This is an NCLEX practice question on Insulin. This question provides a scenario about giving Insulin Lispro (Humalog) and wants to know when the patient is at most risk for hypoglycemia.
This question is one of the many questions we will be practicing in our new series called “Weekly NCLEX Question”.
So, every week be sure to tune into our YouTube Channel for the NCLEX Question of the Week.
NCLEX Pharmacology Practice Question on Insulin
Your patient’s blood glucose level is 215 mg/dL. The patient is about to eat lunch. Per sliding scale, you administer 4 units of Insulin Lispro (Humalog) subcutaneously at 1130. As the nurse, you know the patient is most at risk for hypoglycemia at what time?
As you read the question, you want to start thinking about:
- “What is a normal blood glucose level prior to eating?”
- “What type of Insulin is Lispro? (rapid, short, intermediate, or long-acting?)
- “When is HYPOglycemia most likely to occur with Insulin medications?” During the onset, peak, or duration?
- “What are the onset, peak, and duration for Insulin Lispro?”
A normal blood sugar before meals should be 70-130 mg/dL. Therefore, this patient’s blood glucose level is high, and they need insulin coverage prior to eating because consuming a meal will increase the blood glucose even further.
The physician has ordered Insulin Lispro (Humalog) to be given before meals per sliding scale. So, you will be covering the patient with 4 units of Lispro based on their blood glucose of 215 mg/dL.
What type of insulin is Lispro (Humalog)? It is RAPID-acting. Below are the other categories of insulin and what types they include.
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apdira)
Regular Insulin (Humulin-R, Novolin-R…names generally end with the letter R)
NPH (Novolin-N, Humulin-N…names generally end with the letter N) NOTE: these solutions will be CLOUDY
Now, think about when hypoglycemia is most likely to occur with insulin…is it during the onset, peak, or duration?
Onset: how fast the insulin starts to work
Peak: when the insulin has the strongest effect
Duration: how long the insulin lasts
Hypoglycemia is most likely to occur when the insulin has the strongest effect which is during the PEAK.
What is the peak of short-acting insulin? To help you remember the onset, peak, and duration for each insulin type, be sure to check out these insulin mnemonics.
To remember short-acting insulin onset, peak, duration times remember this mnemonic:
“15 minutes feels like an hour during 3 rapid responses.”
Onset: 15 minutes
Peak: 1 hour
Duration: 3 hours
Therefore, for this medication (based on the time you gave the Lispro at 1130) it would be the following:
The answer is B. If you gave the Lispro at 1130, the patient is at most risk for hypoglycemia 1 hour after administration, which is 1230.