INSULIN NCLEX question

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Let me begin by giving you my "run down". My school is using the Textbook "Foundations and Adult Health Nursing" by Christenson/Kockrow. Unfortunately, we were their "guinea pigs" for this new text, and ALL of our instructors are having a hard time adjusting because our curriculum was written to match a different text, and the textbooks that we got are very difficult to navigate because of a lot of flipflops in the information and a great deal of typos. I am not saying that the text is good, it is just not the best out there. Which brings me to my question,

We are rounding out the "endocrine" system with the subject matter of INSULIN. Types/Dosages/To-dos?Not-To-Dos. The problem I am having is that our instructors have been instructed to write the exams in NCLEX format. This poses an issue for me, because the material was not well presented. We were kinda rushed through the subject matter, and well I just don't get the issue of Onset/Peak/Duration. I've gone online to a couple of sites, but it's just confusing me even more. Is there a dummy's guide to insulin and the conditions that surround them? Any references that won't confuse me will be much appreciated!!!! :bow:

Specializes in Rural - we do it all!!!.
Delta18 said:
THANK YOU! This helps :yeah: But what about the question?!? Can anyone figure out how they arrived at their answer of 1100 and 1700???

Just to clarify: Even though you are administering one injection, that injection contains two different drugs.

Regular insulin and NPH insulin.

That's why there are two peak times.

Hope this helps!

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The even and odds rule: to remember the onset, peak, and duration of intermediate-acting insulin think evens---2, 12, and 24 hrs. To remember short acting insulin, thinks odds--- 1, 3 and 5 hrs. These times are not exact but they are a great memory booster when you need to think fast

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This question seems like a lousy example of patient education. Given the wide potential peak times, to give two specific hours that are high riskf for hypoglycemia doesn't seem like a good teaching strategy. Either the patient is a long-time diabetic and will have a better idea of when they are at risk for hypoglyemia than the nurse, or they are a new diabetic patient who needs to understand more about how insulin works than being told that they are at risk of hypoglycemia at X hour and Y hour.

This question also doesn't really test a students' knowledge of insulin peak times. You could guess answer 2 with minimal retention of information.

1.)1200 and 1300 hours - unlikely, the times are so close together

2.)1100 and 1700 hours

3.)1000 and 2200 hours - 2200 unlikely peak time for 7am dose

4.)0800 and 1100 hours

So then to choose #2 over #4 means remembering that most patients receive routine insulin in the morning and evening... thus the later peaking times seem more likely.

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One thing I noticed was that the peaks and onsets of insulin seemed to vary (like lab values and so many other things in nursing) depending on where I read it. The Pharm book may have said regular peaks in 2-3 hours, our lecture may have said 2-4, and med-surg said 2-5. When I looked at that questions, I guessed the right answer because the peak times looked the closest to what it really is (one short-acting and one long). And of course, it varies from person to person and day to day based on how much/what they've eaten, exercised, etc. As jjjoy said, another tactic to use with NCLEX questions is to look at the answer choices and see which even make sense. You eliminate 1 and 3 if you have any clue when NPH and regular insulin peak. Then you eliminate 4 because you know that NPH is long-acting and you wouldn't combine two types of insulin that both peak in the morning. Don't get too hung up on the exact time periods given, because your text may be a little off from the numbers the boards use. Just make sure you really know which insulins are rapid, short, long-acting, and which is supposed to last 24h.

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Specializes in icu, er, transplant, case management, ps.
MB37 said:
One thing I noticed was that the peaks and onsets of insulin seemed to vary (like lab values and so many other things in nursing) depending on where I read it. The Pharm book may have said regular peaks in 2-3 hours, our lecture may have said 2-4, and med-surg said 2-5. When I looked at that questions, I guessed the right answer because the peak times looked the closest to what it really is (one short-acting and one long). And of course, it varies from person to person and day to day based on how much/what they've eaten, exercised, etc. As jjjoy said, another tactic to use with NCLEX questions is to look at the answer choices and see which even make sense. You eliminate 1 and 3 if you have any clue when NPH and regular insulin peak. Then you eliminate 4 because you know that NPH is long-acting and you wouldn't combine two types of insulin that both peak in the morning. Don't get too hung up on the exact time periods given, because your text may be a little off from the numbers the boards use. Just make sure you really know which insulins are rapid, short, long-acting, and which is supposed to last 24h.

Many of us insulin dependent Type 2's, nurse and non-nurse, are well educated in the symptoms of hypoglycemia. We know when we start to experience the early symptoms, enough to check our blood sugar. And if it has only dropped a little, to continue to monitor it. And to take corrective action. When we run into problems is either when we are in-patients and have nurses who believe they know more then us. Or when the hypoglycemia occurs when we are a sleep.

I have suffered three episodes, in the past six weeks. All occurred when I was asleep at night, either between 2AM to 6AM. And from eight to twelve hours after taking my NPH. I received expert help from the Fire Department paramedics summoned by my roommate. My PCP and endocrinologist's have lowered the dose of my NPH. And I am monitoring my blood sugars closely. The person I depend the most on for current knowledge is a certified diabetic nurse educator. She has the most current and up to date information. And my own body and knowledge. If you want to teach a new insulin dependent Type 2, please involve a certified diabetic educator.

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Woody, any thoughts on the sample test question?

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Specializes in icu, er, transplant, case management, ps.
jjjoy said:
Woody, any thoughts on the sample test question?

I would choose the answer which had the 5PM included in it. I very rarely take regular insulin. And I generally take it on a sliding scale because of my use of steroids to help control my asthma. And most Type 2's who do, take the combination, which has another set of peak times. The peak time for them is two to six hours or one to four hours.

When I have suffered a hypoglycemic episode, it has generally been twelve to sixteen hours after I have taken my evening dose of NPH. Two of the past three times, I woke up about 2AM, went to the bathroom, voided, got up and passed out. I later came to, crawled out to near my bed, went out again, woke and found my roommate kneeling over me. She called 911. Both times I got up to void and collapsed after voiding. By the time the paramedics tested my blood sugar, they stated it was in the twenties. I blame my low blood sugar on not taking in enough carbohydrates at dinner and not eating a snack. I also now check my blood sugar, in the middle of the night, if I get up to go to the bathroom. Better to be safe then sorry

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