Diabetes/Insulin Question Help..

[dking821]

Can someone please help me w/ this question I am not understanding why the answer is Increase morning regular insulin and not the morning NPH

Question:

A pt is receiving NPH and Regular Insulin before breakfast and before dinner. When analyzing the blood sugars from the last three days the nurse would suggest to the dr which adjustment?

BR Lunch Dinner HS

132 210 139 122

100 192 121 111

96 152 132 141

A. Increase morning regular insulin

B. Increase morning NPH insulin

C. Decrease dinner regular insulin

D. Decrease dinner NPH insulin

Thanks, DK

[Daytonite, BSN, RN]

NPH doesn't even start to work for 4 hours. You can see the effects of the NPH on the dinner and HS blood sugars. By lunchtime the NPH insulin is barely starting to kick in, so the patient needs assistance to keep the blood sugar down after consuming calories at breakfast. Thus, "A" Increase morning regular insulin.

[SunnyAndrsn]

You should have a chart somewhere that gives the peak time for regular vs. NPH vs Lantus, that should help explain better why the answer is increase regular. The AM insulin is not given enough coverage.

Can someone please help me w/ this question I am not understanding why the answer is Increase morning regular insulin and not the morning NPH

Question:

A pt is receiving NPH and Regular Insulin before breakfast and before dinner. When analyzing the blood sugars from the last three days the nurse would suggest to the dr which adjustment?

BR Lunch Dinner HS

132 210 139 122

100 192 121 111

96 152 132 141

A. Increase morning regular insulin

B. Increase morning NPH insulin

C. Decrease dinner regular insulin

D. Decrease dinner NPH insulin

Thanks, DK

[classicdame, MSN, EdD]

of course the REAL answer is: give them Lantus bid (works better for me that way!) and rapid acting with meals. I know that was not an option, but it really does better control than NPH and Regular. In my experience, once you increase the regular insulin a.m. dose then both insulins hit about the same time and cause a hypoglycemic event in the afternoon. If your patient is compelled to sleep every afternoon be suspicious that their BS is dropping. Tell them to monitor and document readings 2 hours after lunch to see if hypoglycemia is the culprit.