Help with NPH insulin

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Ok if I could please get your feedback on this question, I have it narrowed down but need help clarifying and rational..

The physician orders Humulin insulin 23 units Subq qAM. The nuse carries out this order correctly when the insulin:

A) dose is given after breakfast

B) dose is based on the fingerstic blood glucose results

C) is given according to the hospitals qAM schedule

D) is administered before breakfast

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Well, what do you have it narrowed down to? And why?

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I believe its d....we havent covered insulin much... But I believe its because if its admin'd before breakfast since its indermediate acting it will give it time to take effect by the time the pt is done eating

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

[TABLE]

[TR]

[TD]Type of Insulin & Brand Names

[/TD]

[TD]Onset

[/TD]

[TD]Peak

[/TD]

[TD]Duration

[/TD]

[TD]Role in Blood Sugar Management

[/TD]

[/TR]

[TR]

[TD=colspan: 5]Rapid-Acting

[/TD]

[/TR]

[TR]

[TD]Humalog or lispro

[/TD]

[TD]15-30 min.

[/TD]

[TD]30-90 min

[/TD]

[TD]3-5 hours

[/TD]

[TD]Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is used with longer-acting insulin.

[/TD]

[/TR]

[TR]

[TD]Novolog or aspart

[/TD]

[TD]10-20 min.

[/TD]

[TD]40-50 min.

[/TD]

[TD]3-5 hours

[/TD]

[/TR]

[TR]

[TD]Apidra or glulisine

[/TD]

[TD]20-30 min.

[/TD]

[TD]30-90 min.

[/TD]

[TD]1-2½ hours

[/TD]

[/TR]

[TR]

[TD=colspan: 5]Short-Acting

[/TD]

[/TR]

[TR]

[TD]Regular ® humulin or novolin

[/TD]

[TD]30 min. -1 hour

[/TD]

[TD]2-5 hours

[/TD]

[TD]5-8 hours

[/TD]

[TD]Short-acting insulin covers insulin needs for meals eaten within 30-60 minutes

[/TD]

[/TR]

[TR]

[TD]Velosulin (for use in the insulin pump)

[/TD]

[TD]30 min.-1 hour

[/TD]

[TD]2-3 hours

[/TD]

[TD]2-3 hours

[/TD]

[/TR]

[TR]

[TD=colspan: 5]Intermediate-Acting

[/TD]

[/TR]

[TR]

[TD]NPH (N)

[/TD]

[TD]1-2 hours

[/TD]

[TD]4-12 hours

[/TD]

[TD]18-24 hours

[/TD]

[TD]Intermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with rapid- or short-acting insulin.

[/TD]

[/TR]

[TR]

[TD]Lente (L)

[/TD]

[TD]1-2½ hours

[/TD]

[TD]3-10 hours

[/TD]

[TD]18-24 hours

[/TD]

[/TR]

[TR]

[TD=colspan: 5]Long-Acting

[/TD]

[/TR]

[TR]

[TD]Ultralente (U)

[/TD]

[TD]30 min.-3 hours

[/TD]

[TD]10-20 hours

[/TD]

[TD]20-36 hours

[/TD]

[TD]Long-acting insulin covers insulin needs for about one full day. This type of insulin is often combined, when needed, with rapid- or short-acting insulin.

[/TD]

[/TR]

[TR]

[TD]Lantus

[/TD]

[TD]1-1½ hour

[/TD]

[TD]No peak time; insulin is delivered at a steady level

[/TD]

[TD]20-24 hours

[/TD]

[/TR]

[TR]

[TD]Levemir or detemir

[/TD]

[TD]1-2 hours

[/TD]

[TD]6-8 hours

[/TD]

[TD]Up to 24 hours

[/TD]

[/TR]

[TR]

[TD=colspan: 5]Pre-Mixed*

[/TD]

[/TR]

[TR]

[TD]Humulin 70/30

[/TD]

[TD]30 min.

[/TD]

[TD]2-4 hours

[/TD]

[TD]14-24 hours

[/TD]

[TD]These products are generally taken twice a day before mealtime.

[/TD]

[/TR]

[TR]

[TD]Novolin 70/30

[/TD]

[TD]30 min.

[/TD]

[TD]2-12 hours

[/TD]

[TD]Up to 24 hours

[/TD]

[/TR]

[TR]

[TD]Novolog 70/30

[/TD]

[TD]10-20 min.

[/TD]

[TD]1-4 hours

[/TD]

[TD]Up to 24 hours

[/TD]

[/TR]

[TR]

[TD]Humulin 50/50

[/TD]

[TD]30 min.

[/TD]

[TD]2-5 hours

[/TD]

[TD]18-24 hours

[/TD]

[/TR]

[TR]

[TD]Humalog mix 75/25

[/TD]

[TD]15 min.

[/TD]

[TD]30 min.-2½ hours

[/TD]

[TD]16-20 hours

[/TD]

[/TR]

[TR]

[TD=colspan: 5]*Premixed insulins are a combination of specific proportions of intermediate-acting and short-acting insulin in one bottle or insulin pen (the numbers following the brand name indicate the percentage of each type of insulin).

http://diabetes.webmd.com/diabetes-types-insulin

[/TD]

[/TR]

[/TABLE]

The time span between insulin and meals may vary depending on the type of insulin that is being taken.

In general, however, insulin should be coordinated with when the patient wants to eat. From the chart above, the "onset" column provides useful information. Again, the "onset" (begins working) refers to when the insulin will begin to work in the body. You want the insulin to begin working in your body at the same time the food is being absorbed. This timing will help avoid low blood sugar levels.

  • Rapid acting insulins. Novolog or another rapid-acting injectable insulin, should be injected about 10 minutes before mealtime.
  • Short-acting insulins. Such as regular insulin, should be taken 30 to 60 minutes before a meal. Intermediate-acting insulins should be taken up to 1 hour prior to a meal.
  • Pre-mixed insulins. Depending on the product used, premixed solutions should be taken 10 minutes or 30 to 45 minutes before mealtime.

Exceptions to Insulin Dosing and Timing

Injections of long-acting insulins are not "timed" to mealtime because of their long duration of action. Ultralente and Levemir are taken once or twice a day irrespective of mealtime. Lantus is only administered once a day (and should be administered at the same time each day). Keep in mind that these long-acting insulins may need to be given with shorter-acting insulin products --depending on individual situations -- that will likely need to be "timed" with mealtime.

I hope this will help you draw a conclusion. :)

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