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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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