Revised: 4/87; 4/88; 4/89; 4/90 Nursing Policy I-25

7/91; 7/92; 3/96; 6/98; 11/00; 7/04; 02/07; 11/09 LSUHSC Shreveport, LA
Rewritten: 5/94
_____________________________________________________________________________

INSULIN ADMINISTRATION

PURPOSE:
To assure proper administration of subcutaneous and intramuscular insulin.
To define the guidelines for administration of constant infusion Insulin therapy on the general
care units when no Intensive Care Unit bed is available.

POLICY:
1. Syringe Use
All insulin shall be drawn up with an insulin syringe.

2. 2nd Nurse Verification

Two licensed personnel shall verify the following prior to administration: the physician’s
order, type of insulin, dosage, route, time, and content. The 2nd Nurse verification shall
be documented in the MAK System. On non-MAK units the 2nd Nurse verifying the
information shall initial on the MAR, on the line, 2nd verification nurse. Nurses in the clinics
shall document the 2nd nurse verification as designated by the department.

3. Different types of insulin are (See Appendix A):

A. Rapid Acting (Humalog, Novolog, and Apidra)
B. Short Acting (Regular)
C. Intermediate Acting (NPH)
D. Long Acting (Lantus, Levemir)
E. Premixed Insulins

4. Labeling
The nurse shall label the insulin bottle with a date and initials upon opening.
Insulin may be kept refrigerated or stored at room temperature.

5. Discarding
The nurse shall dispose of the insulin bottle after 28 days from the date labeled on the
bottle.

See Hospital Policy 8.9.2: Discarding Medications

I25-1
I-25: Insulin Administration Page 2 of 8

6. Routes of Administration
A. Subcutaneous Insulin Injections
1. Sites for subcutaneous injections of routine insulin are shown in the diagram
below.

2. Recent research indicates that insulin injections into the abdomen give the most
consistent absorption rate, and the abdomen is the site of choice if the person is
going to be exercising the extremity.

3. Vigorous exercise of the extremity leads to increased blood flow through the site,
Which results in more rapid absorption and shorter duration of action of the
insulin.
NOTE: Routine subcutaneous insulin injections should not be given into the
deltoid area because in the average sized to thin person this would result
in an intramuscular injection.

Injection Sites for Routine Insulin Administration

Handbook of Nursing Procedures (2001). Springhouse: Springhouse, Pennsylvania,

Page 770.

I25-2
I-25: Insulin Administration Page 3 of 8

B. Intramuscular Injections
1. Occasionally the physician may order an IM insulin injection in order to increase the
absorption rate of the insulin.

2. REGULAR INSULIN is the ONLY insulin that shall be given IM.

Unless the person is thin, it is doubtful that the use of the insulin syringe and needle will
result in an IM injection. (Insulin syringe needle length is 1/2").

3. Since the length of the needle on an insulin syringe is not sufficient to administer insulin
intramuscularly, the following procedure shall be utilized:

a. Draw up insulin in an insulin syringe in the correct amount.

b. Transfer the insulin to a tuberculin syringe, and attach a 5/8" to l" needle.
(The needles on insulin syringes are not removable because they are attached
directly to the syringe to eliminate the dead space in the needle hub).

c. 1. When transferring the insulin from the insulin syringe to the tuberculin
syringe with a detachable needle that has a needle hub space, it is important to
have enough air in the syringe to clear the hub of the needle.

2. The needle hub and needle hold from 3-5 units of insulin. Once the insulin is
transferred to the tuberculin syringe, pull down on the plunger so that when
the insulin is injected, the air will clear the needle and needle hub and all the
insulin will be injected.

d. IM insulin can be injected into the deltoid muscle or another IM site.

I25-3
I-25: Insulin Administration Page 4 of 8

C. Constant Insulin IV Infusion: (Regular Insulin)

1. REGULAR INSULIN is the ONLY insulin that shall be given IV.

2. Constant IV Insulin infusions shall not be placed on the general care units if a bed is
available in an appropriate Intensive Care Unit.

3. The physician shall notify the Unit Manager/Administrative House Manager of the need for
placement of a patient on a continuous insulin infusion on a general care unit while awaiting
transfer to an ICU.

4. A patient with a constant Insulin IV infusion shall have a written a physician’s order as well
as a separate specific order for each rate change based on laboratory results.

5. A patient with a constant insulin infusion shall have blood glucose monitoring at least
every hour with the medical staff assuming responsibility for blood glucose monitoring and
lab work required more frequently than every two hours.

6. The RN shall assess the patient with a constant insulin infusion at least every two hours
for:
a. Level of consciousness (LOC),
b. Signs and symptoms of hypo-hyperglycemia and
c. To assure blood glucose monitoring is completed appropriately.

7. The medical staff shall be responsible for documentation of information relative to the
administration of constant Insulin infusion.

8. Continuous Insulin IV infusions shall be administered via a volumetric infusion pump at all
times.

9. The Pharmacy shall be responsible for mixing Insulin IVPB's. The standard mixture shall
be as follows unless otherwise ordered by the physician:

Adult l00 Units Regular Insulin/l00cc Normal Saline

Pediatric l0 Units Regular Insulin/l00cc Normal Saline.

Exception: Nurses in the ECC and the ICUs may mix the insulin in urgent and emergent
situations.

I25-4
I-25: Insulin Administration Page 5 of 8

Continuous Insulin IV Infusion on the General Care Unit

RESPONSIBLE ACTION
PARTY
MD 1. Notifies Unit Manager/Administrative House Manager of need for
placement of a patient with an insulin infusion on general care units
while awaiting transfer to an ICU.

2. Writes order for administration of constant Insulin infusion.

RN, RN Applicant, 3. Sends copy of Physician order to Pharmacy.

LPN, US

Pharmacy 4. Prepares Insulin admixture and sends to nursing unit.

RN, RN Applicant, 5. Checks the insulin via 2nd nurse verification.

LPN Initiates and regulates Insulin infusion, utilizing pump.

6. Documents IV site condition, infusion pump setting, and patient's

LOC at beginning of infusion and any additional pertinent
information in the medical record.

Medical Staff 7. Evaluates patient at least hourly and performs blood glucose
monitoring and lab required more frequently than every two hours.

8. Informs Registered Nurse of any changes in patient's condition or

treatment regime.

9. Writes a specific order for each rate change based on lab results.

10. Documents all pertinent information in a timely manner in the

medical record.

11. Continues attempt to locate an ICU bed.

RN, RN Applicant, 12 Assesses patient at least every two hours to assure that blood
LPN glucose monitoring and lab have been completed and documents:
a. Patient’s LOC
b. Any sign and symptoms of hypo-hyperglycemia
c. Blood glucose monitoring completed by nursing and medical
staff
d. Any other pertinent patient parameters

I25-5
I-25: Insulin Administration Page 6 of 8

RESPONSIBLE ACTION
PARTY
RN, RN Applicant, 13. Notifies physician of changes in patient's status and documents as
LPN appropriate.

14. Discontinues Insulin infusion as ordered.

References:

Hospital Policy: 8.9.2 – Discarding Medications

Handbook of Nursing Procedures (2001). Springhouse: Springhouse, Pennsylvania

Fundamentals of Nursing Made Incredibly Easy (2007) Lippincott, Williams & Wilkins:
Ambler, Pennsylvania.

Karch, A. (2005) 2005 Lippincott’s Nursing Drug Guide. Lippincott, Williams & Wilkins:
Ambler, Pennsylvania.

American Association of Diabetes Educators Diabetes Education Curriculum (2009) Guiding

Patients to Successful Self Management.

I25-6
I-25: Insulin Administration Page 7 of 8

_______________________________________ ____________________
Jamie Jett, MBA, RN Date
Administrative Nursing Director
Psychiatry, Coordinated Care and Professional Practice

_______________________________________ ____________________
Jean DiGrazia, MBA, RN Date
Assistant Hospital Administrator and CNO
Patient Care Services

I25-7
I-25: Insulin Administration Page 8 of 8

Appendix A
Insulin Reference Guide

Insulin Type Onset Peak Duration

Novolog (aspart) Rapid Acting 5 - 15 minutes 1 - 2 hours 4 - 6 hours
Humalog (lispro) Rapid Acting 5 - 15 minutes 1 - 2 hours 4 - 6 hours
Apidra (glulisine) Rapid Acting 5 - 15 minutes 1 - 2 hours 4 - 6 hours

Humulin R (human regular) Short Acting 30-60 minutes 2 - 4 hours 6 - 10 hours

Novolin R (human regular) Short Acting 30-60 minutes 2 - 4 hours 6 - 10 hours
Reli-On R (human regular) Short Acting 30-60 minutes 2 - 4 hours 6 - 10 hours

Humulin N (NPH) Intermediate Acting 1 -2 hours 4 - 8 hours 10 - 18 hours

Novolin N (NPH) Intermediate Acting 1 -2 hours 4 - 8 hours 10 - 18 hours
Reli-On N (NPH) Intermediate Acting 1 -2 hours 4 - 8 hours 10 - 18 hours

Lantus (glargine) Long Acting 1 -2 hours no peak up to 24 hours

Levemir (detemir) Long Acting 1 -2 hours no peak up to 24 hours

MIXED INSULINS

Humulin 70/30 = 70% NPH (intermediate-acting insulin) + 30% Regular Insulin

Novolin 70/30 = 70% NPH (intermediate-acting insulin) + 30% Regular Insulin
Reli-On 70/30 = 70% NPH (intermediate-acting insulin) + 30% Regular Insulin

Humalog 75/25 = Humalog protamine that is 75% intermediate-acting insulin + 25% Humalog (lispro)

Novolog Mix 70/30 = Novolog protamine that is 70% intermediate-acting insulin + 30% Novolog (aspart)

Reference: AADE Diabetes Education Curriculum

I25-8