Which type of syringe is used to inject minute amounts for intradermal injections?

TYPES OF INSULIN

Insulin is categorized as fast-acting, intermediate-acting, long-acting, and commercial premixed insulin. The following drug labels are arranged according to insulin action.

Insulin has been available since 1925, when it was extracted from beef and pork pancreases. In the 1980s, human insulin was synthetically produced and began replacing beef and pork insulin in the United States. Some individuals are allergic to beef insulin, so since 1998, beef insulin has no longer been manufactured. Pork insulin was more frequently prescribed because it has biologic properties similar to those of human insulin. Since December 2005, pork insulin has not been available in the United States. Some patients may be importing it. Now, insulin analogs have been developed and are currently in use.

Insulins have various descriptions, including color, action, source, and manufacturer. They are either clear (regular or crystalline insulin) or cloudy (NPH) because of the substance, protamine, used to prolong the action of insulin in the body. Insulin action is broken down into onset, peak, and duration. Onset is how long it takes the insulin to begin working. Peak is when the insulin is working most effectively, and duration is how long the insulin remains effective. Additionally, insulins are either DNA recombinant or analogs. Since 2005 only human insulin has been available in the United States. Human insulin is DNA recombinant and is manufactured; it does not come from cadavers. Analog insulin is human insulin that has been manipulated to change the action. The three insulin manufacturers are Eli Lilly, NovoNordisk, and Sanofi-Aventis. Humulin and Novolin are examples of brand names of insulins.

Insulin is categorized as rapid-acting, fast-acting, intermediate-acting, long-acting, and commercial premixed insulin (see Figures 9-15 and 9-16). Insulin is prescribed in units and administered in units. The first rapid-acting insulin, Humalog (lispro insulin), was approved for use in 1996. Lispro and the new rapid-acting insulins, aspart and glulisine, act faster than regular insulin and thus can be administered 5 to 15 minutes before mealtime, whereas regular insulin is given 30 minutes before meals. Rapid-acting insulins can become effective within 5 to 15 minutes of injection and last 3 to 5 hours. Lispro insulin (Humalog) is formed by reversing two amino acids in human regular insulin (Humulin R). Aspart insulin (NovoLog) is an analog of human insulin with a rapid onset. It is structured identically to human insulin expect for one amino acid. Glulisine insulin (Apidra), like aspart insulin, is a synthetic analog of natural human insulin (see Table 9-2 and Figure 9-15). Rapid-acting (Aspart, Apidra, and Humalog) and fast-acting (regular) insulins can be given intravenously as well as subcutaneously. Intermediate-acting and long-acting insulins can ONLY be administered subcutaneously.

TABLE 9-2

Types of Insulin

A, adult; Q child; h, hour; min, minute; subQ; subcutaneous; IV, intravenous, <, less than.
CAUTION: Levemir and Lantus should NOT be mixed with other insulins and should NEVER be given intravenously.

Fast-acting insulin (regular insulin) is also clear but takes longer to start working compared with rapid-acting insulins. It is administered 30 minutes before meals and is effective for 6 to 8 hours. If it is given during or after the meal, the patient may experience low blood sugars. Fast-acting insulin is known as regular or R insulin. Humulin R and Novolin R are brand names of fast-acting human insulin.

Intermediate-acting insulin (NPH, Humulin N, Novolin N) is administered 30 minutes before meals (breakfast) and becomes effective in 1 to 2 hours. Its duration of action in the body is 12 to 18 hours. This type of insulin contains protamine, which prolongs the action in the body. It is cloudy because of the protamine added to the regular insulin. It can ONLY be given subcutaneously. Humulin N can be mixed with Humulin R (regular insulin) or rapid-acting insulin in the same syringe.

The long-acting insulins are insulin detemir (Levemir), an analog of human insulin, and insulin glargine (Lantus). Lantus is the first long-acting recombinant DNA (rDNA) human insulin for patients with type 1 and 2 diabetes mellitus. Lantus and Levemir are clear, colorless insulins that are to be given ONLY subcutaneously and NOT intravenously. Lantus and Levemir CANNOT be mixed with other insulins or given intravenously. The long-acting insulin acts within 1 to 2 hours and last in the body for 18 to 24 hours. The Levemir vial is tall and has a green top. The Lantus vial is taller and narrower than the other types of insulin. It has a purple top and purple print on the label. Levemir is usually administered in the evening or at bedtime; however, it can be administered once or twice a day subcutaneously. Lantus is usually administered at bedtime, thus, the incidence of noctural hypoglycemia is not common. Some patients report more pain at the injection site with long-acting insulins than with Humulin N (NPH).

The use of commercially premixed combination insulins has become popular for patients with diabetes mellitus who mix fast-acting and intermediate-acting insulins. Examples are two groups: the rapid- and intermediate-acting insulin and the fast- and intermediate-acting insulins. The two rapid- and intermediate-acting insulins are Novolog mix 70/30 and Humalog mix 75/25. The fast- and intermediate-acting insulins are Humulin 70/30, Novolin 70/30, and Humulin 50/50 (see Table 9-2). They are available in vials or pens that resembles a fountain pen. Some patients need less than 30% Humulin R and more Humulin N, so these combinations of insulins cannot be used. They must mix their insulins according to the prescribed units of insulin.

Insulin is administered at a 45-, 60-, or 90-degree angle into the subcutaneous tissue. The angle for administering insulin depends on the amount of fatty tissue in the patient. For a very thin person, a 45-degree angle is suggested. A 90-degree angle should be used for obese or average-sized persons. When a 90-degree angle is used, the skin should be pinched upward so the insulin is deposited into the fatty tissue.

What type of syringe is used for intradermal injections?

What type of injection is given intradermal example?

What's the most commonly used intradermal injection site?

Is Insulin syringe intradermal?