A client with type 1 diabetes is prescribed NPH insulin before breakfast and dinner. Although the client reports feeling well, the 6 AM blood glucose level has averaged 60 mg/dL (3.3 mmol/L) over the past week. Which action is appropriate for the nurse to recommend to the client?

Question

A client with type 1 diabetes is prescribed NPH insulin before breakfast and dinner.  Although the client reports feeling well, the 6 AM blood glucose level has averaged 60 mg/dL (3.3 mmol/L) over the past week.  Which action is appropriate for the nurse to recommend to the client?

Quizplus · Accepted Answer

11ecbb05_c987_4aa3_b433_892b9c24c747_MD0009_00 NPH insulin is intermediate-acting with an onset of 1-2 hours, peak of 4-12 hours, and duration of 12-18 hours. Due to its long peak, hypoglycemia (blood glucose <70 mg/dL [<3.9 mmol/L]) can result from use of NPH, especially because the overnight hours (during sleep) typically represent the longest interval between meals. To prevent hypoglycemia related to an evening dose of NPH, the client should eat a bedtime snack consisting of protein and complex carbohydrates (eg, cereal with milk, crackers with peanut butter) (Option B). Complex carbohydrates paired with protein provide sustained, slow release of glucose, thereby preventing hypoglycemia. (Option A) Testing for urine ketones should be done as part of a sick-day plan or when evaluating for diabetic ketoacidosis. Ketosis occurs in hyperglycemia, especially when blood glucose is >180 mg/dL (>10 mmol/L). (Option C) Increasing the client's carbohydrate intake at each meal may disrupt glycemic control and lead to a persistent elevation of blood glucose. Elevated blood glucose can cause complications, such as diabetic ketoacidosis. (Option D) The client may require an adjustment to the prescribed insulin regimen; however, it is dangerous for the client to drastically alter the prescribed dose. In addition, it is outside the nurse's scope of practice to recommend a change in the prescribed dose. Educational objective: NPH insulin is an intermediate-acting insulin that peaks in 4-12 hours. In asymptomatic clients, the best intervention to prevent low blood glucose levels related to an evening dose of NPH is to consume a bedtime snack of protein and complex carbohydrates.

A Client with Type 1 Diabetes Is Prescribed NPH Insulin