Diabetes Mellitus Q 36

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A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise?

  

    A. “The best time for me to exercise is every afternoon.”

    B. “The best time for me to exercise is right after I eat.”

    C. “The best time for me to exercise is after breakfast.”

    D. “The best time for me to exercise is after my morning snack.”

    

    

Correct Answer: A. “The best time for me to exercise is every afternoon.”

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A hypoglycemic reaction may occur in response to increased exercise. Clients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication.

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Option B: Insulins of synthetic origin that have the same structure as human ones generally have faster onset, quicker peak time, and shorter duration than their previous animal counterparts and are less likely to cause allergic reactions. In just the past decade, several rapid-acting insulins have hit (and taken over) the market from regular insulin, including Humalog (generic name: lispro), NovoLog or NovoRapid (aspart), Apidra (glulisine), and VIAject, an extremely rapid-acting formulation that is absorbed in about half the time as Humalog.

Option C: These products are actually insulin analogs; they have a structure similar to that of insulin, but the order of the amino acids (i.e., protein building blocks) is slightly modified, which results in faster absorption and shorter duration. The benefit of these analogs for regular exercisers is that they’re mostly gone from the circulation within two hours after they are taken, lowering the risk of getting low when active later.

Option D: A usual regimen is NPH at breakfast along with regular or Humalog to cover breakfast, an optional rapid-acting injection at lunch, a mandatory one at dinner, and another dose of NPH at bedtime. An alternative regimen is to take rapid-acting insulin doses during the day with a single bedtime dose of NPH.

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