote that[br]down, please write it down.

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His peak is between two and four hours.

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So monitor closely for signs

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of low sugar, that shaky,[br]pale, cool, and clammy.

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We need to give some sugary candy.

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Now finally, our most deadly insulins.

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They're the number one priority

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since they have the[br]number one fastest peak

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and onset, 15 minute onset guys[br]with a 30 to 90 minute peak.

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So rapid acting insulin.

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Remember, Lispro, Aspart and Glulisine.

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So memory tricks here for Aspart

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you gotta remember to move your ASS-parts.

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Guys, it's really fast.

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And Lispro, Just think LESSpro,

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less time for the onset it's 15 minutes.

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And Glulisine, it goes[br]fast like a limousine.

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It's super fast.

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So we give these during meals.

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Keyword here,

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patient is eating or[br]there's food at the bedside.

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Again, guys, patient must be[br]eating in 10 to 15 minutes,

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not before the food's delivered.

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Usually an NCLEX question.

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Those peak times are the[br]must knows for the NCLEX.

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So I'd recommend printing[br]this study guide out

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and reviewing it every day[br]at the week of your exam.

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Now, little insulin quiz.

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We're covering the top three[br]most tested NCLEX questions

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on peak times.

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Here we go.

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Again, peaks are priorities.

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The fastest way to kill your[br]patient is not giving a plate

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of food with the peaks.

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So remember, peaks require plates.

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So we drew a little plate on[br]the flag showing the peak time.

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Now our red rapid guys[br]are the most deadly.

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Always monitor for hypoglycemia,[br]that low sugar below 70

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you're gonna see shaky,[br]sweaty, pale, and clammy.

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So we give that patient some[br]sweet juice, soda, or candy.

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Okay, question number one,

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The nurse gives regular[br]insulin at 12:00 PM for lunch

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but the patient doesn't finish their food.

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So when's the greatest[br]risk for that hypoglycemia?

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Guys, the risk for regular,

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look at the peaks right[br]here, two to four hours.

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So if given at 12, the answer's

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between 2:00 PM and 4:00 PM[br]never before and not after.

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So guys memorize these peak times.

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Now, question number two, A[br]client is on Aspart insulin,

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when should the nurse advise him to eat?

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Again, guys, this is[br]an onset of 15 minutes

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with apeak time between 30 to 90 minutes.

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So Aspart get your ASS-parts moving

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the best answer is the soonest.

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So eating within 10 or 15 minutes.

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Now question number three, the client

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on Glargine is asking the nurse

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When is the best time to[br]eat during this insulin?

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Well, guys, Glargine is large lasting,

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long acting, no peaks.

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So no peaks require no plates.

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Pretty tricky one there.

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Now for a little bonus question

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we saw this a few times[br]in our NCLEX review.

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So the client taking insulin[br]NPH with dinner at 7:00 PM

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What time is the client most

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at risk for that hypo low sugar?

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So NPH has a four to 12 hour[br]peak, the most at risk guys

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we're looking at the green peak here.

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5.5 to six hours has the most peak.

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So the best answer here is[br]midnight or shortly after.

0:08:57.840,0:09:00.930
Now, before we move on to the[br]insulin infusion pump, guys

0:09:00.930,0:09:03.360
the best way to memorize[br]these insulin peak times

0:09:03.360,0:09:05.970
is to print off the study guide[br]or cheat sheet we provide.

0:09:05.970,0:09:06.930
And guys, write this out

0:09:06.930,0:09:10.110
at least seven to 15 times[br]the week of your exam.

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Now for insulin pumps or CSII

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the continuous subcutaneous[br]insulin infusion, guys

0:09:16.470,0:09:18.540
the number one benefit is the steady dose

0:09:18.540,0:09:21.900
of insulin for our type[br]one kids who forget to

0:09:21.900,0:09:24.330
take their insulin and are[br]basically non-compliant.

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The biggest benefit and[br]the coolest part here

0:09:26.760,0:09:29.400
is we have fewer swings[br]in blood sugar level.

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So not high or not low anymore, guys.

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It's a nice even basal rate.

0:09:34.110,0:09:36.840
That's a big key word, even basal rate.

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Now, how do you manage it?

0:09:38.040,0:09:41.010
Well, we usually check the[br]blood sugar four times per day

0:09:41.010,0:09:45.210
and you push keyword there,[br]push an insulin bolus button

0:09:45.210,0:09:48.300
at meal times to get[br]that sugar into the cell.

0:09:48.300,0:09:49.890
Now what if you get an NCLEX question

0:09:49.890,0:09:53.070
about a machine malfunctioning[br]guys, what do you do?

0:09:53.070,0:09:54.270
Do you assess the patient

0:09:54.270,0:09:56.580
or do you assess the machine first?

0:09:56.580,0:10:00.180
Hmm, well, we always[br]assess the patient first

0:10:00.180,0:10:01.830
and then machine second.

0:10:01.830,0:10:03.660
Now that's really big on the NCLEX.

0:10:03.660,0:10:04.860
Thanks for watching.

0:10:04.860,0:10:06.858
For our full video and new quiz bank

0:10:06.858,0:10:09.175
click right up here to[br]access your free trial

0:10:09.175,0:10:12.330
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0:10:12.330,0:10:14.280
Last but not least, a big thanks

0:10:14.280,0:10:17.400
to our team of experts helping[br]us make these great videos.

0:10:17.400,0:10:18.233
All right guys.

0:10:18.233,0:10:19.649
See you next time.

0:10:19.649,0:10:22.149
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