Pharmacological and Parenteral Therapies Q 24
The physician has prescribed Novolog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?
A. "I will make sure I eat breakfast within 10 minutes of taking my insulin."
B. "I will need to carry candy or some form of sugar with me all the time."
C. "I will eat a snack around three o’clock each afternoon."
D. "I can save my dessert from supper for a bedtime snack."
Correct Answer: A. “I will make sure I eat breakfast within 10 minutes of taking my insulin.”
NovoLog insulin onsets very quickly, so food should be available within 10–15 minutes of taking the insulin. The onset of action is 1 to 3 hours. Crystalline NPH insulin administration is subcutaneous. Administration is not Intramuscular or intravenous. NPH insulin is available in a two-phase solution, which means that apart from NPH, it has a solvent or a rapid-acting insulin solution. It comes in the form of a subcutaneous suspension or suspension pen-injector.
Option B: This does not address a particular type of insulin, so it is incorrect. The abdominal subcutaneous injection causes quicker absorption as compared to arms or thighs. The most significant advantage of NPH is that it can be included in premixed formulation with regular insulin. NPH in premixed formulations does not affect the potency and time-action profile of regular insulin. Exercise, massage, and local heat application increase NPH insulin absorption.
Option C: NPH insulin peaks in 8–12 hours, so a snack should be eaten at the expected peak time. It may not be 3 p.m. NPH insulin pen requires adequate mixing to get complete resuspension before injecting it. It may be given once or twice daily. Since the action profile of NPH insulin does not cover 24 hours, a twice-daily dose in the morning and evening or bedtime is the recommended regimen, which applies to the premixed formulations as well.
Option D: There is no need to save the dessert until bedtime. NPH insulin has a somewhat higher risk of hypoglycemia. Inadequate resuspension is thought to contribute to the high day to day variability in the pharmacodynamic and pharmacokinetic profile of NPH insulin, leading to hypoglycemia. Patients can adequately resuspend NPH by rotating the vial several times until its uniformly cloudy.