Insulin Therapy

[suppaduppaCNA]

Hello,

I don't get what is the exact time when to check on your patient after administering insulin. I understand that you should check during the peak time, however peak time is a range not an exact time.

For example (just for the sake of understanding):

XYZ receives NPH @1000. Peak time for NPH is 4-10hr. When should you check on XYZ? @1400? @1700 or @2000?

I would check on the patient several times during the peak time but you usually don't get that option on the test. So what time would you check on the patient and what's your rationale? I really need your insight on this!

Thanks for your input.

[ChristineN, BSN, RN]

If your pt is taking good meal intake, then just checking before meals is fine. However I get more concerned when you have a pt that doesn't have an appetite or is NPO as that pt will drop their blood sugars faster. That is the pt you should be checking on frequently, and assessing for signs of hypoglycemia

[rtx723]

Unless you have a DKA then you check glucose q1hr. But the general rule is to check achs with PO patient. Or on tube feeds then every 6hrs

[SubSippi]

My guess for a test question is to check on them after four hours. My rationale behind that is because otherwise, you're saying that you'll wait either seven or ten hours to check the insulin's effect.

I think that's a poorly worded question, because you'd be checking on them all the time anyway. It would make more sense if it just asked when your patient was at the highest risk for being hypoglycemic.

Also, at my job, I check and see when that particular patient's blood sugar has been dropping over the past few days. If they're a new patient, I ask them if trees a time of day or night when they notice their blood sugar is more likely to drop.

But yeah I know it's different when you're taking tests! Good luck!

[suppaduppaCNA]

Thanks for the reply

Yes! @SubSippi, a better formulated question would be to ask when is the patient at greater risk for hypoglycemia and the perfect answer for that question would be "4-10hr" after the dose because technically the BS can be at the lowest anytime within that time frame.

Unfortunately, at my school we often get questions that are not applicable to real life situation. You just have to go by the best answer choice or what the book says (by the way is the book always right??). And yes checking at the 4th hr post administration makes more sense because that's when the peak time begins. but how about the rest of the time?

I know this is crazy question but I like to know what's the best answer. Let's say if you have these answer choices which one will you pick and why?

a. @1400 (beguining of peak)

b. @1700 (middle of peak)

c. @2000 (towards the end of peak)

[Summer Days]

I would check at 1400. As with all medications, you want to check the patient's reaction to medication at the earliest time possible because safety is always a concern. You are better off being safe and are able to intervene should there be an adverse reaction.

[Esme12, ASN, BSN, RN]

with out knowing the exact question.....I would say beginning of peak as to ascertain if their blood glucose will continue to tolerate the med with a safe glucose level.

Action of Commonly Prescribed Insulin......IOH types of insulin; chart of duration and action of insulin

[TABLE=align: center]

[TR]

[TD]

Name

[/TD]

[TD]

Type

[/TD]

[TD=width: 117]

Onset⁽¹⁾

[/TD]

[TD=width: 117]

Peak⁽¹⁾

[/TD]

[TD=width: 117]

Duration⁽¹⁾

[/TD]

[/TR]

[TR]

[TD=width: 117]

Humalog (Lispro)

[/TD]

[TD=width: 117]

Rapid

[/TD]

[TD=width: 117]

5-15 minutes

[/TD]

[TD=width: 117]

30-75 minutes

[/TD]

[TD=width: 117]

2-3 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

Apidra (glulisine)

[/TD]

[TD=width: 117]

Rapid

[/TD]

[TD=width: 117]

5-15 minutes

[/TD]

[TD=width: 117]

30-75 minutes

[/TD]

[TD=width: 117]

2-4 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

Novolog (Aspart)

[/TD]

[TD=width: 117]

Rapid

[/TD]

[TD=width: 117]

10-20 minutes

[/TD]

[TD=width: 117]

1-3 hours

[/TD]

[TD=width: 117]

3-5 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

Regular ®

[/TD]

[TD=width: 117]

Short-Acting

[/TD]

[TD=width: 117]

30 minutes

[/TD]

[TD=width: 117]

2-5 hours

[/TD]

[TD=width: 117]

5-8 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

NPH (N)

[/TD]

[TD=width: 117]

Intermediate

[/TD]

[TD=width: 117]

1-3 hours

[/TD]

[TD=width: 117]

6-12 hours

[/TD]

[TD=width: 117]

16-24 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

Lente (L)

[/TD]

[TD=width: 117]

Intermediate

[/TD]

[TD=width: 117]

1-3 hours

[/TD]

[TD=width: 117]

6-12 hours

[/TD]

[TD=width: 117]

16-24 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

Ultralente (U)

[/TD]

[TD=width: 117]

Long-Acting

[/TD]

[TD=width: 117]

3-5 hours

[/TD]

[TD=width: 117]

8-14 hours

[/TD]

[TD=width: 117]

18 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

Glargine Lantus

[/TD]

[TD=width: 117]

Very Long-Acting

[/TD]

[TD=width: 117]

1 hour

[/TD]

[TD=width: 117]

Evenly for 24 hours

[/TD]

[TD=width: 117]

24-28 hours

[/TD]

[/TR]

[TR]

[TD=width: 117]

NPH & Regular Mixed in either

50/50 mix, or

70/30 mix

[/TD]

[TD=width: 117]

Premixed

[/TD]

[TD=width: 117]

30-60 minutes

[/TD]

[TD=width: 117]

2-12 hours

[/TD]

[TD=width: 117]

up to 18 hours

[/TD]

[/TR]

[/TABLE]