 Hi and welcome to Nursing School Explained. Today's topic are the different types of insolence. Students sometimes have a little trouble grasping the different concepts and how the different types of insolence work and why there are so many. So I've broken them down into a table to kind of really break down the principles of insulin administration and hopefully you'll get a better understanding of it. So first of all, insulin is typically used for type 1 diabetics but can also be used in type 2 diabetics when the patient has already been established on several different oral, anti-diabetic agents and maybe they are not working and now they need insulin in addition to any other medication that they're already taken. So insulin typically comes in four different types and I have divided this table here into time as to how long the onset is of the medication, the name of it, uses and when we would administer it and then onset peak and duration of how long it's going to be staying in the system working on the patient's metabolism. So first of all, rapid and short acting insolence are typically also referred to as bolus medications or they're administered for male coverage and then intermediate and long acting insolence can be referred to as basal insulin and we'll get a little bit more into that as we move on here. So first is rapid acting insulin and I wrote down here log so that ends in log such as homologue or novologue so that should already be the first time that you're dealing with a rapid type of insulin. And it's usually given right before the meal because now the patient has an increased need to break down the food that they consume and right before the meal would be the time to administer that and it's usually combined with a long acting or intermediate kind of insulin. The onset is fairly quickly because it's rapid acting will be onset 5 to 15 minutes its peak will be at 45 to 75 minutes and the duration will it'll last in the body for two to five hours. So something to really keep in mind here if the patient has right now a blood sugar level of let's say 235 and they're on a sliding scale so that means that depending on how high the blood sugar is what will be depending on how much regular in I'm sorry rapid acting insulin they'll get right now. And because we've taken the blood sugar right now and they're about to eat so the onset needs to be fairly quickly because now we're adding more glucose to their system that they are that they need to break down. And then the other thing to keep in mind is the duration here so now maybe the patients blood sugar was 235 but they don't really eat much of their meal. Maybe they only consume 25% because they are nauseated there's something else going on that was distracting them they're not very hungry. So now knowing that the insulin the duration is two to five hours we have to anticipate when we collect the patient's military that maybe two to five hours after we just administer this rapid acting insulin they might show signs and symptoms of hypoglycemia. Because now they didn't eat that much to really be needing this whatever amount we gave them of the insulin. So this is something that you have to keep in mind onset peak and duration in terms of the patient's blood glucose level and their oral intake. Now the next category is short acting insulin that typically ends in Lin and is also called the regular insulin and regular insulin is the only insulin that can be given in the IV. And that's mostly for safety purposes because we wouldn't want to give an immediate and long acting insulin in the IV. Because then we really have no control over the patient's blood glucose over a long long period of time where the short acting we know how long it's going to take effect in the patient's body. And we can anticipate the levels of the blood sugar being decreased at a certain amount of time and we'll get into that. Short acting insulin ends in Lin so humulin and nobulin would be some examples. It usually is given for meals that are going to be eaten in 30 to 60 minutes. So not quite right before the meal as a rapid but for meals within 30 to 60 minutes. So this is usually the one that they use at the hospital because we cannot really it's not really feasible to be given it to the patient right before the meal. What if we have five different patients to take care of the meal to is all arrived at the same time. So this is something that's not quite that feasible. So short acting will be mostly given and short acting insulin just like rapid will be combined with a long or immediate insulin or one of these insulins from the basal insulin category for onset peak and duration because we want to give it for meals to be eaten within 30 minutes. This is approximately 30 minutes peak will be two to four hours and then it'll last in the body five to eight hours. So again we have to make sure that we monitor how much is the patient consuming of that meal to see and anticipate any kind of hypoglycemia that can occur here. Now the first one of the basal insulins is the intermediate one intermediate category examples would be in pH and lente. So unfortunately there is no no endings here that will help you remember those and intermediate insulin usually covers half a day or overnight and it's combined with a rapid or short acting insulin. So one of the two appear for meal coverage. So one of those bolus or meal coverage insulins are going to be given in addition to the intermediate one for the onset it'll take one to two hours. The peak will be about four to 12 because we want to cover half a day or overnight so it'll last about half a day and overall it can last 18 to 28 hours. And then long acting insulins and in an example is Lantis or Glargene or Detamir. Again no no specific endings to to memorize those and that's called a basal insulin because it lasts about 24 hours and is usually also combined with rapid or short acting insulins for meal coverage. And the benefit here is that it gives the patient is a one time a day dose but it gives the patient a certain level of insulin all day long. So we don't have to worry so much about the peaks and valleys, blood sugars going up and down. We just have to worry about meal coverage because then the insulin requirements will be elevated because now we're delivering extra glucose to the patient system that needs to be broken down. For the long acting insulin onset again one to two hours but there are no peaks or valleys it's basically just one steady graph if you will look at it on a graph. And there are no peaks and valleys no ups and downs as in any of these other insulins and duration will be 20 to 24 hours. So in summary bolus and basal medications our insulins rapid and short acting are mostly used for meal coverage depending on when the patient receives the meal. And then we have intermediate and long acting our basal insulins that are given for more of a long term control and long term steady administration or release of the insulin in the patient system. Now a lot of times how the provider will choose to prescribe these medications will depend on the patient's lifestyle, their ability to administer their insulin and there's a lot of different factors that play your role here. And then down here I also wrote that there is premixed insulin so the patient doesn't necessarily have to have an intermediate and a rapid acting but it will come premixed in one vial already. And so just you understand the numbers that that comes in. So an example here is humulin 7030 means 70% in immediate and 30% short acting. Notice that we have the lint here which is the short acting and humulin again but we have this ratio here which tells us that the first number is always the intermediate acting and the second is the shorter rapid acting. So novel log 7030 would be 70% in immediate and 30% rapid acting because now we have novel log rather than novel lint and novel log is rapid acting. And we can also have different ratios of intermediate and bolus medications or insulin which would be an example humulin 5050. So there will be 50% intermediate and 50% short acting again the humulin short acting here. So in general I hope that you have a better understanding of the different types of insulin now these tables of onset peak and duration is something that you just have to memorize. So on an exam just write yourself this table write it out and that way you can judge as to how to best answer any exam questions what to treat the patient in terms of what to expect with the peaks and valleys here of these different types of insulins. Thank you for watching nursing school explained I'll see you next time.