Understanding Subcutaneous Insulin Medication Order and NovoRapid Insulin for Type 1 Diabetes: A Case Study

This case study discusses the components of a valid routine subcutaneous insulin medication order, NovoRapid insulin for type 1 diabetes, and potential impacts of living with type 1 diabetes through a case study of Ben. It includes academic references and guidelines.

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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 eleven components to ensure patient safety and safe nursing practice are-
Patient's family and given names, address, Date of birth, sex and Medical record
number. Second, First prescribe ID label checked. Third, make sure that NIMC
( National Inpatient Medication Chart ) has been marked before administration.
TheFourth step is Hospital details. The fifth component is that Doctor is notified before
administration of insulin. Sixth is to check the printed name and signature of
prescriber. Seventh is to check administration and expiry date. Eight component is to
check the name of Insulin. Ninth is to check the right amount of dose of. The tenth is
to check the right time in which insulin is to be given and final is the doctor's Signature
(ACSQHC, 2017).
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)

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As Ben's blood glucose level and his blood ketone level was high. Therefore, from
Diagnostic tests, he was diagnosed with type 1 diabetes in an emergency department.
Type 1 diabetes is a result of severe lack of insulin in the body caused by loss of beta
cells( LeMone, Burke, Levett- Jones, Dwyer, Moxham, Reid-Searl & Raymond, 2017).
Lack or lost of beta cells is related to various factors such as- environmental, immunity
of body and susceptibility. Type 1 Diabetes is a slowly progressive disease that
destroys beta cells in the pancreas.
In type 1 diabetes, the body produces very little or no insulin because insulin
producing cells are destroyed by autoimmune reaction in the body. So, body needs
Insulin replacement by insulin injections. Ben has been prescribed novorapid insulin
because it facilitates glucose uptake into body cells which lower blood glucose levels.
It Inhibits the metabolism rate of fats and protein and also inhibit the gluconeogenesis
and stimulates glycogenesis as well (Atkinson, Eisenbarth & Michels, 2014). Insulin
stimulates amino acid uptake, promote fat storage and protein synthesis.
.
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)
The onset action of NovoRapid is between 0-15 minutes, the peak effect is 1-3 hours
and the duration of this insulin is 3.5-5 hours (Bullock & Manias, 2017). NovoRapid
should be administrated immediately before the meal because if the person does not
eat shortly after administration of insulin they will experience hypoglycemia (low blood

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glucose <4.0mmol/L). This may be life-threatening and it could result in
unconsciousness if not treated with carbohydrates.
4. Discuss the definition, causes, symptoms and treatment of
hypoglycaemia, a common adverse effect of NovoRapid. Support your
answer with academic references. (5 marks)
It is extremely important to be aware medication or drug that is to give. Before the
administration of medication, it is important to know about any known allergies. To
ensure a patient's safety and safe nursing practice it is important to know about
adverse effects, and route. To avoid any medication error it is extremely important that
we have educated and knowledge about drug or type of medication we are giving to
them (Ministry of Health NSW, 2013).
5. Discuss the importance of understanding the medication prior to
administration. Support your answer with academic references. (5 marks)
The five rights of medication administration are right patient, right drug, right dose,
right route and right time( NSW Health, 2013). It is very important to reduce any
medication error, for safe nursing practice and patient's safety (Craft et al., 2015). In
the real world, medication error can be life-threatening so it is a way to follow the safe
nursing practice to minimize medication errors.
6. Discuss the 5 rights of medication administration and why it is important
for nurses to follow this procedure. Support your answer with academic
references. (5 marks)

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The five rights of medication administration are right patient, right drug, right
dose, right route and right time( NSW Health, 2013). It is very important to
reduce any medication error, for safe nursing practice and patient's safety
(Craft et al., 2015). In the real world, medication error can be life-threatening
so it is a way to follow the safe nursing practice to minimize medication errors.
7. What is the most appropriate insulin pen needle length for Ben and why?
Support your answer with academic references. (5 marks)
As Ben has lost weight in the past two weeks the appropriate needle length for Ben
would be 4-6mm (Australian Diabetes Educators Association, 2015). If a longer length
needle is used, it might inject the insulin in the blood vessel rather than in the
subcutaneous layer.
8. What diabetes specific nursing assessment would you conduct prior to
administration of NovoRapid insulin to Ben and why? Support your
answer with academic references. (5 marks)
I would check Ben's blood glucose level and five rights of administration prior to give
Novorapid insulin to patient (Craft et al., 2015). Furthermore, I would check the
consistency and appearance of insulin, any known allergies, the site of injection,
inspect for hypersensitivity and ipoatrophy (LeMone et al, 2017).
9. Identify the site and angle you would inject the NovoRapid insulin and
explain why this was selected for Ben. Discuss infection control
considerations. Support your answer with academic references. (5
marks)

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As Ben has lost further 10 kgs in the past 2 weeks. So, therefore, for his body type,
recommended angle for injection is a 90-degree angle to prevent insulin from being
injecting in skin layer as needle length is very tiny (Bullock & Manias, 2016). The ideal
site for insulin injection would be abdomen because it is safe, insulin is absorbed fast
and less painful. To avoid any infections injection site is to be changed every time, a
site should be sterile, proper hand hygiene must be exercised and the same needle
should not be reused (Australian Diabetes Educators Association, 2015)
10. What would you document and where? Why is documentation important?
Support your answer with academic or clinical guideline references. (5
marks)
Patient's BGL results should be documented in National subcutaneous insulin chart
along with the time it has been taken in twenty-four hour time (ACQSHC, 2017). A diet
that has been eaten by the patient in the diet section. After administering the
medication, I will document the dose and time it was given. My initial and the second
nurse's initial in top half section (Insulin chart quick start guide, 2017). It is essential to
complete any necessary documentation like progress notes, fluid medication chart etc
to avoid hyperglycemic or hypoglycemic state and quality nursing practice.
11. Explain the diabetes specific nursing assessment you would provide for
Ben post administration of insulin, when you would provide it and why.
Support your answer with academic references. (5 marks)
As a nurse, I would check Ben's Blood glucose level. Furthermore, I would check any
symptoms of hypoglycemia or hyperglycemia (LeMone et al., 2017). Moreover, I will
monitor any effect of Ben's diet on his Blood glucose level (Craft et al., 2015)

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Part B (10 marks, suggested 200 words)
Discuss the potential impact of type 1 diabetes on Ben.
1. Discuss the daily physical challenges of living with type 1 diabetes that
Ben may face. Support your answer with academic references. (5 marks)
Ben may face daily physical changes as a diabetic he may need to visit hospital or
doctor after a few days for the checkup. He may find hard to check blood sugar level
on a daily basis as he is not used to it. Ben is a teenager, now he needs to be aware
of the diet he consumes which can affect his health (National Diabetes Services
Scheme, 2016). Ben regularly plays sport but now he has to be careful because blood
sugar levels change frequently with physical activities.
2. Discuss potential emotional impacts of living with type 1 diabetes that
Ben may face. Support your answer with academic references. (5 marks)
Diabetic Care requires a lot of attention and precautions related to diet and daily
physical activities. Ben may feel helpless or angry about his condition at a young age.
He may feel embarrassed to use flex pen in front of others. Ongoing treatment and
test may affect his studies as he may unable to concentrate. He may develop a
negative perspective and thoughts about his poor health (Diabetes SA, 2018). Over
time, checking and testing BGL, restricted diet, unable to play sports, lost interest in
studies can cause him stress.

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Reference list
Atkinson, M. A., Eisenbarth, G. S., &amp; Michels, A. W. (2014). Type 1
Diabetes. The Lancet, 383(9911), 69 – 82. Retrieved from
https://doi.org/10.1016/S0140-6736(13)60591-7.
Australian Commission for Safety and Quality in Health Care. (2017). User
Guide to National Subcutaneous Insulin Chart: Acute Facilities. Retrieved from
https://www.safetyandquality.gov.au/wp-content/uploads/2018/01/User-guide-to-the-
national-subcutaneous-insulin-chart-Acute-facilities-October-2017.pdf
Australian Diabetes Educators Association. (2015). Clinical Guiding Principles
for Subcutaneous Injection Technique. Retrieved from https://www.adea.com.au/wp-
content/uploads/2015/11/Injection-Technique-Final-digital-version2.pdf
Bullock, S., & Manias, E. (2017). Medicines and the Pancreas. Fundamentals
of Pharmacology (7th Australian ed) (pp. 750-767). Retrieved from
https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-
27066823_1/courses/401209_2018_spr/Bullock%2C%20S.%2C
%20%26%20Manias%2C%20E.%20Fundamentals%20of%20pharmacology
%20Chapter%2061%281%29.pdf
Craft, J., Gordon, C., Tiziani, A., Heuther, S., McCance K., Brashers, V., &
Rote, N. (2015). Understanding pathophysiology (2nd ed.). Chatswood, NSW:
Elsevier Australia. P. 253-254 Chapter 11
Diabetes SA. (2018). Diabetes and Emotional Well-Being. Retrieved from
https://www.diabetessa.com.au/about-diabetes/diabetes-and-emotional-well-
being.html.

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Insulin chart quick start guide. (2017). Retrieved from:
https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-
27038022_1/courses/401209_2018_spr/Insulin-chart-quick-start-guide-2017-
Handout%281%29.pdf
LeMone, P., Burke, K., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl,
K., & Raymond, D. (2017). Nursing Care of People with Diabetes Mellitus. In A.
Parrish, T (Eds), Medical-Surgical nursing: Critical Thinking for Person-centred care
(3rd Australian ed) (pp. 560-596). Retrieved from
https://vuws.westernsydney.edu.au/bbcswebdav/pid-3539100-dt-content-rid-
27066825_1/courses/401209_2018_spr/Medical-surgical%20nursing-%20Critical
%20thinking%20for%20person-centred%20care%20Chapter
%2019%20Diabetes.pdf.
Ministry of Health New South Wales. (2013). Medication Handling in NSW
Public Health Facilities. Retrieved from
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_043.pdf
National Diabetes Services Scheme. (2016). Living with Diabetes: For Young
People. Retrieved from https://www.diabetesaustralia.com.au/for-young-people
NSW Health. (2013). Medication Handling in NSW Public Health
Facilities.Retrieved from:
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_043.pdf