Assessment of Routine Subcutaneous Insulin Medication Order and NovoRapid Insulin for Type 1 Diabetes

401209 Health Variations 2
Assessment 2: Case study
Assessment Questions
Part A (60 marks, suggested 800 words)
1. Explain the 11 components of a valid routine subcutaneous insulin medication
order and why this is important. Support your answer with academic or clinical
guideline references. (5 marks)
The components of routine subcutaneous insulin medication order are -
 Understand and interpret the insulin prescription correctly. Confirm the name of
the patient, dosage and time of injection. Confirm whether someone else has
not given insulin before.
 Measure the correct dose of the insulin into the syringe or pen.
 Have thorough knowledge about injection sites.
 Examine the chosen site for lipodystrophy.
 Administer the subcutaneous injection.
 Disposal of sharps after use should be done following the safety protocol.
 Monitoring of blood glucose level after administration of insulin.
 Interpret the results correctly and take corrective action if required.
 Mention the time, dose of injection and initial.
 Recognise to hypo- or hyperglycemia.
 Maintain record of the blood glucose levels (NHS).
It is important to follow the above guidelines because insulin administration
affects blood glucose levels and any mistake or oversight when doing so can
put the patient's life to danger.
2. Explain why Ben has been prescribed this medication. Relate to
pathophysiology of type 1 diabetes and the mechanism of action of NovoRapid
insulin. Support your answer with academic references. (10 marks)
Ben's complaints were increased thirst and weight loss. His appetite had also
increased. Type 1 diabetes occurs due to the autoimmune destruction of the beta
cells of the endocrine pancreas. Individuals have to be genetically pre-disposed and
some environmental , genetic or immunologic factors begin to destroy the beta cells.
Once the cells are destroyed and insulin production stops completely the type 1
diabetes manifests itself. The autoantibodies that begin to circulate in the system take
considerable time before all the bet cells are killed by the immune system. It is while
before the symptoms begin to show up in the patient (Paschou, Papadopoulou-
Marketou, Chrousos, & Kanaka-Gantenbein, 2018).
When given subcutaneously, the NovoRapid insulin is quickly absorbed and
can begin acting by lowering blood glucose levels. Because it is administered before
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meals it successfully controls postprandial blood glucose levels rather effectively and
avoids hyperglycemia in patients. Its duration of action is short. It has an additional
aspartic acid at position 28 on the B chain, this helps its rapid absorption when
injected subcutaneously. It lowers blood glucose levels by binding to insulin receptors
on cells so that uptake of glucose by cells occurs. This leads to a lower hepatic
glucose output (Novonordisk).
3. What is the onset, peak and duration of action for NovoRapid insulin according
to Bullock and Manias (2017)? Explain when NovoRapid should be
administered in relation to food intake and why. Support your answer with
academic references. (5 marks)
NovoRapid is a recombinant insulin produced using the Saccharomyces. It is a rapid-
acting insulin and begins acting 10-20 minutes after it has been injected. Its effect
lasts for 1 to 3 hours and it stops working after 3 to 5 hours. It is also called insulin
aspart and gives good postprandial control of blood sugar. Since it is a rapid acting
insulin it is usually administered before meals (Bullock & Manias, 2016).
4. Discuss the definition, causes, symptoms and treatment of hypoglycaemia, a
common adverse effect of NovoRapid. Support your answer with academic
references. (5 marks)
Hypoglycemia is defined as ''the occurrence of a wide variety of symptoms in
association with a plasma glucose concentration of 50 mg per dl or less'' (Field,
1989). Hypoglycemia is a complication that occurs due to medication used to control
blood sugar levels. Hypoglycemia increases the risk of mortality among patients with
diabetes. 92% patients perceived autonomic symptoms of hypoglycemia whereas
88% patients experience neuroglycopenic symptoms (Hendrieckx, et al., 2017). It is
possible to reduce the risk of diabetes by checking blood glucose levels more
frequently. Hypoglycemia can be treated by taking oral glucose to restore the blood
sugar levels. It occurs in diabetes patients irrespective of age, gender, and duration
since onset of diabetes (Hendrieckx, et al., 2017).
5. Discuss the importance of understanding the medication prior to administration.
Support your answer with academic references. (5 marks)
It is important to understand the medication and schedule of administration before
administering so that the correct dosage, timing and effects of the medication are
understood in advance. In case of an adverse effect of the drug the nurse is prepared
with follow up action (NHS).
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