一张图看胰岛素的峰值

🧠 为什么重要

RAPID（lispro、aspart）：起效时间为15分钟，峰值约为1到3小时，持续3到5小时；给药时要让餐食触手可及。REGULAR：起效时间为30到60分钟，峰值2到4小时，持续5到8小时；是IV输注的标准胰岛素。NPH：起效时间为1到2小时，峰值4到12小时，持续12到18小时；外观浑浊，抽药时先抽清澈的再抽浑浊的。GLARGINE和DEGLUDEC：没有真正的峰值，持续24小时或更长；绝不混合。低于70的低血糖：如果患者清醒且能吞咽，给予15克快速碳水化合物，并在15分钟后复查；如果患者不能安全吞咽或无反应，按方案给予glucagon（IM、皮下或鼻内）或IV dextrose。

RAPID (lispro, aspart): onset 15 minutes, peak about 1 to 3 hours, lasts 3 to 5 hours; give with a meal in reach. REGULAR: onset 30 to 60 minutes, peak 2 to 4 hours, lasts 5 to 8 hours; the standard insulin for IV infusions. NPH: onset 1 to 2 hours, peak 4 to 12 hours, lasts 12 to 18 hours; cloudy, draw clear before cloudy. GLARGINE and DEGLUDEC: no real peak, 24 hours or longer; never mixed. Hypoglycemia under 70: if the client is alert and able to swallow, give 15 grams of fast carbohydrate and recheck in 15 minutes; if the client cannot swallow safely or is unresponsive, give glucagon (IM, subcutaneous or intranasal) or IV dextrose per protocol.

🏥 真实场景

🥪 一位护士在0800给予NPH。患者睡过了午餐。到了1400，他出汗且意识混乱。知道峰值窗口的护士已经带着果汁守在床边，并备有glucagon以防他无法吞咽。不知道的护士是从快速反应团队那里才得知的。

🥪 A nurse gives NPH at 0800. The client sleeps through lunch. At 1400 he is sweaty and confused. The nurse who knew the peak window was already at the bedside with juice, and glucagon in case he could not swallow. The nurse who did not finds out from the rapid response team.

📌 要点总结

• Regular是标准的IV胰岛素；速效型需要能拿到食物Regular is the standard IV insulin; rapid-acting needs food in reach
• 先抽清澈的（regular），再抽浑浊的（NPH）；glargine绝不混合Clear (regular) before cloudy (NPH); glargine is never mixed
• 低血糖：如果清醒且能吞咽，给予15克快速碳水化合物并在15分钟后复查；如果不能，则用glucagon或IV dextroseHypoglycemia: if alert and able to swallow, 15 grams of fast carbohydrate and recheck in 15 minutes; if not, glucagon or IV dextrose

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