# A 65-year-old client receives NPH (intermediate-acting) insulin 20 units subcutaneously at 0700. The nurse plans nursing rounds and meals. At which approximate time should the nurse be MOST vigilant for hypoglycemia?

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> subject: Medical Emergencies  
> category: PA

## Question

A 65-year-old client receives NPH (intermediate-acting) insulin 20 units subcutaneously at 0700. The nurse plans nursing rounds and meals. At which approximate time should the nurse be MOST vigilant for hypoglycemia?

## Option

1. 0700 the next day (24 hours post-dose) — NPH insulin is often considered a long-acting insulin, so its peak effect and highest risk for hypoglycemia occur 24 hours after injection; monitor glucose closely at that time.
2. 1100 to 1900 — the typical NPH peak is approximately 4-12 hours after subcutaneous injection, so monitor blood glucose, ensure scheduled meals/snacks, and watch for signs of hypoglycemia during that window. **✔ Correct answer**
3. At 0700, immediately after injection — because NPH insulin is sometimes confused with rapid-acting insulins, its onset is believed to be within minutes, so check blood glucose and provide a meal promptly to prevent hypoglycemia.
4. Between 0730 and 0800 — the onset of NPH insulin is typically 30 to 60 minutes after injection, so blood glucose should be monitored and a meal provided to prevent hypoglycemia during this period.

**Correct answer: 2**

## Explanation

Insulin pharmacokinetics — onset / peak / duration
Knowing the kinetic profile is essential for predicting hypoglycemia and timing meals.
• Rapid-acting (lispro, aspart, glulisine): onset 5-15 min, peak 30-90 min, duration 3-5 h. Inject just before/with meal.
• Short-acting (regular): onset 30 min, peak 2-3 h, duration 5-8 h. Inject 30 min before meal.
• Intermediate-acting (NPH): onset 1-2 h, peak 4-12 h, duration 14-24 h. Cloudy — must be rolled (not shaken). The peak is the highest hypoglycemia-risk window — meals/snacks must cover it.
• Long-acting (glargine, detemir, degludec): glargine onset 2-4 h, no real peak, duration ~24 h; detemir 1-2 h, slight peak 6-8 h, 12-24 h; degludec 1 h onset, no peak, ≥42 h.
• Ultra-long basal like degludec: very flat, low hypo risk overnight.

For a 0700 NPH dose, peak occurs 1100-1900 — that is when the nurse should monitor BG, ensure midmorning, lunch, afternoon snacks, watch for hypoglycemia. Options 1, 3, 4 misstate the kinetic profile.

## In-depth explanation

Clinical reasoning summary
Insulin pharmacokinetics — onset / peak / duration
Knowing the kinetic profile is essential for predicting hypoglycemia and timing meals.
• Rapid-acting (lispro, aspart, glulisine): onset 5-15 min, peak 30-90 min, duration 3-5 h. Inject just before/with meal.
• Short-acting (regular): onset 30 min, peak 2-3 h, duration 5-8 h. Inject 30 min before meal.
• Intermediate-acting (NPH): onset 1-2 h, peak 4-12 h, duration 14-24 h. Cloudy — must be rolled (not shaken). The peak is the highest hypoglycemia-risk window — meals/snacks must cover it.
• Long-acting (glargine, detemir, degludec): glargine onset 2-4 h, no real peak, duration ~24 h; detemir 1-2 h, slight peak 6-8 h, 12-24 h; degludec 1 h onset, no peak, ≥42 h.
• Ultra-long basal like degludec: very flat, low hypo risk overnight.

For a 0700 NPH dose, peak occurs 1100-1900 — that is when the nurse should monitor BG, ensure midmorning, lunch, afternoon snacks, watch for hypoglycemia. Options 1, 3, 4 misstate the kinetic profile.

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