Name of the Procedure:

• Common Name: Intermediate-acting Insulin Injection
• Technical/Medical Term: Insulin, intermediate acting (NPH or Lente); 5 units (HCPCS Code: S5552)

Summary

Intermediate-acting insulin is an injectable medication used to manage blood sugar levels in individuals with diabetes. This type of insulin takes longer to start working but lasts for an extended period, thereby helping to maintain stability in blood glucose levels throughout the day.

Purpose

Intermediate-acting insulin is used primarily for:

• Managing blood glucose levels in individuals with type 1 or type 2 diabetes.
• Providing a longer-acting insulin option that complements other forms of insulin and helps maintain more consistent blood sugar control.
• The goal is to prevent hyperglycemia (high blood sugar) and its complications, such as nerve damage, kidney problems, and cardiovascular issues.

Indications

• Elevated blood glucose levels that cannot be managed by diet, exercise, or oral medications alone.
• Patients diagnosed with type 1 diabetes or those with type 2 diabetes who require insulin therapy.
• Situations where rapid and consistent blood sugar control is necessary.

Preparation

• Patients should follow their healthcare provider’s instructions regarding dosing times and any necessary adjustments to current medications.
• No specific fasting or diagnostic tests are required for the administration of insulin unless otherwise directed by a healthcare provider.

Procedure Description

1. Preparation: Clean the area of the skin where the injection will be administered using an alcohol swab.
2. Insulin Injection:
   • Assemble the insulin syringe and needle or prepare the insulin pen as per the manufacturer's instructions.
   • Draw 5 units of the intermediate-acting insulin into the syringe or set the pen to administer the correct dose.
   • Pinch the skin at the injection site to form a fold.
   • Insert the needle at a 90-degree angle (or 45 degrees if using a longer needle or injecting into a less fatty area).
   • Inject the insulin slowly and steadily.
   • Withdraw the needle and release the pinched skin.
3. Post-Injection: Dispose of the needle and syringe properly in a sharps container.

Tools, Equipment, or Technology:

• Insulin syringe and needle, or insulin pen.
• Alcohol swabs.
• Sharps container for disposal of needles.

Anesthesia or Sedation: Not applicable.

Duration

The actual injection procedure takes only a few minutes to complete.

Setting

This procedure can be performed in various settings, including:

• At the patient's home (self-administered or administered by a caregiver).
• Outpatient clinic.
• Doctor’s office.

Personnel

Typically, no healthcare professional is required for each administration, assuming the patient or caregiver is trained. Initial training may be conducted by:

• Diabetes educator.
• Nurse.
• Physician or healthcare provider.

Risks and Complications

• Common: Local site reactions (redness, swelling), mild hypoglycemia (low blood sugar).
• Rare: Severe hypoglycemia, allergic reactions at the injection site, lipodystrophy (changes in fat tissue at the injection site).

Benefits

• Better control of blood glucose levels.
• Reduced risk of diabetes-related complications when blood sugar is well-managed.
• Improved overall health and well-being.

Recovery

• Patients can resume normal activities immediately after injection.
• Monitor blood sugar levels as advised by the healthcare provider.
• Follow specific diet and exercise recommendations.
• Attend follow-up appointments to assess blood sugar control and adjust dosages if necessary.

Alternatives

• Oral medications for blood sugar control.
• Fast-acting or long-acting insulin alternatives.
• Non-insulin injectable medications.
• Lifestyle modifications (diet, exercise).

Pros and Cons of Alternatives:

• Oral Medications: Easier to take but may not be sufficient for all patients.
• Fast-Acting Insulin: Good for immediate blood sugar control but does not provide long-lasting effects.
• Long-Acting Insulin: Lasts longer than intermediate insulin but may take longer to start working.

Patient Experience

• During Procedure: Minor discomfort or slight pain at the injection site, brief.
• After Procedure: May experience mild irritation at the injection site, should monitor blood sugar levels regularly.
• Pain Management and Comfort Measures: Use of short, thin needles to minimize discomfort; rotating injection sites to prevent skin issues.