Insulin Ike — Insulin Types, Peaks & Administration Safety
Know the peak, know the risk — hypoglycemia strikes hardest when the insulin is working hardest
Ike takes rapid-acting insulin with breakfast and NPH at bedtime, and one afternoon his mother finds him sweaty, shaky and confused right around the time his morning rapid-acting dose should be peaking.
Ike manages type 1 diabetes with multiple daily insulin injections, and each type behaves on its own timeline: rapid-acting peaks fast and short, regular acts a bit slower, NPH peaks broadly in the mid-range, and long-acting basal insulins have no real peak at all. Mixing up peak times means missing the exact window when a client is most likely to become hypoglycemic. Cloudy NPH must never be drawn up first when mixing with clear rapid or regular insulin, and rotation of injection sites prevents lipohypertrophy that alters absorption.
Read Insulin Ike's full story →The story arc
The setup
Ike, a teenager with type 1 diabetes, is prescribed rapid-acting insulin before meals and NPH at bedtime.
The turn
He takes his rapid-acting dose at breakfast but gets distracted and delays eating for over 30 minutes.
The crisis
Around the time his insulin should be peaking, Ike becomes diaphoretic, shaky, tachycardic and confused, with a fingerstick glucose of 48 mg/dL.
The save
The nurse gives 15 grams of fast-acting carbohydrate, rechecks glucose in 15 minutes, repeats if still low, and once stable reinforces that meals must follow rapid-acting insulin within minutes, not delayed.
NCLEX study section — Insulin Types, Peaks & Administration Safety
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pharmacology
Take this chapter into practice questions on the same topic.