When does hypoglycemia usually occur?

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Hello! If a pt is to receive regular insulin at 0730 am, what time is he/she most likely to experience a hypoglycemic reaction? I've tried searching the Internet and my textbooks to find out if it mostly has to do with the onset, peak or duration , and I'm having no luck. My choices are 0800, 0930, and 1200. This isn't for a test or anything, just homework. And I'm stumped! Please help! Thanks!

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There isn't going to be an answer you can look up unless it is in the back of the book since it is for the most part application and not a simple fact. Think about the effect of regular insulin on the body. How does it act and how fast and for how long? What keeps the blood sugar up after they take it? If you can answer those you have all the information you need to answer the question.

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I know it is an application question in which the correct answer cannot be looked up! I am trying to figure out what effects the possibility of hypoglycemia the most...onset, peak or duration. I also know that the onset of regular insulin is 30 to 60 minutes, peak is 2 to 3 hours, and duration is 3 to 6 hours. What I don't know is which factor most commonly causes hypoglycemia. Is it before the onset may take place? Or is it as the insulin is wearing off towards the end if the duration? I'm leaning towards the end of duration but I'm not sure, and I really want to understand this!

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You are looking at the insulin and you are looking at this from the wrong angle. What is it that is happening with the patient that affects glycemic status?

Number one rule of nursing: always look first to your patient.

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We are given no info about the patient. All it says is they are scheduled for regular insulin at 0730, so when is hypoglycemia most likely to occur...?

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I'm leaning towards the end of duration but I'm not sure, and I really want to understand this!

I wasn't trying to be mean or anything I was trying to spare you trying to look it up further and try to get you to think the question through so you understand it. I get that you want to understand it, but I am trying to help you to figure it out for yourself instead of me just handing you the answer. I'll try to go a bit more in depth.

Couple things to think through with your answer. You know insulin lowers blood sugar so if it is keeping blood sugar at a normal level and it wears off blood sugar will not be low(hypoglycemic) it will be high (hyperglycemic). That leaves the rest of the curve to think about and narrows it down to 0800 and 0930.

Try drawing the curve out and labeling it. Now factor in meals and the effect they have on blood sugar. Where on the curve should blood sugar be at it's lowest factoring in those meals?

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I feel like a real moron because I feel like I don't have enough info to answer this question. Meals raise blood sugar, but I don't know what time the pt eats. I know u typically test about 2 hours after eating, so maybe it's 0930? But it could be 0800 if he took insulin but then didn't eat. And one thing I read said the risk for hypoglycemia is before the next meal. I'm so confused...

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The answer is 0800. It's one of those questions where they want you to understand the concept of how quickly it takes the insulin to create a change in the body. Regular insulin takes effect within about a half hour. A rapid acting insulin would act within about 10-15 minutes, hence why is should be given with the patient's meal in front of them. At around 0930 you would expect an intermediate insulin to start taking effect and around noon a long-acting insulin would start causing a decrease in blood sugar.

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Thank you! So basically it has to do with the onset of the particular insulin in addition to their food consumption. I think I was looking at this the wrong way...

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Yeah, as mazy and Nolli said, there are many things that influence how the body reacts to the insulin that is given. It depends on whether or not the patient is eating/has eaten, their tolerance for the insulin, and/or medications that are being taken, etc. You have to remember that onset determines when an effect will happen, peak is the point in which it has its greatest effect, and duration is how long that effect will take place. Each are important for different reasons, however for this question onset of action will be your answer. If you were to take out all other variables, what would be the first of the three characteristics (onset, peak, and duration) to take effect? Hence why the onset is the most important (for this question).

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It makes sense to me now! Thank you all for your help!

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The answer is 0930. The purpose of insulin is to lower BS. If peak time is when a medication has it's 'greatest effect' on the body, wouldnt that be the 'most likely' time that the pt would experience hypoglycemia?

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