The physician has prescribed NPH 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 2 hours 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: C. “I will eat a snack around three o’clock each afternoon.”
NPH insulin peaks in 8–12 hours, so a snack should be offered at that time. It is on the list of essential medicines of the world health organization (WHO).NPH insulin is FDA-approved in the adult and pediatric population for the control of type 1 and type 2 diabetes mellitus. It is currently the most widely used basal insulin that simulates the physiological basal insulin action. Basal insulin provides a constant supply of insulin in the body that is necessary for glucose regulation despite fasting, such as between meals and overnight.
Option A: NPH insulin onsets in 90–120 minutes, so answer A is incorrect. American Diabetes Association guidelines recommend NPH insulin dose of 0.4 to 1.0 units/kg/day subcutaneously for the management of type 1 diabetes mellitus. A higher dose is necessary during medical illness and puberty. A dose of 0.1 to 0.2 units/kg/day subcutaneously is recommended in type 2 diabetes mellitus depending on body weight and the patient’s hyperglycemia.
Option B: NPH insulin is time-released and does not usually cause sudden hypoglycemia. NPH insulin is an isophane suspension of human insulin and categorized as an intermediate-acting insulin. It helps increase the cellular intake of glucose in the liver, adipose tissue, and skeletal muscles. It acts as basal insulin and stimulates the liver to promote hepatic glycogen synthesis, fatty acid metabolism for lipoprotein synthesis.
Option D: The client should eat a bedtime snack. NPH cannot classify as ideal basal insulin. It shows much variability in its absorption and action after subcutaneous injection. This situation leads to fluctuations in blood glucose control and causes hypoglycemic episodes. For this reason, it requires meticulous monitoring, including fasting blood glucose, and changes in HbA1c values.