A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:
A. 2-4 hours after administration
B. 6-14 hours after administration
C. 16-18 hours after administration
D. 18-24 hours after administration
Correct Answer: B. 6-14 hours after administration
The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
Option A: Regular human insulin has an onset of action of 1/2 hour to 1 hour, peak effect in 2 to 4 hours, and duration of action of 6 to 8 hours. The larger the dose of regular the faster the onset of action, but the longer the time to peak effect and the longer the duration of the effect.
Option C: Pre-mixed insulin is NPH pre-mixed with either regular human insulin or a rapid-acting insulin analog. The insulin action profile is a combination of short and intermediate-acting insulins.
Option D: Long-acting insulin analogs have an onset of insulin effect in 1 1/2-2 hours. The insulin effect plateaus over the next few hours and is followed by a relatively flat duration of action that lasts 12-24 hours for insulin detemir and 24 hours for insulin glargine.
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