WEBVTT

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- Now as far as diabetic treatments, guys

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we're gonna cover all
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
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
few insulin receptors working.

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

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So we focus on diet

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and exercise to help repair
those broken receptors

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aka increase insulin sensitivity.

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Then we give drugs like
oral meds and insulin

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

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

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Typically we give food during
a peak since the greatest risk

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for low sugar is during
those insulin peaks.

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Guys, the number one
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
that low sugar, sugar below 70.

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Now number two, if you
get low sugar below 70

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or if your patient looks shaky

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or trembly, the classic
signs pale, cool, sweaty

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or even clammy, give that
patient some sugary candy.

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The priority key terms again,
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
sugary food here guys.

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So soda, juices, crackers,
and low fat milk.

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Not high fat milk or peanut butter.

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Guys, fat will slow the
sugar absorption here.

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

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Sleeping means unresponsive
or unarousable,

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responsive only two painful stimuli.

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

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always assess the sugar
and symptoms first.

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And after you give sugar, always
reassess 15 minutes later,

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we always follow up after any intervention

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always checking the
sugar and the symptoms.

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Now the third rule, insulin
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
been here for a long time

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

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They're basically antisocial.

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So the keywords, draw up
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
lanturn, it burns all night.

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Now number four here guys,
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
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
every two or three weeks

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and the best location is
always on the abdomen.

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Keywords here near the
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
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
increase the insulin

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during the Ss, like stress, like surgery

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sepsis or infection, and
even sickness and steroids.

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Now, as far as insulin types

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who put sugar and
potassium into the cells.

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Now these are must knows
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
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,
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
is Detemir lasts all year.

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It's long lasting and
Glargine is large lasting.

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Now NPH are cloudy,
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
cloudy in an IV bag.

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Now when we do mix it
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
between four and 12 hours

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

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

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

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

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If you haven't wrote that
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,
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
number one fastest peak

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and onset, 15 minute onset guys
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
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
there's food at the bedside.

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Again, guys, patient must be
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
must knows for the NCLEX.

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So I'd recommend printing
this study guide out

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

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Now, little insulin quiz.

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We're covering the top three
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
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
the flag showing the peak time.

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Now our red rapid guys
are the most deadly.

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Always monitor for hypoglycemia,
that low sugar below 70

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

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

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Okay, question number one,

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The nurse gives regular
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
risk for that hypoglycemia?

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Guys, the risk for regular,

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look at the peaks right
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
never before and not after.

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So guys memorize these peak times.

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Now, question number two, A
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
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
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
in our NCLEX review.

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So the client taking insulin
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
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
midnight or shortly after.

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Now, before we move on to the
insulin infusion pump, guys

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the best way to memorize
these insulin peak times

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is to print off the study guide
or cheat sheet we provide.

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And guys, write this out

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at least seven to 15 times
the week of your exam.

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Now for insulin pumps or CSII

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the continuous subcutaneous
insulin infusion, guys

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the number one benefit is the steady dose

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of insulin for our type
one kids who forget to

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take their insulin and are
basically non-compliant.

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The biggest benefit and
the coolest part here

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is we have fewer swings
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.

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That's a big key word, even basal rate.

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Now, how do you manage it?

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Well, we usually check the
blood sugar four times per day

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and you push keyword there,
push an insulin bolus button

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at meal times to get
that sugar into the cell.

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Now what if you get an NCLEX question

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about a machine malfunctioning
guys, what do you do?

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Do you assess the patient

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or do you assess the machine first?

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Hmm, well, we always
assess the patient first

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and then machine second.

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Now that's really big on the NCLEX.

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Thanks for watching.

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All right guys.

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See you next time.

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