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- Now as far as diabetic treatments, guys
we're gonna cover all the diabetic pharmacology
including the seven rules of insulin.
So write these down.
These are the most tested.
So remember, Type One
we have none or no insulin.
The body destroyed the pancreas
so they are insulin dependent for life.
And Type Two, the problem is you, your diet
and a little bit of genetics.
So remember Type Two, we have few insulin receptors working.
So the first treatment is to fix you, your habits.
So we focus on diet
and exercise to help repair those broken receptors
aka increase insulin sensitivity.
Then we give drugs like oral meds and insulin
but only if diet and exercise, don't manage it alone.
So for our seven insulin rules, peaks equals plate guys.
Typically we give food during a peak since the greatest risk
for low sugar is during those insulin peaks.
Guys, the number one way to kill your patient
is not giving food during the peaks.
So know your peak times.
During peaks we monitor for that low sugar, sugar below 70.
Now number two, if you get low sugar below 70
or if your patient looks shaky
or trembly, the classic signs pale, cool, sweaty
or even clammy, give that patient some sugary candy.
The priority key terms again, are the A's and the S's.
If your patient is awake
ask them to eat, always sugary food here guys.
So soda, juices, crackers, and low fat milk.
Not high fat milk or peanut butter.
Guys, fat will slow the sugar absorption here.
And if they're sleeping, then we stab them with IV D50.
Sleeping means unresponsive or unarousable,
responsive only two painful stimuli.
So don't just go stabbing sleeping diabetics here, guys
always assess the sugar and symptoms first.
And after you give sugar, always reassess 15 minutes later,
we always follow up after any intervention
always checking the sugar and the symptoms.
Now the third rule, insulin with no peaks and no mixes.
It's our long acting dudes.
Guys, the memory trick is the old dudes
like grumpy old men who have been here for a long time
they're past their peak and they never mix well with others.
They're basically antisocial.
So the keywords, draw up in two separate syringes.
So remember, Detemir lasts all year
and Glargine is large, lasting
and Lantus is like a lanturn, it burns all night.
Now number four here guys, a big NCLEX favorite.
They're gonna try and trick you.
So the IV only insulin is regular insulin.
So remember a memory trick here.
Regular insulin is ready to go IV
or regular is right in the vein.
Not NPH, not Lispro, not Lantus guys.
No one except regular.
He's the VIP for the IV.
Now number five, we draw up insulin always clear to cloudy.
Guys, just think you want clear days
before you want cloudy ones.
So draw up regular insulin first
the clear and then NPH the cloudy second.
Six, we rotate locations every two or three weeks
and the best location is always on the abdomen.
Keywords here near the Umbilicus, naval or belly button.
And guys, we never aspirate.
Basically never draw back on that plunger.
It'll cause scar tissue and swelling.
And also we never massage
or add heat after sub-Q injections.
Now lastly, number seven, DKA
the extreme high sugar condition in type one diabetes.
Guys, we have a separate video for that
but here's the big NCLEX question here.
Do we give insulin on sick days?
What if the patient's not eating
or basically too nauseous to eat?
Well, yes, we give insulin without food
we just monitor that glucose closely.
So remember, we always increase the insulin
during the Ss, like stress, like surgery
sepsis or infection, and even sickness and steroids.
Now, as far as insulin types
who put sugar and potassium into the cells.
Now these are must knows for the NCLEX specifically
the peak times, coming up 60%
of the time and all endocrine questions.
And a little FYI for the NCLEX guys
we're not using brand names anymore.
Only generic.
So no more Novolog or Novolin.
If your school's still using this
then they're behind on the times.
So again, for reinforcement
our first group is the long acting guys
our antisocial old dudes, guys
they have no peak and never mix with others.
Big NCLEX keyword again
draw up in separate syringes, never mix.
These guys have no peaks, so they require no plates
or basically they're not food dependent
and hence they have a minimal risk
for that hypo low sugar.
So the brain is pretty safe here.
Again, our memory trick here is Detemir lasts all year.
It's long lasting and Glargine is large lasting.
Now NPH are cloudy, dude, always being mixed.
So remember the Ns intermediate insulin
and we never give it IV drip or bag.
Guys never put anything cloudy in an IV bag.
Now when we do mix it always mix clear to cloudy,
clear days before cloudy.
So we usually give NPH two times per day
not four times a day.
So don't let the NCLEX trick you.
Now the peak time is between four and 12 hours
but most dangerous in the middle, around five to six hours.
So make sure you have a plate of food with that peak.
Next is regular insulin, that's ready to go IV.
Guys again, he's the only dude allowed IV push or IV bag.
If you haven't wrote that down, please write it down.
His peak is between two and four hours.
So monitor closely for signs
of low sugar, that shaky, pale, cool, and clammy.
We need to give some sugary candy.
Now finally, our most deadly insulins.
They're the number one priority
since they have the number one fastest peak
and onset, 15 minute onset guys with a 30 to 90 minute peak.
So rapid acting insulin.
Remember, Lispro, Aspart and Glulisine.
So memory tricks here for Aspart
you gotta remember to move your ASS-parts.
Guys, it's really fast.
And Lispro, Just think LESSpro,
less time for the onset it's 15 minutes.
And Glulisine, it goes fast like a limousine.
It's super fast.
So we give these during meals.
Keyword here,
patient is eating or there's food at the bedside.
Again, guys, patient must be eating in 10 to 15 minutes,
not before the food's delivered.
Usually an NCLEX question.
Those peak times are the must knows for the NCLEX.
So I'd recommend printing this study guide out
and reviewing it every day at the week of your exam.
Now, little insulin quiz.
We're covering the top three most tested NCLEX questions
on peak times.
Here we go.
Again, peaks are priorities.
The fastest way to kill your patient is not giving a plate
of food with the peaks.
So remember, peaks require plates.
So we drew a little plate on the flag showing the peak time.
Now our red rapid guys are the most deadly.
Always monitor for hypoglycemia, that low sugar below 70
you're gonna see shaky, sweaty, pale, and clammy.
So we give that patient some sweet juice, soda, or candy.
Okay, question number one,
The nurse gives regular insulin at 12:00 PM for lunch
but the patient doesn't finish their food.
So when's the greatest risk for that hypoglycemia?
Guys, the risk for regular,
look at the peaks right here, two to four hours.
So if given at 12, the answer's
between 2:00 PM and 4:00 PM never before and not after.
So guys memorize these peak times.
Now, question number two, A client is on Aspart insulin,
when should the nurse advise him to eat?
Again, guys, this is an onset of 15 minutes
with apeak time between 30 to 90 minutes.
So Aspart get your ASS-parts moving
the best answer is the soonest.
So eating within 10 or 15 minutes.
Now question number three, the client
on Glargine is asking the nurse
When is the best time to eat during this insulin?
Well, guys, Glargine is large lasting,
long acting, no peaks.
So no peaks require no plates.
Pretty tricky one there.
Now for a little bonus question
we saw this a few times in our NCLEX review.
So the client taking insulin NPH with dinner at 7:00 PM
What time is the client most
at risk for that hypo low sugar?
So NPH has a four to 12 hour peak, the most at risk guys
we're looking at the green peak here.
5.5 to six hours has the most peak.
So the best answer here is midnight or shortly after.
Now, before we move on to the insulin infusion pump, guys
the best way to memorize these insulin peak times
is to print off the study guide or cheat sheet we provide.
And guys, write this out
at least seven to 15 times the week of your exam.
Now for insulin pumps or CSII
the continuous subcutaneous insulin infusion, guys
the number one benefit is the steady dose
of insulin for our type one kids who forget to
take their insulin and are basically non-compliant.
The biggest benefit and the coolest part here
is we have fewer swings in blood sugar level.
So not high or not low anymore, guys.
It's a nice even basal rate.
That's a big key word, even basal rate.
Now, how do you manage it?
Well, we usually check the blood sugar four times per day
and you push keyword there, push an insulin bolus button
at meal times to get that sugar into the cell.
Now what if you get an NCLEX question
about a machine malfunctioning guys, what do you do?
Do you assess the patient
or do you assess the machine first?
Hmm, well, we always assess the patient first
and then machine second.
Now that's really big on the NCLEX.
Thanks for watching.
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All right guys.
See you next time.
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